Epidemiology of acute hepatitis in the Stann Creek District of Belize, Central America

Hepaptits is common in the Stann Creek District of Southern Belize to determine the etiologies, incidence and potential risk factors for acute jaundice, we conducted active surveillance for cases. Cases of jaundice diagnosed by a physician within the previous 6 weeks were enrolled. Evaluation included a questionnaire and laboratory tests for Hepatitis A, B. C, D, and E, a blood film for malaria, and a serologic test for syphilis. Etiologies of jaundice among 62 evaluable patients included acute hepatitis A, 6 (9.7 percent), acute hepatitis B, 49 (79.0 percent) hepatitis non-A-E, 2 (3.2 percent), and malaria, 5 (8.1 percent). There were no cases of acute hepatitis E. One patient each with antibody to hepatitis C and D were detected. The annualized incidence of hepatitis A was 0.26 per 1000. All cases of hepatitis A were in children 4-16 years of age. The annualized incidence of hepatitis B, 2.17 per 1000, was highest in adults aged 15-44 years (4.4 per 1000) and was higher in men (36 cases; 3.09 per 1000) than women (13 cases; 1.19 per 1000). Four (31 percent) of the women with hepatitis B were pregnant. The annualized incidence was significantly higher in Mestizo (6.18 per 10000 and Maya (6.79 per 1000) than Garifuna (0.38 per 1000) or Creole (0.36 per 1000). Persons with Hepatitis B were significantly more likely to be born outside of Belize (82 percent), had been in Belize < 5 years (73 percent), and lived and worked in rural areas (96 percent) than was the general population. Of those o 14 years of age with Hepatitis B, only 36 percent were married. Few persons admitted to transfusions, tattoos, IV drug use, multiple sexual partners, visiting prostitutes, or sexually transmitted diseases. Only 1 of 49 had a reactive test for syphilis. Six patients were hospitalized (including 3 with acute hepatitis B and one with Hepatitis A), and none to our knowledge died. Acute hepatitis B is the most common cause of viral hepatitis in the Stann Creek District, but the modes of transmission remain obscure. Infants, women attending prenatal clinics, and new workers are potential targets for immunization with Hepatitis B vaccine. (AU)

Hepatitis B-associated Polyarteritis Nodosa and Hypertensive Encephalopathy

The case of a two-year old boy with hypertensive encephalopathy to Hepatitis B-associated polyarteritis nodosa is presented. Polyarteritis nodosa is a rare condition in children and its association with Hepatitis B viral infection is also rare (AU)

Hepatitis B associated nephrotic syndrome in Jamaican children: a 12 year review

Between December 1984 and November 1996, 171 children under 12 years of age presented to the University Hospital of the West Indies with nephrotic syndrome. Of these, 10 were diagnosed hepatitis B surface antigen (HbsAg) positive on routine screening. Their clinicopathological data were analyzed and renal histology documented. Eight of the ten children had membranous nephropathy (MN), while the remainder had mesangial proliferative glomerulonephritis (MesN) and minimal change nephrotic syndrome (MCNs). The young ages and steroid sensitivity of these two children suggested that hepatitis B virus (HBV) infection was coincidental rather than causative. Steroids were ineffective in inducing remission in any of the 4 MN patients so treated. At a mean follow-up of 36 months, 7/10 patients had experienced complete or partial remission and 3 had persistent nephrotic syndrome. None was in renal failure and 60 percent had asymptomatic biochemical hepatitis. Remission occurred in the MN group either 2 to 9 months from the onset of oedema whether or not steroids were administered. Our data suggest that the prevalence of HBV infection in Jamaica may be intermediate rather than low and that the route of transmission may be horizontal. It is recommended that hepatitis B vaccination be a part of the regular immunization in Jamaica, and that all children with nephrotic or atypical glomerular disease be screened for HbsAg as HBV nephropathy is usually clinically indistinguishable from idiopathic renal disease.(AU)

Hepatitis B virus, human immunodeficiency virus type-1 and syphilis among women attending prenatal clinics in Belize, Central America

