Incidence and Clinical Features of Autoimmune Hepatitis in the Province of Santa Fe (Argentina).

OBJETIVES: The aim of the study is to investigate the incidence and clinical features of autoimmune hepatitis (AIH) in children from the province of Santa Fe, Argentina, for 10 years. METHODS: From the records of all of the pediatric hepatologists in the province of Santa Fe, Argentina, we reviewed the clinical charts of patients <18 years who were diagnosed with AIH (simplified score >6 points) and followed between January 2003 and December 2013. Population data were extracted from the 2010 national census. Values were expressed as percentages and median ± interquartile range. Mann-Whitney U test was used for comparison between the groups. RESULTS: Sixty-seven patients fulfilled inclusion criteria, from which 11 (16%) were later reclassified as having "autoimmune sclerosing cholangitis" according to biochemical, histological, and radiological findings. A final sample of 56 patients (39 F) with AIH was analyzed, giving an annual incidence of 0.56/100,000. Median age at presentation was 8 (5.7-11) years, and the median follow-up was 4 (2-7) years. Type 1 AIH was diagnosed in 89%. An acute presentation was observed in 53%, while 13 (23%) showed cirrhosis on initial biopsy. Prednisone (87%) and azathioprine (60%) were the most common drugs prescribed. At the end of follow-up, 53/56 (95%) were alive, including 4 patients (7%) who underwent liver transplantation. CONCLUSIONS: AIH has an estimated incidence of 0.56/100,000 per year in children from the province of Santa Fe (Argentina). Overall survival rate was 95%. A subgroup of patients diagnosed as AIH develops predominant biliary disease and should be better classified as autoimmune sclerosing cholangitis.

Registro prospectivo durante un año de enfermedad inflamatoria intestinal en población pediátrica argentina / One-year prospective registry of inflammatory bowel disease in the Argentine pediatric population

Introducción. La enfermedad inflamatoria intestinal (EII) comprende la colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Su diagnóstico es cada vez más frecuente en pediatría y la incidencia es desconocida en Argentina. El objetivo de este trabajo fue determinar la incidencia anual de EII en menores de 18 años de nuestro país, los aspectos epidemiológicos y las formas clínicas de presentación. Población y métodos. Estudio prospectivo, multicéntrico y observacional que abarcó todo el territorio nacional. Se incluyeron menores de 18 años con diagnóstico de EII de centros públicos y privados entre el 1/6/2012 y el 31/5/2013, a través de protocolo en la web. Resultados. Participaron 17 centros, y se registraron 50 pacientes en 10 centros. La incidencia fue 0, 4/100 000 < 18 años; EC, 20; CU, 25; y EII no clasificable, 5. Distribución según sexo: 26 varones y 24 mujeres. La edad media al momento del diagnóstico fue de 9, 7 años y la demora diagnóstica, de 16, 5 meses. Los síntomas y signos más frecuentes fueron diarrea crónica con sangre y/o moco, dolor abdominal y adelgazamiento. El retraso del crecimiento fue menor de lo esperado. Las manifestaciones extraintestinales se presentaron en el 24% en CU y en el 25% en EC. La localización más frecuente en EC fue ileocolónica, y, en CU, pancolónica. No se observó CU con formas graves. Conclusiones. La incidencia fue menor que la reportada por otros registros. Se considera conveniente la creación de un registro permanente, que no solo permita conocer la incidencia, sino también servir de apoyo a los centros referentes que diagnostican y tratan esta patología.

Introduction. Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD). IBD diagnosis has become increasingly common in pediatrics but its incidence is unknown in Argentina. The objective of this study was to determine the annual incidence of IBD in children and adolescents younger than 18 years in Argentina, its epidemiological aspects, and clinical presentations. Population and methods. Prospective, observational, multicenter study conducted in Argentina. Children and adolescents younger than 18 years from public and private facilities, diagnosed with IBD between June 1st, 2012 and May 31st, 2013 were included via a web protocol. Results. Seventeen sites participated in the study; 50 patients were recruited from 10 sites. IBD incidence was 0.4/100 000 among individuals <18 years; CD, 20; UC, 25; and idiopathic IBD, 5. Distribution by sex: 26 boys and 24 girls. Patients' mean age at diagnosis was 9.7 years, and delay in the diagnosis was 16.5 months. The most common symptoms and signs were chronic diarrhea with blood and/or mucus, abdominal pain, and weight loss. Growth retardation was less common than expected. Extraintestinal manifestations were observed in 24% of UC cases and in 25% of CD cases. The most common location of CD was the ileum and colon, and of UC was the entire colon (pancolonic). There were no cases with severe UC. Conclusions. The incidence was lower than that reported in other registries. We recommend the development of an ongoing registry, to establish the incidence of IBD, but also to serve as backup for referring facilities where this disease is diagnosed and treated.

