Hepatitis B virus infection in upper and lower Egypt

Genomics in Egypt: Current Status and Future Aspects

Egypt is the third most densely inhabited African country. Due to the economic burden and healthcare costs of overpopulation, genomic and genetic testing is a huge challenge. However, in the era of precision medicine, Egypt is taking a shift in approach from “one-size-fits all” to more personalized healthcare via advancing the practice of medical genetics and genomics across the country. This shift necessitates concrete knowledge of the Egyptian genome and related diseases to direct effective preventive, diagnostic and counseling services of prevalent genetic diseases in Egypt. Understanding disease molecular mechanisms will enhance the capacity for personalized interventions. From this perspective, we highlight research efforts and available services for rare genetic diseases, communicable diseases including the coronavirus 2019 disease (COVID19), and cancer. The current state of genetic services in Egypt including availability and access to genetic services is described. Drivers for applying genomics in Egypt are illustrated with a SWOT analysis of the current genetic/genomic services. Barriers to genetic service development in Egypt, whether economic, geographic, cultural or educational are discussed as well. The sensitive topic of communicating genomic results and its ethical considerations is also tackled. To understand disease pathogenesis, much can be gained through the advancement and integration of genomic technologies via clinical applications and research efforts in Egypt. Three main pillars of multidisciplinary collaboration for advancing genomics in Egypt are envisaged: resources, infrastructure and training. Finally, we highlight the recent national plan to establish a genome center that will aim to prepare a map of the Egyptian human genome to discover and accurately determine the genetic characteristics of various diseases. The Reference Genome Project for Egyptians and Ancient Egyptians will initialize a new genomics era in Egypt. We propose a multidisciplinary governance system in Egypt to support genomic medicine research efforts and integrate into the healthcare system whilst ensuring ethical conduct of data.

Current situation of viral hepatitis in Egypt

An estimated 8-10 million people suffer from viral hepatitis in Egypt. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the major causes of viral hepatitis in Egypt as 50% or more of the Egyptian population are already exposed to HAV infection by the age of 15. In addition, over 60% of the Egyptian population test seropositive for anti-HEV in the first decade of life. HEV mainly causes self-limiting hepatitis; however, cases of fulminant hepatitis and liver failure were reported in Egypt. Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are the main causes of chronic hepatitis, liver cirrhosis, and liver cancer (hepatocellular carcinoma [HCC]) in Egypt. Globally, Egypt had the highest age-standardized death rate due to cirrhosis from 1990 to 2017. The prevalence rate of HBV (1.3%-1.5%) has declined after national infantile immunization. Coinfection of HBV patients with HDV is common in Egypt because HDV antibodies (IgG) vary in range from 8.3% to 43% among total HBV patients. After the conduction of multiple national programs to control HCV infection, a lower rate of HCV prevalence (4.6%) was recently reported. Data about the incidence of HCV after treatment with direct antiviral agents (DAAs) are lacking. An HCC incidence of 29/1000/year in cirrhotic patients after DAA treatment is reported. A higher rate of infiltrative pattern among HCC patients after DAA treatment is also recognized. Viral hepatitis is one of the major public health concerns in Egypt that needs more attention and funding from health policymakers.

Association between Severity of Liver Disease, Frequency of Helicobacter pylori Infection, and Degree of Gastric Lesion in Egyptian Patients with Hepatitis B Virus Infection