Women and their infants may benefit from therapeutic interventions when hepatitis B, human immunodeficiency virus (HIV), or syphilis are detected during the prenatal period. We initiated hepatitis B and HIV screening of women attending prenatal clinics in Belize. Risk factor assessment information for hepatitis B infection and demographic data were determined by interview. Of 543 evaluable women, 81 (14.9 percent) were seropositive for hepatitis B core antibody (anti-HBc); one woman had asymptomatic hepatitis B surface antigenemia. Antibodies to HIV-1 were detected in one woman. Reactive syphilis serologies were detected in 15 (2.8 percent) women. Anti-HBc seroprevalence varied by district (range 3.1-43.5 percent) and ethnicity (range 0.0-40.9 percent). Significant identified risks for anti-HBc seropositivity from univariate analyses included being of the Garifuna ethnic group, residence or birth in the Stann Creek or Toledo districts, a reactive syphilis serology, a household size of eight or greater, and five or more lifetime sexual partners. Multivariate analyses identified ethnicity and a reactive rapid plasma reagin as the best predictors of anti-HBc seropositivity. Highly variable differences in anti-HBc prevalence by district may permit the targeting of limited public health resources for education, screening, and prevention programs.(AU)

Seroprevalence of hepatitis B virus among school-age children in the Stann Creek District of Belize, Central America

Adults in the Stann Creek district of Belize have a high prevalence of hepatitis B virus (HBV) infection, but the age of onset of these infections is unclear. We conducted a seroprevalence study of hepatitis B markers among Stann Creek school-age children to provide information for planning a hepatitis B vaccine program. The overall prevalence in 587 students was high for antibody to hepatitis B core antigen (anti-HBc) (43.3percent) and hepatitis B surface antigen (HBsAg) (7.7 percent). There was marked variation of anti-HBc by school and by the predominant ethnic groups attending those schools. Maya had the highest prevalence (76 percent), followed by Mestizo (50 percent), Garifuna (37 percent), and Creole (25 percent). Children less than nine years of age attending the rural primary schools (mostly Garifuna and Creole) (p< 0.05). Anti-HBc was found in 42 percent and 36 percent of students at the two high schools. Of the five schools tested, only at the urban primary school did anti-HBc positivity increase with age. Based on an analysis of the cost of serologic screening before immunization compared with mass vaccination, preimmunization serologic screening resulted in vaccine program cost savings in four of the five schools. Because most children in the rural areas contract hepatitis B before entering school, immunization against HBV should be integrated into the routine infant immunization program (AU)

Prevalence of hepatitis B virus among health care workers in Belize, Central America

A seroprevalence survey of hepatitis B virus (HBV) markers was conducted among health care workers in Belize to help determine the epidemiology of hepatitis B and to determine if screening before immunization might lower vaccine costs. Of the 330 workers tested, 94 (29 percent) were positive for antibody to HBV core antigen (anti-HBc) and three (1 percent) had HBV surface antigen. The presence of anti-HBc increased significantly with age from 12 percent in those 18-24 years old to 52 percent in those o 50 years old. The rate was 17 percent of 48 men compared with 30 percent of 282 women (P = 0.05). Rates increased with years of medical service and were higher among nurses (69 of 228; 30 percent) and nonprofessional staff (15 of 44; 34 percent) than among physicians (0 of 20). The presence of anti-HBc also differed significantly among ethnic groups: Mestizo, 4 percent; Creole, 33 percent and Garifuna, 57 percent. Rates differed by district ranging from 3 percent in a northern district (mostly Mestizo) to 67 percent in a southern district (mostly Garifuna). Parenteral exposure to hepatitis B through needle stick injuries and blood transfusions was not associated with anti-HBc. Multiple logistic regression analysis confirmed ethnicity, district of residence, and age as the best predictors of anti-HBc in health care workers. Cost analysis suggests that because of regional differences in exposure, testing of health care workers for anti-HBc in the Belize and Stann Creek districts in southern Belize before hepatitis B immunization would result in vaccine program cost savings (AU)

Prevalence of hepatitis B virus among health care workers in Belize, Central America

A seroprevalence survey of hepatitis B markers was conducted among health care workers in Belize to help determine the epidemiology of hepatitis B and to determine if screening before immunization might save vaccine costs. Of the 330 workers tested, 94 (29 percent) were positive for anti-HBc and 3 (1 percent) had HBsAg. Anti-HBc increased significantly with age from 12 percent in those 18-24 tears old to 52 percent in those 25-50 years old. The rate was 17 percent of 48 men compared with 30 percent of 282 women (p=0.05). Rates increased with years of medical service and were higher among nurses (69/228; 30 percent) and domestic workers (15/44; 34 percent) than among physicians (0/20). Anti-HBc differed significantly among ethnic groups: Mestizo, 4 percent; Creole, 33 percent and Garifuna, 57 percent percent. Rates differed by district, ranging from 3 percent in a northern district (mostly Mestizo) to 67 percent in a southern district (mostly Garifuna). Parenteral exposure to hepatitis B through needle stick injjuries and blood transfusions was not associated with anti-HBs. Multiple logistic regression analysis confirmed ethnicity, district of residence and age as the best predictors of anti-HBc. Regional differences in exposure suggest that testing of health care workers for anti-HBc before hepatitis B immunization in the 3 southern districts of Belize may result in vaccine cost savings (AU)

