Spread of viral hepatitis in organized children's collectives and the methods for its early diagnosis]

The authors present the results of observations over 407 children aged from 2 months to 16 years from the foci of viral hepatitis in children's collective bodies. During the quarantine a determination was made in children of the glutamic-pyroracemic, glutamic-oxalic transaminases (GPT and GOT, respectively) and of the hepatitis B antigen (HBAg). A necessity of using the enzymatic tests for the purpose of early diagnosis of viral hepatitis was shown, since 84% of the cases developing in the next focus coursed as an unicteric form without any markked clinical signs; HBAg was revealed in 6.1% of the children examined. A complex examination of the personnel and of the persons who came in contact with the patients with viral hepatitis showed the ways of spread of hepatitis B in a collective body; it was found that the viral hepatitis B infection took place both by parenteral and enteral routes. The expediency of active observation over the children, recipients of blood and plasma, with determination in them of the activity of the enzymes and HBAg for early diagnosis of parenteral infection was substantiated. It was also shown that the incidence of the unicteric forms of viral hepatitis in a focus of infection depended not on the periods of gamma-globulin administration but on the age of children who contracted the infection. Thus, the prevalence of the unicteric forms of the disease over the icteric ones in children under 3 years of age was more pronounced than in older children.     

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.     

Serum catalase enzyme activity in liver diseases

Serum catalase activity was moderately increased in fatty liver, acute alcoholic hepatitis and in the decompensated form of cardiac circulatory failure. It showed significant increase in acute yellow atrophy and in toxic hepatitis while no changes were detected in liver cirrhosis and viral hepatitis. Serum catalase activity showed a good correlation (r = 0.820) with the serum glutamate dehydrogenase activity. In accordance with our results, the inexpensive assay of serum catalase activity is suggested for the detection of severe liver cell damage.     

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.     

Dynamics of immunological indices in patients with chronic viral hepatitis B and the effect of thymalin therapy

The work deals with the results of the study of T-lymphocytes and their subpopulations (active, thermostable, theophylline-sensitive and theophylline-resistant) in 102 children with chronic viral hepatitis B, depending on the effectiveness of thymalin therapy. The sensitization of lymphocytes to specific antigens was studied. Among patients with chronic viral hepatitis B and cirrhosis of the liver the homozygous phenotype of haptoglobin is registered essentially more frequently (63.6% and 82.4% respectively) than among healthy persons (44.0%). The patients of this group showed a decrease in the number of T-lymphocytes, disturbances in the suppressor/helper ratio: hypersuppression in persisting hepatitis and hyposuppression in active hepatitis. In 71.6% of cases thymalin therapy produced an effect manifested by clinico-biochemical remission, an increase in the number of T-lymphocytes, thermostable cells and the normalization of the T-suppressor/T-helper ratio. In these patients sensitization to HBsAg essentially decreased (from 30.5% to 13.9%), while sensitization to human liver lipoprotein retained its high level even after treatment with thymalin.     

Epidemiology of Zoonotic Hepatitis E: A Community-Based Surveillance Study in a Rural Population in China

Background

Hepatitis E is caused by two viral genotype groups: human types and zoonotic types. Current understanding of the epidemiology of the zoonotic hepatitis E disease is founded largely on hospital-based studies.

Methods

The epidemiology of hepatitis E was investigated in a community-based surveillance study conducted over one year in a rural city in eastern China with a registered population of 400,162.

Results

The seroprevalence of hepatitis E in the cohort was 38%. The incidence of hepatitis E was 2.8/10,000 person-years. Totally 93.5% of the infections were attributed to genotype 4 and the rest, to genotype 1. Hepatitis E accounted for 28.4% (102/359) of the acute hepatitis cases and 68.9% (102/148) of the acute viral hepatitis cases in this area of China. The disease occurred sporadically with a higher prevalence during the cold season and in men, with the male-to-female ratio of 3∶1. Additionally, the incidence of hepatitis E increased with age. Hepatitis B virus carriers have an increased risk of contracting hepatitis E than the general population (OR = 2.5, 95%CI 1.5–4.2). Pre-existing immunity to hepatitis E lowered the risk (relative risk  = 0.34, 95% CI 0.21–0.55) and reduced the severity of the disease.