The relationship between hepatitis B virus (HBV) infection, severity of liver disease, frequency of Helicobacter pylori infection, and degree of gastric lesions was not yet fully investigated in Egyptian patients. The present work was performed on 100 Egyptian patients with HBV from the National Hepatology and Tropical Medicine Institute and 70 healthy volunteers as control group. The participants were subjected to full medical history taking, clinical examination, and laboratory investigations. All patients were positive for HBV surface antigen (HBV sAg), HBV DNA, and negative for hepatitis C virus antibodies. The severity of the liver disease was assessed using Child-Pugh scoring system. Screening of all participants for H. pylori Ag in stool was performed. Biopsy specimens were taken from the gastric lesions of H. pylori-infected patients for histopathological examination. The mean age of the patients and control group were 34.9 and 33.4 years, respectively. The levels of the liver enzymes were statistically higher in HBV patients than the control group. Helicobacter pylori Ag in stool was detected in 45.7% of the control group, and a higher percentage (60%) was detected in the patients group. Chronic gastritis with glandular atrophy and metaplasia was found in 15.6% of patients of Child-Pugh A, 70% of Child-Pugh B, and 100% of Child-Pugh C. It could be concluded that the prognosis of the liver disease significantly influences the severity of the gastric pathology in H. pylori infection.

A review of the infection-associated cancers in North African countries

Cancer is typically classified as a leading non-communicable disease; however, infectious agents, such as Helicobacter pylori (H. pylori), hepatitis B virus (HBV), hepatitis C virus (HCV) and human papilloma virus (HPV), contribute significantly to the pathogenesis of various cancers. Less developed countries, including countries of the North African (NA) region, endure the highest burden of infection-related cancers. The five most common infection-associated cancers in NA in order of incidence are bladder cancer, cervical cancer, liver cancer, stomach cancer, and nasopharyngeal carcinoma. This review aims to outline the epidemiologic pattern of infection-associated cancers in five NA countries (namely: Morocco, Algeria, Tunisia, Libya and Egypt) highlighting the similarities and differences across the region. The present study employed an initial literature review of peer-reviewed articles selected from PubMed, ScienceDirect and World Health Organization (WHO) databases based on key word searches without restriction on publication dates. Original research articles and reports written in French, as well as data from institutional reports and regional meeting abstracts were also included in this extensive review. Egypt, Libya, Tunisia, Algeria and Morocco were selected to be the focus of this review.

Occult hepatitis B virus infection among hepatitis C virus seropositive and seronegative blood donors in Alexandria, Egypt. J Egypt Public Health Assoc. 2013;88:8-13. [PMID: 23528526 DOI: 10.1097/01.epx.0000422774.29308.b3]

BACKGROUND AND AIMS

Occult hepatitis B virus infection (OBI, serum hepatitis B surface antigen negative but hepatitis B virus DNA positive) is an emerging problem in the safety of blood transfusion. The introduction of hepatitis B surface antigen in the screening panel for blood bank donors has substantially reduced, but not entirely eliminated, the risk of hepatitis B virus infection. It has been suggested that infection with hepatitis C virus may inhibit hepatitis B virus replication. Therefore, this study aimed at estimating the prevalence and risk factors for OBI among blood donors and determining its relationship with hepatitis C virus infection.

SUBJECTS AND METHODS

Presence of hepatitis B virus DNA and hepatitis C virus RNA was investigated for among 508 hepatitis B surface antigen-negative blood donors in Alexandria, Egypt. Half of the donors were identified as hepatitis C virus antibody reactive.

RESULTS

OBI was detected in 21 donors (4.1%) from the studied population: eight were among hepatitis C virus antibody positive donors (3.2%), among whom seven (33.3%) had hepatitis C virus RNA in their serum, and 13 (5.1%) were among hepatitis C virus antibody negative donors, with no statistically significant difference. The only significant risk factor for OBI among the studied blood donors was visiting local barbers.

CONCLUSION AND RECOMMENDATIONS

OBI is a considerable risk in blood banks, making screening for hepatitis B virus infection only on the basis of surface antigenemia insufficient.

Prevalence of mutations within major hydrophilic region of hepatitis B virus and their correlation with genotypes among chronically infected patients in Egypt

BACKGROUND AND STUDY AIMS

Mutations within the major hydrophilic region (MHR) of the hepatitis B surface antigen (HBsAg) have been reported in relation to viral persistence by evasion from vaccine and immunotherapy, severity of liver disease and lack of detection by commercial kits. The aim of this study was to elucidate the circulation of hepatitis B virus (HBV) genotypes, subgenotypes and serotypes in Egypt, with recognition of the pattern and prevalence of MHR mutations possibly occurring during the course of the disease.