One-year prospective registry of inflammatory bowel disease in the Argentine pediatric population. / Registro prospectivo durante un año de enfermedad inflamatoria intestinal en población pediátrica argentina.

INTRODUCTION: Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD). IBD diagnosis has become increasingly common in pediatrics but its incidence is unknown in Argentina. The objective of this study was to determine the annual incidence of IBD in children and adolescents younger than 18 years in Argentina, its epidemiological aspects, and clinical presentations. POPULATION AND METHODS: Prospective, observational, multicenter study conducted in Argentina. Children and adolescents younger than 18 years from public and private facilities, diagnosed with IBD between June 1st, 2012 and May 31st, 2013 were included via a web protocol. RESULTS: Seventeen sites participated in the study; 50 patients were recruited from 10 sites. IBD incidence was 0.4/100 000 among individuals <18 years; CD, 20; UC, 25; and idiopathic IBD, 5. Distribution by sex: 26 boys and 24 girls. Patients' mean age at diagnosis was 9.7 years, and delay in the diagnosis was 16.5 months. The most common symptoms and signs were chronic diarrhea with blood and/or mucus, abdominal pain, and weight loss. Growth retardation was less common than expected. Extraintestinal manifestations were observed in 24% of UC cases and in 25% of CD cases. The most common location of CD was the ileum and colon, and of UC was the entire colon (pancolonic). There were no cases with severe UC. CONCLUSIONS: The incidence was lower than that reported in other registries. We recommend the development of an ongoing registry, to establish the incidence of IBD, but also to serve as backup for referring facilities where this disease is diagnosed and treated.

INTRODUCCIÓN: La enfermedad inflamatoria intestinal (EII) comprende la colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Su diagnóstico es cada vez más frecuente en pediatría y la incidencia es desconocida en Argentina. El objetivo de este trabajo fue determinar la incidencia anual de EII en menores de 18 años de nuestro país, los aspectos epidemiológicos y las formas clínicas de presentación. POBLACIÓN Y MÉTODOS: Estudio prospectivo, multicéntrico y observacional que abarcó todo el territorio nacional. Se incluyeron menores de 18 años con diagnóstico de EII de centros públicos y privados entre el 1/6/2012 y el 31/5/2013, a través de protocolo en la web. RESULTADOS: Participaron 17 centros, y se registraron 50 pacientes en 10 centros. La incidencia fue 0,4/100 000 < 18 años; EC, 20; CU, 25; y EII no clasificable, 5. Distribución según sexo: 26 varones y 24 mujeres. La edad media al momento del diagnóstico fue de 9,7 años y la demora diagnóstica, de 16,5 meses. Los síntomas y signos más frecuentes fueron diarrea crónica con sangre y/o moco, dolor abdominal y adelgazamiento. El retraso del crecimiento fue menor de lo esperado. Las manifestaciones extraintestinales se presentaron en el 24% en CU y en el 25% en EC. La localización más frecuente en EC fue ileocolónica, y, en CU, pancolónica. No se observó CU con formas graves. CONCLUSIONES: La incidencia fue menor que la reportada por otros registros. Se considera conveniente la creación de un registro permanente, que no solo permita conocer la incidencia, sino también servir de apoyo a los centros referentes que diagnostican y tratan esta patología.

Single-dose Universal Hepatitis A Immunization in One-year-old Children in Argentina: High Prevalence of Protective Antibodies up to 9 Years After Vaccination.

BACKGROUND: Single-dose hepatitis A virus (HAV) vaccination was implemented in all Argentinean children 12 months of age in 2005. Previous studies demonstrated high prevalence of protective antibody response 4 years after single-dose vaccination. This study assessed long-term seroprotection against HAV after vaccination. METHODS: Children who received 1 dose of HAV vaccine at 1 year of age at least 6 years before enrollment were included at 5 centers in Argentina between 2013 and 2014. Demographic and socioeconomic characteristics were collected through a questionnaire. Blood samples were tested for anti-HAV antibodies. Antibody values ≥10 mIU/mL were considered seroprotective. Logistic regression analysis was performed to evaluate the association between demographic and socioeconomic variables and seroprotection. RESULTS: A total of 1088 children were included, with a median postvaccination interval of 7.7 years (range 6.3-9.2 years). Of these children, 97.4% (95% confidence interval: 96.3%-98.3%) had protective antibodies against HAV. No association between demographic or socioeconomic variables and seroprotection was found. Geometric mean concentration of antibody levels against HAV was 170.5 mUI/mL (95% confidence interval: 163.2-178.2 mUI/mL). CONCLUSIONS: Single-dose universal hepatitis A immunization in 1-year-old children resulted in sustained immunologic protection for up to 9 years in Argentina. These findings, along with the low current disease burden, confirm the success of the intervention.