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Annals of Medicine Jun 1992
Review
Topics: Hepatitis A; Hepatitis B; Hepatitis C; Hepatitis D; Hepatitis E; Hepatitis, Viral, Human; Humans; Polymerase Chain Reaction
PubMed: 1627318
DOI: 10.3109/07853899209147827 -
Hepatology (Baltimore, Md.) Jul 2021During 2016-2020, the United States experienced person-to-person hepatitis A outbreaks that are unprecedented in the vaccine era, during which case-fatality ratios...
BACKGROUND AND AIMS
During 2016-2020, the United States experienced person-to-person hepatitis A outbreaks that are unprecedented in the vaccine era, during which case-fatality ratios reported by some jurisdictions exceeded those historically associated with hepatitis A.
APPROACH AND RESULTS
To identify factors associated with hepatitis A-related mortality, we performed a matched case-control study (matched on age [±5 years] and county of residence in a 1:4 ratio) using data collected from health department and hospital medical records of outbreak-associated patients in Kentucky, Michigan, and West Virginia. Controls were hepatitis A outbreak-associated patients who did not die. There were 110 cases (mean age 53.6 years) and 414 matched controls (mean age 51.9 years); most cases (68.2%) and controls (63.8%) were male. Significantly (P < 0.05) higher odds of mortality were associated with preexisting nonviral liver disease (adjusted odds ratio [aOR], 5.2), history of hepatitis B (aOR, 2.4), diabetes (aOR, 2.2), and cardiovascular disease (aOR, 2.2), as well as initial Model for End-Stage Liver Disease (MELD) score ≥ 30 (aOR, 10.0), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio > 2 (aOR, 10.3), and platelet count < 150,000/μL (aOR, 3.7) among hepatitis A outbreak-associated patients in the independent multivariable conditional logistic regression analyses (each model adjusted for sex).
CONCLUSIONS
Preexisting liver disease, diabetes, cardiovascular disease, and initial MELD score ≥ 30, AST/ALT ratio ≥ 1, and platelet count < 150,000/μL among hepatitis A patients were independently associated with higher odds of mortality. Providers should be vigilant for such features and have a low threshold to escalate care and consider consultation for liver transplantation. Our findings support the recommendation of the Advisory Committee on Immunization Practices to vaccinate persons with chronic liver disease, though future recommendations to include adults with diabetes and cardiovascular disease should be considered.
Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Disease Outbreaks; End Stage Liver Disease; Female; Hepatitis A; Hepatitis A Vaccines; Humans; Male; Middle Aged; Risk Assessment; Risk Factors; Severity of Illness Index; United States; Young Adult
PubMed: 33217769
DOI: 10.1002/hep.31645 -
The American Journal of Tropical... Jul 2019Hepatitis E virus (HEV) infection is associated with a high fatality rate among pregnant women, and gestational complications have been reported among pregnant women...
Hepatitis E virus (HEV) infection is associated with a high fatality rate among pregnant women, and gestational complications have been reported among pregnant women infected with hepatitis A virus (HAV). The aim of this study was to determine the seroprevalence of HAV and HEV infections among pregnant women in Haiti. We stratified the population ( = 1,307) between West and non-West regions. Specimens were tested for total HAV antibody (anti-HAV), and IgM and IgG HEV antibody (anti-HEV). Overall, 96.8% pregnant women were positive for total anti-HAV, 10.3% for IgG anti-HEV, and 0.3% for IgM anti-HEV. The prevalence of IgG anti-HEV in the non-West region (12.3%) was significantly greater than that in the West region (5.3%) ( < 0.0001). Most pregnant women in Haiti had evidence of past exposure and immunity to HAV. The non-West region had a higher prevalence of HEV. Improvement in water and sanitation will help in the prevention and control of these infections in Haiti.