Detection of hepatitis B surface antigen in St. Vincent and The Grenadines 1989-1993

Hepatitis B, formerly called serum hepatitis, is a disease of worldwide importance because of the extent of morbidity and mortality it inflicts on its victims, and the demands it imposes on the economic and medical resources of a country. The hepatitis B surface antigen (HBsAg) is the first serologic marker to appear following a hepatitis B viral infection. As the condition improves clinically, the titre falls and subsequently disappears (usually within six months). If the titre persists after six months the patient is likely to become a chronic carrier. HBsAg is the only serologic marker tested for in St. Vincent and the Grenadines. Testing for this marker began in 1986. This article presents the results analysed over the last five years. Based on the results of the population tested, future steps that should be taken to control the spread of the disease are recommended (AU)

A survey of hepatitis B among health workers in Jamaica

One thousand, five hundred and thirty-seven health staff, presenting for hepatitis B vaccination in Jamaica, were surveyed in 1990/91 for hepatitis B markers and/or expose to blood or hepatitis. Antibodies to either hepatitis B surface antigen (HBsAg) or hepatitis B core (HBc) were found in 19.8 percent of 817 persons tested. Males were more likely to have antibodies to Hepatitis B Virus (HBV) than females (29 percent compared with 18 percent, Odds Ratio 1.6;95 percent CI 0.98-2.9). HBsAg was found in 5.3 percent of 562 persons tested compared with 1 percent of blood donors. One or more needlestick accidents were reported by 60 percent of the sample, and blood or liquid splashing on the face was reported by 48 percent. Jaundice and hepatitis were reported by 1.2 percent and 3.5 percent of health staff, respectively. HBaAg carrier status was associated with years of service (p=0.039). Prevalence of antibodies to HBV increased with age (p=0.004) and years of service (p=0.028). The effect of age and years of service appears to be largely independent (r=0.44). This survey reaffirms the importance of health workers being immunized with hepatitis B vaccine, and adhering rigorously to universal precautions in patient care and laboratory practice (AU)

Initial report of a hepatitis investigation in rural Belize

In spring 1991, Belizian health officials expressed concern about a possible hepatitis outbreak in a banana farming district. A study was designed to identify cases and to address the serological prevalence of hepatitis virus markers. Three populations were studied: (i) persons meeting a clinical case definition for hepatitis; (ii) designated banana workers; and (iii) people in a random sample of households in the community. Information was collected using questionnaires and sera were collected for laboratory testing. This report presents the preliminary results of a study conducted in June 1991. Among people who met the clinical case definition, 24 percent of 42 tested had immunoglobulin M antibody to hepatitis B virus (HBV) core antigen (anti-HBc IgM). In the worker and household survey populations, 248 and 280 people, respectively, were tested for anti-HBc IgM. In each group, 4 percent were positive. HBV surface antigen was found in 37 percent of 43 clinical cases, 18 percent of workers, and 13 percent of people in the household survey. Among the 3 study populations, the prevalence of HBV core antibody (anti-HBc) ranged from 73 percent to 81 percent. Almost all tested persons had evidence of prior infection with hepatitis viruses A and B was widespread, but an aetiology could not be established for most of the clinical cases. However, the prevalence of hepatitis B markers in this population was very high compared to other reports from the Caribbean (AU)

The prevalence of hepatitis A and B infection among different ethnic groups in Belize - abstract

Little is known about the prevalence of infection with hepatitis viruses in Belize, Central America. We conducted a serological survey among members of the Belize Defence Force (BDF), which comprises the five major ethnic groups in Belize, in order to estimate the prevalence of hepatitis A and B among men and women of military age in Belize. Of approximately 600 men and women in the BDF, 394 (66 per cent) volunteered to participate. Antibody to hepatitis A was found in 95 per cent with similar rates by age, rank and ethnicity. Antibody to hepatitis B core antigen (anti-HBc) was found in 31 per cent. The prevalence of anti-HBc varied significantly among the ethnic groups, with the lowest rates in Mayan Indians (5 per cent) and Mestizo (7 per cent), with significantly higher rates among Creoles (30 per cent) and Garifuna (54 per cent). Rates increased with increasing age from 25 per cent in those 18 - 24 years to 35 per cent in those over 35 years of age (p = 0.6, chi-square for trend). Hepatitis B surface antigen was found in 15 (4 per cent) overall. Rates of hepatitis A and B antibodies among 70 military recruits (mean age 20 years) were similar to those among regular forces; anti-HAV was found in 91 per cent, anti-HBc in 34 per cent, and HBsAg in 6 per cent. In this young healthy population, exposure to hepatitis A before the age of 18 years is almost universal, while exposure to hepatitis B is related to age and ethnicity (AU)

