Large-scale survey of hepatitis B virus infection in families

Horizontal transmission of de novo hepatitis B between spouses: A case report

We report a female patient with acute hepatitis B due to horizontal transmission of hepatitis B virus from her husband, who suffered from de novo hepatitis B. A 48-year-old man underwent peripheral blood stem cell transplantation (PBSCT) for adult T-cell leukemia/lymphoma. Nine months after the initial treatment, he was referred to our hospital because of jaundice. Laboratory data showed elevated serum aminotransferase levels and hepatitis B surface antigen (HBsAg) positivity. We diagnosed de novo hepatitis B because a pre-PBSCT serum sample was negative for HBsAg and positive for anti-hepatitis B core antibody (HBcAb). His liver function improved with entecavir therapy. Two months after his diagnosis of hepatitis B, his 31-year-old wife was admitted with fever and appetite loss. She was diagnosed with acute hepatitis B because of increased serum aminotransferase levels and HBsAg and immunoglobulin M HBcAb positivity. Sequencing of HBV DNA in the serum obtained from both patients showed 99.9% homology. Therefore, we diagnosed her acute hepatitis B as due to horizontal transmission of de novo hepatitis B from her husband. HBV derived from de novo hepatitis B should be considered a potential source of infection, although intrafamilial transmission of de novo hepatitis B is rare.

Horizontal transmission of hepatitis B virus in children with chronic hepatitis B

AIM: To determine the possible routes of intrafamilial transmission pattern in pediatric cases of chronic hepatitis B virus (HBV) infection.

METHODS: In this descriptive retrospective study, 302 children with chronic HBV infection from 251 families and their parents attending the Social Security Children’s Hospital and Doctor Sami Ulus Children’s Hopsital in Ankara between December 1998 and May 2000, were enrolled in. Screenings and diagnosis of chronic HBV infections were established according to the Consensus 2000.

RESULTS: In the studied 302 children with chronic HBV infection, mothers of 38% and fathers of 23% were HBsAg positive. The HBsAg positivity in at least two siblings of the same family was 61% when both parents were HBsAg positive.

CONCLUSION: It is well known that horizontal transmission is quite common in countries where Hepatitis B Virus is moderately endemic. To our best knowledge, this is the largest series observed regarding the horizontal transmission in pediatric chronic HBV infection in Turkey. It is necessary to expand the preventive programs to target not only the newborn period but also all stages of childhood.

Liver cancer in Asian migrants to the United States and their descendants

The incidence of primary liver cancer in Chinese, Japanese, and Filipino migrants to the United States and their descendants is compared with that of United States-born Whites. Incident liver cancer cases were ascertained between 1973 and 1986 from population-based cancer registries serving the San Francisco/Oakland (CA) metropolitan area, 13 counties of western Washington, and Hawaii. The population of these three areas, with regard to age, race, and country of birth, was estimated from a special tabulation of the 1980 US census. Rates of primary liver cancer were higher for men born in Asia than Asian men born in the US, who, in turn, had higher rates than did US Whites (respective annual rates per 100,000: Chinese, 26.5 and 9.8; Japanese, 16.5 and 6.6; Filipinos, 11.4 and 6.5; US Whites, 3.4). Among Asian American women, the trends were not as consistent (respective annual rates per 100,000: Chinese, 2.2 and 3.7; Japanese, 1.9 and 1.4; Filipino, 2.6 and 0; US Whites, 1.1). In general, liver cancer incidence among Asian Americans was lower than among residents of Asia. These findings are compatible with substantial variation among Asians in the prevalence of one or more etiologic factors for liver cancer, such as hepatitis-B infection and aflatoxin consumption, in relation to residence and place of birth.