PATIENTS AND METHODS

Eighty-eight samples from patients with chronic HBV infection were included in the study. The surface protein-encoding gene (S gene) in the HBV genome was subjected to amplification and partial sequencing.

RESULTS

Based on phylogenetic analysis, only genotype D was found circulating among patients. The majority of isolates belonged to subgenotype D3 (86.3%), followed by D7 (8%), then D5 (3.4%) and lastly D1 (2.3%). Two subtypes were identified: ayw2 (97%) and ayw3 (2%). The 'w' sub-determinant was not defined in one isolate (1%). A significant proportion of patients (13/88, 14.8%) exhibited mutations in the MHR, 10 of whom harboured mutations in the 'a' determinant region and three outside. The first loop comprised four patients with three mutations (P127S, P127T and Y134F). The second loop contained six patients, all with one mutation, S143L, which was most frequently encountered in this study (6.8%).

CONCLUSIONS

We conclude that genotype D, subgenotype D3 and HBsAg subtype ayw2 are the most common types circulating in Egypt, which account for 100%, 86.3% and 97% of the population, respectively, with a moderate degree of MHR mutations.

Hepatitis B surface gene variants isolated from blood donors with overt and occult HBV infection in north eastern Egypt

Background

Major hydrophilic region in genomic HBV extending from aa99 to aa169, clustered with a highly conformational epitope, is critical to the antigenicity of hepatitis B surface antigen (HBsAg) and may affect the diagnosis of HBV in HBV screening test. So, this study aimed to characterize variants of S gene product of hepatitis B virus (HBV) isolated from patients with overt or occult HBV infection in north-eastern Egypt.

Methods

The study included sera of two different groups of volunteer blood donors (VBDs), 82 with overt HBV that were positive for HBsAg and anti-HBc and 343 donors negative for HBsAg eligible for donation. Of the latter group, only 44 were positive for anti-HBc. All anti-HBc positive sera were subjected to HBV DNA detection and partial sequence analysis targeting the HBV S gene.

Results

HBV DNA was detected in 22.7 % of HBsAg-/anti-HBc + (10/44 patients) and in 90 % of HBsAg + donors (74/82 patients) with significant statistical difference (P = 0.0001). Phylogenetic analysis showed that HBV strains retrieved from both groups were of genotype D. Amino acid escape mutation T125M was detected in only 2 samples of the occult infection group and in none of the overt group (P = 0.01). Different amino acid substitutions were identified in overt infection group: S143L/T (16.2 %, 12/74) and P120T/S (2.7 %, 2/74). Q129R was significantly more frequent in cases with occult HBV infection (40 %, 4/10) than overt group (6.8 %, 5/74) (P = 0.01).

Conclusions

HBV genotype D predominated both in patients with overt and occult HBV infection. Different profiles of amino acid substitutions in the major hydrophilic region were seen in these two groups in Egypt.

Characteristics of hepatitis viruses among Egyptian children with acute hepatitis

Hepatitis viral infection is hyperendemic in Egypt, western Asia and Africa. However, little is known about the status of hepatitis viruses among rural Egyptian children. Therefore, this study sought to examine the prevalence and characteristics of hepatitis viruses among symptomatic Egyptian children. Serological and molecular analyses of hepatitis viral infection were conducted in 33 children hospitalised at Mansoura University with symptomatic hepatic dysfunction (mean ± standard deviation age, 9.7±3.4 years; alanine aminotransferase level, 130±68 IU/ml). Eleven children (33%) were positive for anti-haemagglutination-IgM and were diagnosed with acute hepatitis A. Hepatitis B surface antigen (HBsAg) and anti‑hepatitis C virus (HCV) were detected in 9 (27%) and 7 (21%) children, respectively, indicating acute-on-chronic infection with hepatitis viruses. None of the children was positive for anti‑hepatitis B core antigen-IgM. Phylogenetic analysis confirmed that all HBVs belonged to genotype D (subgenotype D1) and that HCV belonged to genotypes 4a and 1g. HBV-DNA was detected in 9 children (27%) in the pre-S/S region and in 16 children (48%) in the core promoter/precore region. The Y134F amino acid mutation in the 'α' determinant region was detected in all of the patients. The A1762T/G1764A double mutation, and the T1846A and G1896A single mutations were common in children with occult HBV infection. In conclusion, hepatitis viral infection, including acute-on-chronic infection with HCV and HBV, is common in Egyptian children hospitalised with acute hepatitis.