Conclusions

Hepatitis E in the rural population of China is essentially that of a zoonosis due to the genotype 4 virus, the epidemiology of which is similar to that due to the other zoonotic genotype 3 virus.     

Characteristics of the epidemic process manifested as chronic viral hepatitis

The incidence rates of chronic viral hepatitis in Leningrad over the period of 1962-1984 were studied. The tendency towards a rise in total morbidity because of increased incidence of chronic hepatitis B was shown to appear in recent years. This increase in morbidity was mainly due to its rise among adult males and children, which led to the shift of morbidity to younger age groups. The seasonal rises of morbidity in winter and spring were found to be characteristic of viral hepatitis.     

Role of carriers of the hepatitis B surface antigen as possible sources of infection in children's collectives

The complex clinico-epidemiological and laboratory surveys of the children and the staff in 71 institutions for children of preschool age were made at the period of increased viral hepatitis morbidity in these institutions, and the dynamic observations of 11 children's institutions having children with prolonged HBs-antigenemia were carried out. In the foci of viral hepatitis the level of antigenemia in the children and the staff exceeded (p less than 0.01) that in the control group. The dynamic observations (lasting up to 6 years) of the groups containing HBsAg-carriers revealed that 6 children, previously HBsAg-negative, showed a short-term HBs-antigenemia in the absence of any evidence of the parenteral (instrumental) route of infection. This fact indicates that the role of HBsAg-carriers as the possible sources contributing to the transfer of hepatitis B through everyday contacts in children's institutions cannot be ruled out. Periodic clinico-epidemiological and laboratory surveys of groups with HBsAg-carriers are recommended.     

DNA damage evaluated by alkaline single cell gel electrophoresis (SCGE) in children of Chernobyl, 10 years after the disaster

Using the alkaline single cell gel electrophoresis (Comet) assay, the extent of DNA damage was evaluated in leukocytes of 43 Belarussian children (16 healthy and 27 affected by thyroid cancer). Thirty-nine healthy children from Pisa (Italy) were enrolled in the study as controls. In addition to basal levels of DNA damage, leukocytes were treated in vitro with bleomycin (BLM), a radiomimetic drug, to evaluate a possible adaptive response in different groups of children. Results with the Comet assay indicated an increased level of DNA damage (P=0.037) in leukocytes of Belarussian children compared to the Italian control group. In addition, within the Belarus group, lower basal levels of DNA damage (P<0.001) were found in children with cancer compared to healthy children. Tumor affected children were living in less radiocontaminated areas (P<0.04) than the healthy children and there was a significant relationship (P=0.03) between the amount of environmental radiocontamination and DNA damage in leukocytes. There were no differences in the sensitivity of leukocytes from different groups of children to BLM, indicating the absence of an adaptive response. The lack of an adaptive response may have been due to the use of noncycling cells and/or the bleomycin dose chosen. Tests for the presence of clastogenic factors (CF) in the blood serum of children showed that 39% of the tumor affected children and 19% of the healthy children in the exposed group were positive as compared to the Italian control group (0%) (Chi-square test, P<0.04). The higher levels of genomic damage in children evaluated 10 years after the Chernobyl disaster could be related to the increased incidence of individuals with CF.     