Morbidity and mortality from chronic hepatitis B virus infection in family members of patients with malignant and nonmalignant hepatitis B virus-related chronic liver diseases

Three-hundred forty-one HBsAg-positive family members of 152 patients with chronic hepatitis B virus infection (47 asymptomatic carriers, 59 with chronic hepatitis, 17 with cirrhosis and 29 with hepatocellular carcinoma) were prospectively studied to determine the morbidity and mortality from chronic hepatitis B virus infection in the family members of patients with malignant and nonmalignant hepatitis B virus-related chronic liver diseases. Most of the family members had no history of acute hepatitis, were asymptomatic and were unaware of their carrier status. However, 5.3% had stigmata of chronic liver disease, 6% had serum ALT levels that exceeded two times the upper limit of normal and 78% of those who had biopsies had chronic hepatitis with or without cirrhosis. During a follow-up period of 12 to 90 mo (median = 39 mo), 3% had symptoms of chronic liver disease; 24% had transient, recurrent or persistent elevation in serum ALT levels, 1.4% had cirrhosis and 1% had hepatocellular carcinoma. Neither hepatocellular carcinoma in the index patient nor a previous history of hepatocellular carcinoma in the family was associated with an increase in the morbidity and mortality from chronic hepatitis B virus infection in the HBsAg-positive family members.

Study of seroconversion of antibody to human T-cell lymphotropic virus type-I in children of Okinawa, Japan

From 1983 to 1986, 1,813 children in nursery schools in Ishigaki Island and 1,228 children under 15 years old in the rural area in the Yaeyama District of Okinawa, Japan, were tested for anti-HTLV-I; 18 children (1.0%) in Ishigaki Island and 39 children (3.2%) in the rural area were positive. In order to survey when anti-HTLV-I developed in these children, their older serum samples were investigated retrospectively for 1 to 5 years. Two cases of seroconversion from anti-HTLV-I negative to positive were found between the age of 2 and 4, and there were no cases of seroconversion over 4 years old. Among the children who suffered maternal transmission of HTLV-I and developed anti-HTLV-I before the age of 15, about 80% of the children were considered to have anti-HTLV-I before the age of 2, and the remainder developed anti-HTLV-I before the age of 4.

A dynamic study of the intrafamilial spread of hepatitis B virus infection: relation with the viral replication

A total of 848 household contacts of 285 hepatitis B surface antigen (HBsAg) chronic carriers were included in a prospective study. Of the total number of contacts negative for hepatitis B virus (HBV) markers at baseline, 330 relatives of 145 HBsAg carriers were observed over a mean period of 20.1 months. Among all household contacts, 284 (33.5%) were found positive for at least one HBV marker. The prevalence of HBV markers was significantly higher among the contacts of more than one HBsAg carrier (75.9%) than among those with only one (26.0%) (P less than .001). The presence of hepatitis B e antigen (HBeAg), specific HBV-DNA polymerase (HBV-DNAp), HBV-DNA, and polymerized human serum albumin (pHSA-R) in the index case was associated with a significantly higher incidence of HBV markers among household contacts. During the follow-up, the number of household contacts initially negative for HBV markers who became infected was found to be in direct relation to the presence of HBeAg, HBV-DNAp, HBV-DNA and pHSA-R in the index case.

The etiology of acute hepatitis in hospitalized children in Cairo Egypt

Seromarkers for hepatitis A, B and D were used to determine the cause of acute hepatitis in 94 children (age 2 to 14 years) prospectively studied when they were admitted to Embaba Fever Hospital in Cairo, Egypt, between January and April 1983. The diagnoses were: hepatitis A (4%), hepatitis B (33%), acute hepatitis in HBsAg carriers (10%), dual infections with A and B (2%), and hepatitis non-A, non-B (NANB) (50%). Past hepatitis A was diagnosed in 96%. Among acute hepatitis B infections, 17% (5 of 29 tested) had anti-delta antibody; of HBsAg positive persons, 15% (6 of 40) were HBeAg positive. Two patients had simultaneous presence of HBsAg and antiHBs. For differential diagnosis, clinical, epidemiological, and biochemical findings were evaluated but did not distinguish hepatitis B from NANB hepatitis. Males predominated for HBV infections. No risk factors were found for 58% of HBV and 70% of NANB infections; of the remaining patients, 42% percent of HBV and 30% of NANB infections were associated with injections or surgery but none with transfusion or known contact with hepatitis cases.