Topics: Adolescent; Adult; Antibodies, Viral; Female; Haiti; Hepatitis A; Hepatitis A virus; Hepatitis E; Hepatitis E virus; Humans; Immunoglobulin G; Pregnancy; Pregnancy Complications, Infectious; Seroepidemiologic Studies
PubMed: 31115307
DOI: 10.4269/ajtmh.19-0020 -
Vaccine Oct 2021Safe and effective hepatitis A vaccines have been recommended in the United States for at-risk adults since 1996; however, adult vaccination coverage is low.
BACKGROUND
Safe and effective hepatitis A vaccines have been recommended in the United States for at-risk adults since 1996; however, adult vaccination coverage is low.
METHODS
Among a random sample of adult outbreak-associated hepatitis A cases from three states that were heavily affected by person-to-person hepatitis A outbreaks, we assessed the presence of documented Advisory Committee on Immunization Practices (ACIP) indications for hepatitis A vaccination, hepatitis A vaccination status, and whether cases that were epidemiologically linked to an outbreak-associated hepatitis A case had received postexposure prophylaxis (PEP).
RESULTS
Overall, 74.1% of cases had a documented ACIP indication for hepatitis A vaccination. Fewer than 20% of epidemiologically linked cases received PEP.
CONCLUSIONS
Efforts are needed to increase provider awareness of and adherence to ACIP childhood and adult hepatitis A vaccination and PEP recommendations in order to stop the current person-to-person hepatitis A outbreaks and prevent similar outbreaks in the future.
Topics: Adult; Child; Disease Outbreaks; Hepatitis A; Humans; Immunization; Prevalence; United States; Vaccination
PubMed: 34598818
DOI: 10.1016/j.vaccine.2021.09.051 -
PloS One 2023High-throughput sequencing is a robust tool used for identifying and tracking pathogen outbreaks. Whole-genome sequencing of hepatitis A virus (HAV) remains poor due to...
High-throughput sequencing is a robust tool used for identifying and tracking pathogen outbreaks. Whole-genome sequencing of hepatitis A virus (HAV) remains poor due to ultra-low viral loads, limitations of next-generation sequencing technology, and its high costs in clinical applications. This study evaluated multiplex polymerase chain reaction (PCR)-based nanopore sequencing to obtain whole-genome sequences of HAV. The HAV genomes were obtained directly from patient specimens for a rapid molecular diagnosis of viral genotypes. Serum and stool samples were collected from six patients with hepatitis A infection. Amplicon-based nanopore sequencing was performed from the clinical specimens to identify HAV genotypes by acquiring nearly complete-genome sequences. TaqMan-based quantitative PCR (qPCR) was conducted to detect and quantify multiple HAV genes. Singleplex-based nanopore sequencing demonstrated high genome coverage rates (90.4-99.5%) of HAV within 8 h, at viral RNA loads of 10 to 105 copies/μL. TaqMan qPCR showed multiplex quantification of HAV genes namely, VP0, VP3, and 3C. This study provides useful insights into rapid molecular diagnosis during hepatitis A outbreaks and may ultimately augment public health disease surveillance in the hospital and epidemiology field.
Topics: Humans; Hepatitis A; Hepatitis A virus; Nanopore Sequencing; Disease Outbreaks; Genotype
PubMed: 37437048
DOI: 10.1371/journal.pone.0288361 -
International Journal of Infectious... Jul 2010Since hepatitis A virus (HAV) is acquired primarily through the fecal-oral pathway, several investigators have used HAV seropositivity as a proxy for exposure to this... (Review)
Review
BACKGROUND
Since hepatitis A virus (HAV) is acquired primarily through the fecal-oral pathway, several investigators have used HAV seropositivity as a proxy for exposure to this pathway. This paper is a critical review of the evidence relevant to the association between seropositivity to HAV and Helicobacter pylori, and considers the validity of comparisons for testing the hypothesis that H. pylori spreads by the fecal-oral route.