Seroprevalence of hepatitis C and B among blood donors in Egypt: Minya Governorate, 2000-2008

It is an interesting issue to study the prevalence of hepatitis C and B viruses in Egypt in the last decade. In this study, the overall hepatitis B surface antigen and antibody to hepatitis C virus prevalence were 1.65% and 9.02%, respectively. Antibody to hepatitis C virus and hepatitis B surface antigen prevalence estimates dropped from 11.06% to 6.3% (P = .001) and 1.24% to 1.17% (P = .2), respectively.

Viral hepatitis a to e in South mediterranean countries

Viral hepatitis represents an important health problem in the South Mediterranean countries, Egypt, Libya, Tunisia, Algeria and Morocco. Emerging natural history and epidemiological information reveal differences in the overall epidemiology, risk factors and modes of transmission of viral hepatitis A, B, C, D, E infections in the South Mediterranean region. The differences in the in incidence and prevalence of viral hepatitis across North African countries is attributed to variations in health care and sanitation standards, risk factors and immunization strategies. The active continuous population movement through travel, tourism and migration from and to the South Mediterranean countries contribute to the spread of infections due to hepatitis viruses across borders leading to outbreaks and emergence of new patterns of infection or introduction of uncommon genotypes in other countries, particularly in Europe.

Epidemiology of hepatitis B and C viruses: a global overview

This article reviews the prevalence, disease burden, genotype distribution, and transmission patterns of hepatitis B virus (HBV) and hepatitis C virus in the 6 World Health Organization regions. The global epidemiology of hepatitis B and C demonstrates a predominantly declining prevalence of the diseases. Improvement in the control of hepatitis B has been largely achieved with implementation of a more universal HBV vaccine program, although a large gap still remains in the effort toward global prevention of hepatitis B. The transmission of hepatitis C has been greatly impacted by mandatory screening of blood donors in most countries in the world, although intravenous drug use continues to be a major source of infection. Public education regarding the risks of exposure to infected paraphernalia as well as household items such as razors is necessary in the continuing effort to curb this disease.

Epidemiology of hepatitis viruses among hepatocellular carcinoma cases and healthy people in Egypt: a systematic review and meta-analysis

Liver cancers are strongly linked to hepatitis B virus (HBV) and hepatitis C virus (HCV). Egypt has the highest prevalence of HCV worldwide and has rising rates of hepatocellular carcinoma (HCC). Egypt's unique nature of liver disease presents questions regarding the distribution of HBV and HCV in the etiology of HCC. Accordingly, a systematic search of MEDLINE, ISI Web of Science, ScienceDirect and World Health Organisation databases was undertaken for relevant articles regarding HBV and HCV prevalence in Egypt among healthy populations and HCC cases. We calculated weighted mean prevalences for HBV and HCV among the populations of interest and examined differences in prevalence by descriptive features, including age, year and geographic region. Prevalences for HBV and HCV were 6.7% and 13.9% among healthy populations, and 25.9% and 78.5% among HCC cases. Adults had higher prevalences of both infections (Adult HBV=8.0%, Child HBV=1.6%; Adult HCV=15.7%, Child HCV=4.0%). Geographically, HBV was higher in the south, whereas HCV was greater in the north (North HBV=4.6%, South HBV=11.7%; North HCV=15.8%, South HCV=6.7%). Among HCC cases, HBV significantly decreased over time (p=0.001) while HCV did not, suggesting a shift in the relative influences of these viruses in HCC etiology in Egypt. Our results highlight large amounts of heterogeneity among the epidemiological factors associated with liver disease in Egypt and underscore the necessity of an integrated strategy for the successful prevention of viral hepatitis infections and chronic liver disease.