A survey of hepatitis B among health workers in Jamaica - abstract

A convenience sample of 1537 health staff in Jamaica were surveyed in 1990/91 for hepatitis B markers and/or exposure to blood or hepatitis. Antibodies to either hepatitis B surface antigen (HBsAg) or hepatitis B core (HBc) were found in 19.8 per cent of 817 persons tested. HBsAg was found in 5.3 per cent persons tested. One or more needlestick accidents were reported by 60 per cent of the sample and blood or liquor splashing on the face was reported by 48 per cent. Jaundice and hepatitis was reported by 1.2 per cent and 3.5 per cent respectively. Prevalence of antibodies to hepatitis B virus (HBV) increased with age (p = 0.004) and years of service (p = 0.28) while HBsAg carrier status was associated with years of service (p = 0.039). Males were more likely to have antibodies to HBV than females (Odds Ratio 1.63, 95 per cent, CI 0.98 - 2.71). This survey reaffirms the importance of health workers being immunized with hepatitis B vaccine and adhering rigorously to universal precautions in patient care and laboratory practice (AU)

Risk of transfusion-related hepatitis and HTLV-1 in Barbados - abstract

The study was designed to determine the prevalence of hepatitis B, hepatitis C, and human T-cell lymphotropic virus type 1 (HTLV-1) among blood donors in Barbados, with a view to reviewing the blood bank screening practices currently in place. Blood samples from 1,022 consecutive blood donors were collected and stored. Samples were then tested for hepatitis B surface antigen (HBsAg), antibodies to surface and core antigens of hepatitis B (anti-HBs) and anti-HBc, respectively, hepatitis C (HCV), and HTLV-1. HBsAg was found in 0.98 per cent, anti-HBs in 7.24 per cent, anti-HBc in 8.4 per cent (n=619), anti-HCV in 2.57 per cent (n=894) and anti-HTLV-1 in 1.4 per cent (n=708). It is recommended that while screening of blood donors is adequate for hepatitis B infection, urgent consideration should be given to additional screening for hepatitis C and HTLV-1 (AU)

Update: international task force for disease eradication

In 1998, a decade after the successful eradication of smallpox, the International Task Force for Disease Eradication (ITFDE) was formed to systematically evaluate the potential for global eradicability of candidate diseases, identify specific barriers to their eradication that might be sumountable, and promote eradication efforts. This group includes representatives from the World Health Organization, United Nations International Children's Emergency Fund, United Nations Development Project, the World Bank and the Rockefeller Foundation. In its first two meetings in April and October 1989, the ITFDE determined that two of eight diseases examined were eradicable and three others were candidates for elimination of transmission or clinical sympthoms. In its third and fourth meetings in August 1990 and June 1991, the ITFDE evaluated the potential eradicability of seven other diseases. This report summarizes the results of the third and fourth meetings (AU)

Seroprevalence of chlamydia trachomatis, hepatitis B and retroviruses in female STD patients and pregnant women in Jamaica - abstract

The seroprevalence of chlamydia trachomatis (Ct), hepatitis B (HBV), human immunodeficiency nirus (HIV) and human T-lymphotropic virus-type 1 (HTLV-I) was investigated in a high-risk group, patients from a sexually transmitted diseases clinic and prostitutes, as well as a low-risk group, antenatal group. In the STD group 100 sera were tested. Seropositivity for Ct was 82 percent,for HBsAg 3 percent, HBcAb 23 percent, HIV-Ab 2 percent and HTLV-1 Ab 8 percent. Among the 76 prostitutes, the seropsitivity was even higher: Ct 97 percent, HBsAg 8 percent, HBc,Ab 41 percent, HIV-Ab 9 percent and HTLV-1 Ab 17 percent. The antenatal women studied as a normal control population had lower levels: Ct 52 percent, HBsAg 0.7 percent, HBcAb 9 percent, HIV-Ab 0.7 percent and HTLV-1 Ab 2.8 percent. It is noteworthy that the seroprevalence for all the STDs investigated was markedly higher in the promiscuous group. Although the level for Ct antibodies was in the antenatal women, even this group showed a high prevalence of this very commonly occurring STD. (AU)