MATERIALS AND METHODS
A Medline search identified reports of all types published in the English language literature that were linked to the keywords 'Campylobacter pylori', 'hepatitis A', or 'Helicobacter pylori', cross-referenced with 'seroepidemiology', 'seroprevalence', or 'seropositivity'. Studies identified by the search were included in the review if they used specific IgG antibodies to classify the serostatus of subjects for both HAV and H. pylori infection and provided an estimate of the magnitude of the association between HAV and H. pylori or information that permitted calculation of an odds ratio (OR).
RESULTS
Out of the 21 studies identified, 15 met the inclusion criteria. The studies showed ORs for an association of HAV and H. pylori that ranged from 0.81 to 8.4. After adjustment for potential confounders, ORs shifted toward the null. They also showed that HAV seroprevalence is lower than H. pylori seroprevalence in early life and then becomes higher in later life. Thus in most populations, the trends cross over at some point.
CONCLUSION
The observed associations between the two infections are generally overestimated by the confounding effects of age and socio-economic status-related factors, and when these factors are controlled, the association becomes weak. Moreover, HAV infection elicits a long-term antibody response, while H. pylori infection does not. Consequently, serostatus comparison does not constitute a convincing test of the fecal-oral transmission hypothesis for H. pylori.
Topics: Adolescent; Adult; Aged; Antibodies, Bacterial; Antibodies, Viral; Child; Child, Preschool; Feces; Helicobacter Infections; Helicobacter pylori; Hepatitis A; Hepatitis A virus; Humans; Infant; Infant, Newborn; Middle Aged; Seroepidemiologic Studies; Young Adult
PubMed: 20060352
DOI: 10.1016/j.ijid.2009.09.003 -
California Medicine Sep 1972The histological features of 24 pancreases obtained from patients who died of causes other than hepatitis, pancreatitis or pancreatic tumors, included a variable degree...
The histological features of 24 pancreases obtained from patients who died of causes other than hepatitis, pancreatitis or pancreatic tumors, included a variable degree of autolysis, rare foci of inflammatory reaction but no hemorrhagic fat necrosis or destruction of elastic tissue in vessel walls (elastolysis). Assays of elastase in extracts of these pancreases showed no free enzyme, but varying amounts of proelastase.A review of autopsy findings in 33 patients with fatal liver necrosis attributed to halothane anesthesia, demonstrated changes of acute pancreatitis only in two. On the other hand, a review of 16 cases of fulminant viral hepatitis revealed changes characteristic of acute pancreatitis in seven - interstitial edema, hemorrhagic fat necrosis, inflammatory reaction and frequently elastolysis in vessel walls. Determination of elastase in extracts of one pancreas showed the bulk of the enzyme in free form. Furthermore, assays of urinary amylase in 44 patients with viral hepatitis showed increased levels of this enzyme (2583 +/- 398 mean value +/- standard error, Somogyi units per 100 ml in 13, or 29.5 percent). The evidence suggests that acute pancreatitis may at times complicate viral hepatitis. Although direct proof of viral pancreatic involvement is not feasible at present, a rational hypothesis is advanced which underlines similar mechanisms of tissue involvement in both liver and pancreas that may be brought about by the hepatitis viruses.
Topics: Adult; Aged; Autolysis; Autopsy; Child, Preschool; Female; Halothane; Hepatitis A; Humans; Liver Diseases; Male; Middle Aged; Necrosis; Pancreatitis
PubMed: 5070694
DOI: No ID Found -
Journal of Clinical Microbiology Sep 2019Laboratory surveillance plays an important role in the detection and control of hepatitis A outbreaks and requires the application of rapid and accurate molecular...
Laboratory surveillance plays an important role in the detection and control of hepatitis A outbreaks and requires the application of rapid and accurate molecular diagnostic tools for hepatitis A virus (HAV) RNA detection, subgenotype identification, and sequence-based genotyping. We describe the development and validation of a triplex real-time, reverse transcription-PCR (triplex rRT-PCR) assay for the identification and discrimination of HAV subgenotypes IA, IB, and IIIA and a singleplex rRT-PCR assay designed to detect all HAV genotypes infecting humans. Overall, the accuracy, sensitivity, and specificity of the new assays were >97% for serum and plasma specimens collected during unrelated outbreaks of HAV in California and Michigan compared to a nested RT-PCR genotyping assay and the ISO 15216-1 rRT-PCR method for HAV detection. The new assays will permit the rapid detection of HAV RNA and discrimination among subgenotypes IA, IB, and IIIA in serum and plasma specimens, which will strengthen public health surveillance efforts for HAV outbreak detection and response.