Evaluation of liver tissue by polymerase chain reaction for hepatitis B virus in patients with negative viremia

AIM: To assess the clinical significance of Hepatitis B virus (HBV) DNA localization in the liver tissue of patients with positive HBsAg and negative viremia.

METHODS: HBV virological parameters of 33 HBsAg positive chronic hepatitis patients, including seromarkers and HBV DNA amplification in both sera and liver biopsies, were evaluated.

RESULTS: Ten patients had negative viremia and positive HBV DNA in their liver biopsies. Most of them had HBeAg-negative/HBeAb-positive chronic hepatitis. Their liver biochemical and histopathological profiles were different from the viremic patients. Their disease pattern was designated as “hepatitis B in situ”.

CONCLUSION: Hepatitis B in situ is a consequential entity which can be missed in clinical practice. It is a new clinical pattern of chronic HBV infection that considers HBV in liver biopsy and adds a new indication for antiviral therapy.

Global epidemiology of hepatitis B virus

The burden of hepatitis B virus (HBV) disease and efforts to control infection will determine the future size of the population requiring treatment of HBV infection. To quantify the current prevalence of HBV infection and to reexamine the epidemiology of HBV infection, a structured review was conducted that focused on available primary literature for over 30 countries worldwide. The prevalence of chronic HBV infection continues to be highly variable, ranging over 10% in some Asian and Western Pacific countries to under 0.5% in the United States and northern European countries. The current global estimate of the number of HBV infected individuals is 350 million. Routes of transmission include vertical (mother to child or generation to generation through close contact and sanitary habits), early life horizontal transmission (through bites, lesions, and sanitary habits), and adult horizontal transmission (through sexual contact, intravenous drug use, and medical procedure exposure) and are evident to varying degrees in every country. Younger age at acquisition of infection continues to be the most important predictor of chronic carriage. However, the choice of serologic markers, temporal influences, and representativeness of the study population limit comparability of HBV seroprevalence results. HBV vaccination programs will decrease the future global burden of HBV infection and evidence of reduced burden is mounting in country-specific populations, but vaccination programs have still not been implemented in all countries, thereby maintaining reservoirs of infection and continued HBV transmission. Regardless of vaccination, large numbers of persons are infected with HBV or will become infected. Preventing the most severe HBV disease consequences in infected individuals, such as cirrhosis and hepatocellular carcinoma, will require appropriate therapeutic agents.

Prevalence and risk factors of HBsAg in Gaza: implications for prevention and control

The Epidemiology of hepatitis B virus (HBV) infection was not precisely known in Gaza. This study investigated the prevalence and risk factors of hepatitis B surface antigen (HBsAg) and simulated the incidence of HBV infection from reported cases of acute hepatitis due to HBV. Blood samples from 810 randomly selected individuals from the general population and from 17,060 blood donors were tested for HBsAg. The prevalence of HBsAg was found to be 3.5% in the general population and 3.8% in blood donors. The simulation model revealed the incidence of HBV infection decreased between 1990 and 1999 from 233 to 56 per 100,000 per annum. The decline started in 1994 and continued afterwards, presumably after the introduction of universal vaccination against HBV and screening blood donors for HBV. However, the authors discuss additional measures to control the transmission of HBV among non-vaccinated cohorts.

The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt

BACKGROUND

The population of Egypt has a heavy burden of liver disease, mostly due to chronic infection with hepatitis C virus (HCV). Overall prevalence of antibody to HCV in the general population is around 15-20%. The risk factor for HCV transmission that specifically sets Egypt apart from other countries is a personal history of parenteral antischistosomal therapy (PAT). A review of the Egyptian PAT mass-treatment campaigns, discontinued only in the 1980s, show a very high potential for transmission of blood-borne pathogens. We examine the relative importance of PAT in the spread of HCV in Egypt.

