A Longitudinal Analysis of Mortality Related to Chronic Viral Hepatitis and Hepatocellular Carcinoma in the United States.

(1) Background: Hepatocellular carcinoma (HCC) contributes to the significant burden of cancer mortality in the United States (US). Despite highly efficacious antivirals, chronic viral hepatitis (CVH) remains an important cause of HCC. With advancements in therapeutic modalities, along with the aging of the population, we aimed to assess the contribution of CVH in HCC-related mortality in the US between 1999-2020. (2) Methods: We queried all deaths related to CVH and HCC in the multiple-causes-of-death files from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database between 1999-2020. Using the direct method of standardization, we adjusted all mortality information for age and compared the age-adjusted mortality rates (AAMRs) across demographic populations and by percentile rankings of social vulnerability. Temporal shifts in mortality were quantified using log-linear regression models. (3) Results: A total of 35,030 deaths were identified between 1999-2020. The overall crude mortality increased from 0.27 in 1999 to 8.32 in 2016, followed by a slight reduction to 7.04 in 2020. The cumulative AAMR during the study period was 4.43 (95% CI, 4.39-4.48). Males (AAMR 7.70) had higher mortality rates compared to females (AAMR 1.44). Mortality was higher among Hispanic populations (AAMR 6.72) compared to non-Hispanic populations (AAMR 4.18). Higher mortality was observed in US counties categorized as the most socially vulnerable (AAMR 5.20) compared to counties that are the least socially vulnerable (AAMR 2.53), with social vulnerability accounting for 2.67 excess deaths per 1,000,000 person-years. (4) Conclusions: Our epidemiological analysis revealed an overall increase in CVH-related HCC mortality between 1999-2008, followed by a stagnation period until 2020. CVH-related HCC mortality disproportionately affected males, Hispanic populations, and Black/African American populations, Western US regions, and socially vulnerable counties. These insights can help aid in the development of strategies to target vulnerable patients, focus on preventive efforts, and allocate resources to decrease HCC-related mortality.

Ecological study of viral hepatitis in Brazil: a geographical and temporal analysis

Introduction: Viral hepatitis is a group of diseases that present high hepatotropism and are related to liver dysfunctions, having either an acute or a chronic course. Their worldwide epidemiology is diverse, with several endemic places, such as South America. The objective of this study was to analyze the epidemiology of viral hepatitis in Brazil, in order to better understand its pattern of distribution and evolution. Method: A temporal aggregation study was conducted using the Viral Hepatitis Database of the Brazilian Ministry of Health. The serological markers used were HBsAg and anti-HCV for hepatitis B and C, respectively. Mortality data were collected from the Mortality Information System for deaths attributed to viral hepatitis. The period analyzed was from 2007 to 2016/17. Results: The incidence was 7.88 (95% CI, 7.30-8.45) for hepatitis B and 11.9 (95% CI, 11.15-12.65) for hepatitis C. Mortality attributed to viral hepatitis was 1.61 (95% CI, 1.35-1.87) deaths per 100,000 people. An analysis of municipal distribution data showed several endemic areas. The Brazilian regions most affected by hepatitis B virus were the northern and southern borders, Santa Catarina coast and Espírito Santo state, while hepatitis C virus was mostly present in metropolitan areas such as Porto Alegre and São Paulo. Conclusions: Viral hepatitis has a diverse geographic distribution in the Brazilian territory, with highly endemic areas. The distribution differs between hepatitis B and hepatitis C viruses. (AU)

Epidemiological profile of viral hepatitis in Rio Grande do Sul and its health macro-regions

Introduction: Viral hepatitis comprises a group of viruses characterized by high global prevalence and hepatic tropism. Its epidemiology is extremely variable throughout the world, and South America is an endemic place. A better understanding of the regional reality is fundamental for proposing new public health measures. Methods: We conducted an aggregate temporal study of the Viral Hepatitis Database of the Ministry of Health of the state of Rio Grande do Sul (RS), with an epidemiological profile of the reactive results of HBsAg and Anti-HCV tests, together with data on mortality from acute Hepatitis B and chronic viral hepatitis from the respective Health Macro-Regions from 2007 to 2015. Results: The incidence of new cases of hepatitis B in RS during the analyzed period was 11 (95% CI, 9.7-12.1) cases per 100,000 inhabitants. Meanwhile, the Northern region of the state, represented by the municipality of Passo Fundo, had 32.7 (95% CI, 28.3-37) and 22.8 (95% CI, 19.5-26) new cases of hepatitis B per 100,000 inhabitants for men and women, respectively. The incidence of new cases of hepatitis C in the State of Rio Grande do Sul was 29.2 (95% CI, 24.5-34.9 in 100,000 inhabitants). Conclusion: Viral hepatitis remains an important pathology in the context of Rio Grande do Sul and its Macro-Regions. (AU)

Acute liver failure in children: observations in Vitória, Espírito Santo State, Brazil

In this communication we report 46 cases of acute liver failure in children diagnosed at the Hospital Infantil Nossa Senhora da Glória in Vitória, E Santo. Serology for IgM anti-HAV, IgM anti-HBc, HbsAg, anti-HCV and biochemical tests were performed in all cases in a routine laboratory. The M/F ratio was 1.1:1 and the mean age was 4.7±3.2 years, without gender difference. Anti-HAV IgM+ in 38 (82.6 percent) cases, anti-HbcIgM+ in two (4.3 percent) cases and 6 (13.1 percent) cases were negative for all viral markers investigated. Anti- HCV+ in one anti-HAV IgM+ case. HbsAg+ in two anti-HbcIgM+ and in two HAVIgM+ cases. Among the six A, B and C negative cases, four (8.6 percent) did not have the suspected exogenous intoxication. Mortality was 50 percent, without gender or age differences. These results demonstrate that HAV infection is the main etiology of acute liver failure in children in Brazil, confirming that, although it is a self limited, relatively mild illness, it can cause serious and even fatal disease. The observation of four cases without A, B and C viral markers and no history of exogenous intoxication, agree with the observation of non A-E acute sporadic hepatitis in Northeastern Brazil

Hepatitis aguda fulminante no A no B en el embarazo: un caso clínico de probable hepatitis esporádica producida por virus E / Fulminating acute non A non B hepatitis in pregnancy: a clinical case of probably sporadic hepatitis produced by E virus

Se destaca la mayor gravedad de la hepatitis E en la embarazada y la alta mortalidad materna y fetal en la hepatitis aguda fulminante. Se presneta el caso clínico de una paciente de 19 años, primigesta, embarazo de 29 semanas con diagnóstico de hepatitis aguda fulminante no A no B, probable E por el cuadro clínico, que evoluciona con muerte fetal y ante la gravedad del cuadro se planteó un transplante hepático que no se logra por falta de donante; la paciente fallece el día 16 desde su ingreso. En el estudio histopatológico de hígado destaca una necrosis hepática masiva y un shock terminal