Topics: California; Disease Outbreaks; Epidemiological Monitoring; Genotype; Genotyping Techniques; Hepatitis A; Hepatitis A virus; Humans; Michigan; Molecular Epidemiology; Real-Time Polymerase Chain Reaction; Reverse Transcriptase Polymerase Chain Reaction; Sensitivity and Specificity
PubMed: 31217273
DOI: 10.1128/JCM.00500-19 -
Postgraduate Medical Journal Jul 1971Infectious hepatitis is epidemiologically and immunologically distinct from serum hepatitis. The Australia antigen is related more specifically to serum hepatitis. The... (Review)
Review
Infectious hepatitis is epidemiologically and immunologically distinct from serum hepatitis. The Australia antigen is related more specifically to serum hepatitis. The possible role of coronavirus—and paramyxovirus-like particles in the aetiology of some infections of the liver in man and in marmosets inoculated with human infectious hepatitis material is discussed and the difficulties in the interpretation of the currently available data are emphasized. The recent studies in Melbourne of a faecal antigen found in some patients with infectious hepatitis and the discovery of an antiserum in Milan which reacted with an antigen associated with epidemic hepatitis are discussed. Mention is made of the recent isolation in Detroit-6 cells of virus-like particles from patients with infectious hepatitis. It is concluded that viral hepatitis is an infection of multiple aetiology and that the successful cultivation of the agent or agents of hepatitis remains the outstanding and most urgent problem.
Topics: Animals; Antigens, Viral; Bone Marrow; Cell Line; Culture Techniques; Feces; Haplorhini; Hepatitis A; Hepatitis B; Hepatitis B Antigens; Humans; Immunization, Passive; Orthomyxoviridae Infections; Paramyxoviridae; Sternum
PubMed: 4327058
DOI: 10.1136/pgmj.47.549.476 -
Viruses Nov 2018The accurate virus detection, strain discrimination, and source attribution of contaminated food items remains a persistent challenge because of the high mutation rates...
The accurate virus detection, strain discrimination, and source attribution of contaminated food items remains a persistent challenge because of the high mutation rates anticipated to occur in foodborne RNA viruses, such as hepatitis A virus (HAV). This has led to predictions of the existence of more than one sequence variant between the hosts (inter-host) or within an individual host (intra-host). However, there have been no reports of intra-host variants from an infected single individual, and little is known about the accuracy of the single nucleotide variations (SNVs) calling with various methods. In this study, the presence and identity of viral SNVs, either between HAV clinical specimens or among a series of samples derived from HAV clone1-infected FRhK4 cells, were determined following analyses of nucleotide sequences generated using next-generation sequencing (NGS) and pyrosequencing methods. The results demonstrate the co-existence of inter- and intra-host variants both in the clinical specimens and the cultured samples. The discovery and confirmation of multi-viral RNAs in an infected individual is dependent on the strain discrimination at the SNV level, and critical for successful outbreak traceback and source attribution investigations. The detection of SNVs in a time series of HAV infected FRhK4 cells improved our understanding on the mutation dynamics determined probably by different selective pressures. Additionally, it demonstrated that NGS could potentially provide a valuable investigative approach toward SNV detection and identification for other RNA viruses.
Topics: Animals; Cell Line; Chromosome Mapping; Genetic Variation; Hepatitis A; Hepatitis A virus; High-Throughput Nucleotide Sequencing; Host-Pathogen Interactions; Humans; Polymorphism, Single Nucleotide; Sequence Analysis, DNA
PubMed: 30423964
DOI: 10.3390/v10110619