Epidemiology of acute hepatitis B in a university hospital in São Paulo, Brazil
retrospective study of two five-year periods
Keywords:
Hepatitis, Hepatitis B, Acute hepatitis B, EpidemiologyAbstract
CONTEXT: HBV infection is endemic in Brazil and acute HBV infection is still a common disease. OBJECTIVE: To analyze incidence, risk factors and evolution of acute HBV infection. SETTING: University Hospital. PATIENTS: 357 patients with acute HBV infection, comparing two periods: 1985-1989 vs. 1990-1994. RESULTS: The overall incidence declined from 50 new cases/year in 1985-89 (30% of all cases) to 25 new cases/year in 1990-94 (8% of all cases). Transmission among male homosexuals (3.9% of cases in 85-89) declined to 1.3% in 90-94 (p>0.05). Amongst health care workers (HCW) it declined from 8.2% to 2.0% (p=0.02). Conversely, heterosexual transmission increased from 4.8% to 10.1% (p=0.06). Chronification of HBV infection following the acute episode was observed in 1.7%. Fulminant hepatic failure was seen in 3.4%. However, 27.2% of patients were lost to follow-up before normalization of the biochemical tests. CONCLUSIONS: The different patterns of risk factors observed is probably related to measures for preventing AIDS and to HCW vaccination programs. Chronification following acute episodes was not a common event.
Downloads
References
Margolis HS, Alter J, Hadler SC. Hepatitis B: evolving epidemiology and implications for control. Semin Liver Dis 1991;11:84-92.
Beasley RP. Hepatitis B virus: the major etiology of hepatocellular carcinoma. Cancer 1988; 61:1942-56.
Hoofnagle JH, Di Bisceglie A . Serologic diagnosis of acute and chronic hepatitis. Semin Liver Dis 1991; 2:3-83.
Andre F. Overview of a 5-year clinical experience with a yeast-derived hepatitis B vaccine. Vaccine 1990; 8:S74-8.
Francis DP. The public´s health unprotected: reversing a decade of underutilization of hepatitis B vaccine. JAMA 1995; 274(15):1201-8.
Carrilho FJ, Silva LC. Epidemiologia. In: Silva LC. Hepatites agudas e crônicas. 2Ş ed. Săo Paulo: Sarvier; 1995:73-95.
Gayotto LCC, Quarentei AA, Cabral GL. Soroepidemiologia das hepatites A e B nas áreas dos rios Biá e Alto Juruá, Amazonia Ocidental. GED 1984; 3:106-16.
Tabor E. Viral hepatitis: epidemiology and prevention. In: Berk JE. Bocku's gastroenterology. 4th ed. Philadelphia: Saunders; 1985:2811-24.
Lauer JL , Van Drumen NA , Washbun JW. Transmission of hepatitis B virus in clinical laboratory areas. J Infect Dis 1979; 140:513-6.
Alter M, Ahtone J, Weisfuse I, Starko K, Vacalis TD, Maynard JE. Hepatitis B virus transmission between heterosexuals. JAMA 1986; 256(10):1307-10.
Osmon DR, Melton LJ, Keyes TF, et al. Viral Hepatitis: a population-based study in Rochester, MN, 1971-1980. Arch Intern Med 1987; 147:1235-1240.
McQuillan GM, Townsend TR, Fields HA, Leahy BS, Polk BF. Seroepidemiology of hepatitis B virus infection in the United States. Am J Med 1989; 87 (suppl 3A):5S-10S.
Squarcione S, Pompa MG, Vellucci L, Virtuani L. Epidemiology of hepatitis B in Italy by reports to the National Surveillance System. IX Triennial International Symposium on Viral Hepatitis and Liver Disease (Abstracts). April, 21-25, 1996. A-237, p.107.
Frider B, Sookonian S, Rebora N. Professional risk: hepatitis B vaccination strategies in a general hospital. Acta Gastroenterol Latinoam 1992; 22:29-35.
Alter MJ, Hadler SC, Margolis HS, Alexander WJ, Hu PY, Judson FN, et al. The changing epidemiology of hepatitis B in the United States. JAMA 1990; 263(9):1218-22.
Terazawa S, Kojima M, YamanakaT, et al. Hepatitis B virus mutants with precore region defects in two babies with fulminant hepatitis and their mothers positive for antibody to hepatiis B and antigen. Pediatr Res 1991; 29:5-9.
Rinker J, Calambos J. Prospective study of hepatitis B in thirty two inadvertently infected people. Gastroenterology 1981; 81:686-91.
Roumeliotou A, Papavangelou G. Chronic liver disease rarely follows acute hepatitis B in non-immunocompromised adults. Infection 1992; 20(4):221-3.
Hyams KC. Risks of chronicity following acute hepatitis B virus infection: a review. Clin Infect Dis 1995; 20: 992-1000.
Koff RS. Difficult serologic diagnosis in viral hepatitis. In: Hollinger FB, Lemon SM, Margolis H, editors. Viral hepatitis and liver disease. Baltimore: Williams & Wilkins; 1991:790-1.
