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 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)

Seroprevalence of hepatitis B virus, HIV-1, and syphilis among women attending prenatal clinics in Belize, Central America - abstract

We initiated hepatitis B (HB) screening of women attending selected prenatal clinics in Belize. Risk factors for HB infection and demographic data were determined by interview. Of 548 women, 81 (15 percent) were seropositive for HB Core Antibody (anti-HBc); one had HB surface antigenemia. Antibodies to the HIV-1 were detected in one woman. Fifteen women had reactive syphilis serologies. Anti-HBc seroprevalence varied by district (range 3 percent - 44 percent) and by ethnicity (Creole, 19 percent; Garifuna, 43 percent; East Indian, 6 percent; Mayan, 22 percent; Mestizo/Spanish, 8 percent; Dutch German-Menonite, 0 percent). Risk factors for anti-HBc identified from univariate analyses included: being of the Garifuna ethnic group (p<.00001), residence in the Stann Creek, district (p<0.00001), a reactive syphilis serology (p=0.02), a house-hold size of 8 or greater (p=0.02), and five or more lifetime sexual partners )p=0.01). Health care work, tattoos and intravenous drug use were not identified as risks. Multivariate analyses by stepwise logistic regression identified ethnicity (p=0.0001) and a reactive rapid plasma reagin (RPR) (p=0.02), as significant independent predictors of anti-HBc seropositivity. Strategies to screen all pregnant women and provide immunoprophylaxis to susceptible infants may be effective in interrupting neonatal HB in Belize. Highly variable differences in anti-HBc rates by district may permit the targeting of limited public health resources for education and prevention of HB and other sexually transmitted diseases (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)

Initial report of a viral hepatitis investigation in rural Belize - abstract

In spring 1991, concern was expressed in Belize about a hepatitis outbreak. A cross-sectional study was designed to address hepatitis prevalence in a farming district. Three populations were identified: anyone meeting a case definition for hepatitis, any designated worker, and a random sample of the community by household. Survey information was collected on the farm, household, and individual. Sera were collected for laboratory study. This study reports on the current findings from 509 sera collected in June 1991. There had been widespread exposure to hepatitis A(98 percent). New hepatitis was primarily due to hepatitis B(24 percent of clinical cases, 4 percent of people in the random household sample, and 5 percent of workers). In our total, 16 percent had hepatitis B surface antigen and were potential carriers, while 73 percent had evidence of past hepatitis C by our detection method, and delta particle was not present in any of the tested cases. Hepatitis E antibody was detected in two cases. One risk revolved around perceptions of good medical care, using injectable medications. (AU)

An outbreak of rotaviral gastroenteritis in Belize - abstract

An outbreak of gastroenteritis was identified in Belize in February 1991. Forty-five of the 467 cases reported through mid-March were tested for the presence of rotavirus antigen in faecal specimens, using an ELISA method. Of these, 23 (51 percent) were positive. An analysis of 1,605 cases of gastroenteritis reported since October, 1988 at a clinic in Belize City, indicated that the outbreak was seasonal, with an increase in incidence January through May and a peak incidence January through March. The seasonally coincides with the rainfall pattern in Belize. This supports the supposition that the mode of transmission for rotavirus is faecal-oral. There was no significant difference in the sexual distribution. Over 69 percent of the reported cases in the outbreak and approximately 45 percent of the historical cases were in infants and children less than 4 years of age. The percentage of cases in individuals more than 4 years of age is higher than would be expected in an outbreak due solely to rotavirus and suggesting other aetiologies were responsible for some cases (AU)