Enzootic hepatitis A infection in cynomolgus monkeys (Macaca fascicularis)

During a toxicology study in cynomolgus (long-tailed or crab-eating) monkeys (Macaca fascicularis), a randomly distributed incidence of significantly increased hepatic enzyme activity was observed. Premedication hepatic enzyme activity in all monkeys of this study was normal, but increased alanine aminotransferase (ALT) activity was found in 4 of the 24 animals 2 weeks after initiation of the study and in 10 of 24 at 4 weeks. A drug-related effect was considered unlikely initially because the increases were not doserelated, and a 3-year review of 655 cynomolgus monkeys revealed a 15–20% incidence of increased hepatic enzyme activity. Good correlation was subsequently established between increased hepatic enzyme activity, active hepatitis A virus (HAV) infection, and histomorphologic confirmation of hepatitis (chronic periportal inflammation). Follow-up viral serodiagnostic screening of resident macaques revealed an overall incidence of anti-HAV IgG in 80% (155/193) of cynomolgus and in 70% (14/20) of rhesus monkeys. Serial screening demonstrated that several initially negative monkeys became seropositive for anti-HAV IgG, and a few acquired active infection (anti-HAV IgM). Among newly acquired cynomolgus monkeys, 2.5% (2/80) had an acute HAV infection, and 35% (28/80) eventually tested positive for anti-HAV IgG while quarantined in the primate facility. The characterization of an enzootic HAV infection in incoming monkeys posed a significant risk for the primate colony and handlers. Rigorous sanitation, isolation, and quarantine procedures, including personnel training and additional protective clothing for personnel working in the primate colony, reduced tho potential for transmission and arrested the outbreak. Experimenters should be cautious in ascribing toxicity to a test article based solely on increased hepatic enzyme activity associated with chronic periportal inflammation.     

Elevation of liver-galactosylhydroxylysyl glucosyltransferase activity in human primary hepatocellular carcinoma

The activity of L-GGT (EC 2.4.1.66), an enzyme catalyzing the intracellular biosynthesis of collagen, was determined in human primary hepatic cancer, acute viral hepatitis and cirrhotic liver tissues and compared to the mean level of enzyme activity in normal human liver tissues. The mean levels of L-GGT activity in primary hepatocellular carcinoma (PHC), acute viral hepatitis and cirrhotic tissues were 7.78, 2.69 and 2.16 times the mean level of enzyme activity in normal human liver tissues. The mean level of L-GGT activity in PHC was 3.61 times the mean level of L-GGT activity in cirrhosis and 2.90 times the mean value of liver enzyme activity in acute viral hepatitis. The findings in this study provide a basis for the highly elevated serum values of this intracellular enzyme in patients with primary hepatic cancer and the data indicate that L-GGT activity may be increased in primary liver cancer to compensate for an increased rate of collagen synthesis.     

Correlation between serum enzymes and serum unsaturated vitamin B12 binding proteins in primary liver carcinoma

The serum unsaturated vitamin B12-binding capacity (UBBC), unsaturated transcobalamin (UTC) I, UTC II, UTC III levels, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase activities and bilirubin concentration were estimated in 61 patients with liver diseases (31 with hepatoma, 30 with viral hepatitis). The levels of serum cobalamin, UTC I, UTC III, UBBC, alanine and aspartate aminotransferases, and bilirubin were raised in both hepatoma and viral hepatitis patients. Serum UTC II was reduced in both conditions. Alkaline phosphatase activity was significantly increased in hepatoma. Four significant correlations were observed among these parameters in the hepatoma patients while only one significant correlation was observed in viral hepatitis.     

Viral hepatitis A and B as a mixed infection in children

Serological examinations of 1,200 children, hospitalized at the viral hepatitis department over a year, for the presence of hepatitis A (HA) and hepatitis B (HB) markers have revealed a 7% incidence rate of mixed HA and HB infections. Three variants of mixed infection have been established (true mixed infection, HA combined with asymptomatic HBsAg carriership, cross superinfection) and the relative significance of each of them has been determined. Mixed infection took an unfavorable course with a tendency to the prolongation of the pathological process eventuating in chronic hepatitis, especially in cases of true mixed infections (15.9%).     