METHODS

The degree of exposure to PAT by cohort was estimated from 1961-86 Ministry of Health data. A cohort-specific exposure index for PAT was calculated and compared with cohort-specific HCV prevalence rates in four regions.

FINDINGS

HCV prevalence was calculated for 8499 Egyptians aged 10-50 years. A significant association between seroprevalence of antibodies to HCV and the exposure index (1.31 [95% CI 1.08-1.59]; p=0.007) was identified across four different regions. In all regions cohort-specific HCV prevalence was lowest in children and young adults than in older cohorts. These lower prevalence rates coincided with the gradual and final replacement of PAT with oral antischistosomal drugs at different points in time in the four regions.

INTERPRETATION

The data suggest that PAT had a major role in the spread of HCV throughout Egypt. This intensive transmission established a large reservoir of chronic HCV infection, responsible for the high prevalence of HCV infection and current high rates of transmission. Egypt's mass campaigns of PAT may represent the world's largest iatrogenic transmission of blood-borne pathogens.

Prevalence of hepatitis B surface antigen among pregnant women in a low-risk population

OBJECTIVES

To estimate the prevalence of chronic hepatitis B carriers among our low-risk obstetric population and to determine the need for routine screening.

METHODS

A group of 1224 pregnant women, admitted to Gazi University Medical Center, were screened for HBsAg using an enzyme-immunoassay technique, and the obstetrical care records were reviewed.

RESULTS

Fifty-three patients were seropositive with a prevalence of 4.33% for HBV chronic carrier status in our obstetric population.

CONCLUSIONS

Routine HBsAg screening is advisable in our antenatal population.

Familial clustering of hepatitis B virus infections and prevention of perinatal transmission by immunization with a reduced number of doses in an area of intermediate endemicity (Tunisia)

Hepatitis B surface antigen (HBsAg) was detected in 3.3% of 7162 pregnant Tunisian women tested and HBeAg in 9.6% of the HBsAg-positive mothers. Family members of 46 of these HBsAg-positive mothers (33 husbands and 61 children aged 1-6 years) were investigated for the presence of HBV markers. HBsAg was detected in 21% of the children and 18% of the husbands. Fifty children born to HBsAg-positive mothers received hepatitis B vaccine at birth, at the age of 2-3 months and at the age of 9 months. After immunization, anti-HBs were detected in 92% of them with an anti-HBs geometric mean titre of 415 mIU ml-1. Compared with the HBsAg carrier state in older siblings, the protective efficacy was estimated to be 60%. It was 100% for infants born to HBeAg-negative mothers, but only 31% for those born to HBeAg-positive mothers. For a better efficacy, the schedule of the EPI needs to be modified to include an immunization session at 1 month of age.

Acute sporadic non-A, non-B hepatitis in a pediatric population living in Cairo, Egypt

One-hundred and four cases of acute viral hepatitis and 100 controls 13 years of age and less were entered into a study of acute hepatitis in children in Cairo, Egypt. Study subjects, who were mainly from a lower socioeconomic level, were selected from a public pediatric clinic. Acute non-A, non-B hepatitis was diagnosed in 51 (49%) patients, hepatitis A in 46 (44%), possible hepatitis B in three (3%), and EBV hepatitis in four (4%) patients. Contact with a family member with jaundice was found to be significantly associated with hepatitis A. A history of a blood transfusion, a medical injection, and knowledge of an individual outside of the household with jaundice during the prior six months were significantly associated with non-A, non-B hepatitis. A significant association was not found between the type of hepatitis and the age and gender of study subjects and the extent of household crowding. In this pediatric population living in an urban area of a developing country, non-A, non-B hepatitis was found to be a major cause of acute sporadic hepatitis.