Characterization of viral genomes in the liver and serum of chimpanzee long-term hepatitis B virus carriers: a possible role for supercoiled HBV-DNA in persistent HBV infection

In chimpanzee hepatitis B virus (HBV) carriers, the molecular mechanism for viral persistence has been examined by analyzing the properties of viral DNA molecules in liver and serum. Two extrachromosomal HBV-DNA molecules migrating on Southern blots at 4.0 kb and 2.3 kb were observed in chimpanzee liver DNA. There was no evidence for integration of HBV sequences into the host genome. The HBV-DNA molecule which migrated at 4.0 kb position represents a full-length "nicked," relaxed circular form, and the DNA molecules migrating at 2.3 kb position represents a supercoiled form of the HBV genome. Evidence for supercoiled HBV-DNA in serum was obtained by production of the relaxed circular intermediate upon digestion of Dane particle DNA with specific nucleases S1 and Bal 31. A possible role of these two extrachromosomal HBV-DNA molecules in the biology of hepatitis B virus infection and the mechanism for viral persistence are discussed.     

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.     

Adenosine deaminase and guanosine deaminase activities in sera of patients with viral hepatitis.

In order to investigate purin and primidin metabolism pathways in hepatitis, adenosine deaminase (ADA) and guanosine deaminase (GDA) activities in sera of patients with different types and manifestations of viral hepatitis disease (A, B, C, D, E, chronic, acute) were investigated and compared with the control group of healthy individuals. Hepatitis cases were classified with respect to their serological findings and clinics. When compared all the hepatitis cases with the controls, levels of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase enzymes, as well as ADA and GDA, were significantly higher than the control group (p<0.01). Levels of ADA and GDA in hepatitis cases were determined as 26.07 11.98 IU/l and 2.37 1.91 IU/l, respectively. When compared their ADA and GDA levels amongst the classified hepatitis groups, there was no difference in ADA levels amongst cases (p>0.05). However, GDA levels in hepatitis A group were closed to the controls. Increase in serum ADA activities in hepatitis forms may be dependent on and reflect the increase in phagocytic activity of macrophages and maturation of T-lymphocytes, and may be valuable in monitoring in viral hepatitis cases.     

Frequency of detecting viral hepatitis B markers in the patients of a hemodialysis ward

The data, obtained as the result of the examination of 22 patients with chronic renal insufficiency and analysis of 105 samples of transfusion blood at the department of chronic hemodialysis, are presented. To detect the markers of hepatitis B (HBsAg, anti-HBs, anti-HBc), a complex of biochemical investigations was carried out with the use of counter-current immunoelectrophoresis, the passive hemagglutination test, enzyme immunoassay, and solid-phase radioimmunoassay. The markers of hepatitis B were detected in 72.6% of patients with chronic renal insufficiency and in 21% of healthy persons. Changes in the activity of biochemical characteristics of hepatic samples were detected only in one patient. In no case clinical symptoms of the disease were observed. Out of 105 samples of transfusion blood, 9.5% contained HBsAg. The results of our investigations indicate that the markers of hepatitis B are widely spread among patients with chronic renal insufficiency, which makes it possible to consider them as a "high risk group" with respect to hepatitis B infection. To decrease the risk of hepatitis B among patients with chronic renal insufficiency, it is very important that highly sensitive tests be introduced into practice for the selection of donors and the detection of patients with the asymptomatic forms of hepatitis B and carriers at the department of chronic hemodialysis.     

Prophylactic efficacy of reaferon in viral hepatitis A and acute respiratory infections in children

Reaferon, the analog of human alpha 2-interferon obtained by gene engineering techniques, was studied with a view to its use for the prevention of hepatitis A. The study involved children of preschool age in Tashkent. In a strictly controlled trial children aged 2-6 years received the preparation orally in a dose of 1 X 10(6) I. U. or the diluent alone used as placebo. The preparation was administered to 1,100 children and the placebo to 1,078 children. The preparation and placebo were administered twice a week for two months. On the whole, during that period hepatitis A morbidity in both test and control groups of children was the same (5.1% and 4.9% respectively), but among children of nursery age receiving Reaferon the incidence of hepatitis A and acute respiratory viral infections was lower than among those receiving the placebo, though this difference was statistically significant only for cases of acute respiratory infections.