Occupational exposure to hepatitis B virus in hospital personnel in Cairo, Egypt

To identify hospital occupational categories at potential risk of hepatitis B virus infection, a serologic survey was conducted for hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) by enzyme-linked immunosorbent assay in 765 employees at 4 hospitals in Cairo, Egypt. Overall, 3% HBsAg and 28% anti-HBs seromarkers. Combined HBsAg and anti-HBs frequencies by occupational group were: nonprofessional staff (60%), dentists (32%), graduate nurses (33%), physicians (29%), and student nurses (26%). The main risk factors for hepatitis B infection were frequency of exposure to patients' blood (for physicians, p less than 0.001) and to patients with jaundice (for dentists, p less than 0.01), and years of exposure to patients, as reflected by duration of occupation (for physicians, p less than 0.001) and by age of health care worker. Seropositivity by sex was greater for males (p less than 0.01). Physician specialties with highest risk of infection (29 to 53%) were surgery, infectious diseases, obstetrics-gynecology, and emergency medicine.

The relationship between uncomplicated schistosomiasis and hepatitis B infection

Clinical and laboratory findings and hepatitis B virus (HBV) markers were compared in 105 patients with uncomplicated schistosomiasis mansoni, schistosomiasis haematobium, or both infections. 34 (32%) had HBs antigen (Ag); 51 (49%) had anti-HBs and/or anti-HBc; 20 (19%) had no markers for HBV. In comparison with the non-HBV-infected group, the group with HBsAg had more complaints of nausea and vomiting, and higher mean values for serum bilirubin and aspartate aminotransferase, and were less likely to complain of loose stools. In comparison with the non-HBV-infected group both groups having HBV markers were older, more likely to have received prior therapy (parenteral therapy in particular) for schistosomiasis, less likely to complain of blood in their stools, and more likely to have higher serum total proteins, albumin, globulin, and alanine aminotransferase. This study supports two mechanisms which could cause an association between HBV infection and schistosomiasis: (i) self-selection by patients with schistosomiasis seeking medical care for symptoms due to HBV infection and (ii) iatrogenic infection with HBV during parenteral treatment for schistosomiasis. It also suggests that much of the clinical morbidity ascribed to uncomplicated chronic schistosomiasis may be caused by a concomitant occult HBV infection.

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.

Maternal-infant transmission of hepatitis B in Egypt

In order to determine whether maternal-infant (vertical) transmission of hepatitis B is a common route of infection leading to chronic antigenemia in Egypt, 901 asymptomatic women in labor were evaluated. Forty-three women (4.8 percent) were positive for HBsAg, but only one woman was positive for HBeAg. From one year of observation of children born to 13 of the HBsAg-positive mothers, vertical transmission of hepatitis B was estimated to have occurred in approximately 1.7% of births, with chronic antigenemia resulting from 0.6% of births. It was also possible to observe 29 children born to women negative for HBsAg. Horizontal transmission of hepatitis B occurred in 17.2 percent of these children during the first year of life. Maternal-infant transmission of hepatitis B at birth does not appear to be the predominant mechanism of hepatitis B transmission or a common cause of chronic antigenemia in Egypt. The first year after birth appears to be a more important period of hepatitis B transmission. Therefore, vaccination of all children at birth with hepatitis B vaccine could be an effective vaccine strategy despite a low incidence of vertical hepatitis B transmission.

Ethiopian National Hepatitis B Study

A nationwide seroepidemiological study of hepatitis B markers prevalence was conducted in Ethiopia on 5,270 young males from all regions of the country. Overall prevalence rates were 10.8% for HBsAg and 73.3% for "at least one marker positive"; a remarkable geographical and ethnic variability of marker prevalence was observed, reflecting the wide differences existing in Ethiopia in sociocultural environment and activities such as tribal practices and traditional surgery. Sexual practices and medical exposure also play some role as determinants of hepatitis B marker prevalence in Ethiopia. General preventive measures, with particular reference to health education, by affecting incriminating habits and practices could have some impact on infection rates in Ethiopia, in the absence of a vaccination strategy presently unrealistic in this region of the world.