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Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA.

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Presentation on theme: "Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA."— Presentation transcript:

1 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Viral Hepatitis. Epidemiology & Research in ARGENTINA. South America. Jorge Enrique González

2 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Lab Surveillance System Sentinel TBC Vaccines HUS Hepatitis STD Diarrheas Pneumonies Febrile Illness Nosocomial Infections Specific Networks Provinces Networks Modular System (since 2001) Programs Medical consultations Meningoencephalitis Immunizables Laboratories Cards Early Alert + Sentinel Units Injuries Specialized National Health Surveillance System

3 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 SENTINEL UNITS (SU) for VIRAL HEPATITIS for VIRAL HEPATITIS & population density & population density (24 SU in 17 Provinces) 1 dot = 100 inhab / km2 *Common working protocol -Guidelines consensus -Guidelines consensus -Web resident specific software -Web resident specific software *External Quality Control for Serology -Biannual Panel for HBV & HCV -Biannual Panel for HBV & HCV *Fluent communication - Monthly newsletter (electronic) - Monthly newsletter (electronic) - Annual meetings (n:17)(since 1992) - Annual meetings (n:17)(since 1992) Posters at this meeting #P-003#P-004 Saturday 03/ hrs hrs

4 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Access to Sanitation (% of population) 2001 (% of population) 2001 Access to Tap water (% of population) 2001 (% of population) 2001 Sewage 42.5 % Area: sq km Safe water 77 % Population : (mostly urban) Birth cohort (2008) : Urban population : 89.4 %

5 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 GEOGRAPHICAL DISTRIBUTION OF HEPATITIS A VIRUS INFECTION

6 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 HAV infection in Argentina

7 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Hepatitis A surveillance

8 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Cobertura país: 93,5% Cobertura de Vacunación anti Hepatitis A en niños de 1 año de edad, según provincias. Argentina 2007 Source : National Health Surveillance System Vaccination coverage against HAV in one-year-old children. Argentina 2007 provinces % coverage Country coverage 93.5% Poster at this meeting #P-002 Saturday 03/ hrs

9 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Fields Virology 2001 ; Rev Med Virol 2003 Hepatitis E

10 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Identification of 2 Novel Isolates of Hepatitis E Virus in Argentina Schlauder GG, Frider B, Sookoian S, Castaño G & Mushawar I. Virus Discovery Group Abbott Laboratories, Chicago. USA Unidad de Hígado. Hospital Argerich. Buenos Aires Argentina. Ar 1 Male, 80 years Ar 2 Male, 65 years JID 2000;182:294-7

11 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 HEV Phylogenetic relation between swine & human Argentinian strains Identification of the first strain of Swine Hepatitis E virus in South America and prevalence of anti-HEV antibodies in swine in Argentina. Munné et al Journal of Medical Virology; 78:

12 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Liver International ALEH 2004; 24:Supp4 0.1 US1 swUS1 B1 M1 Ct1 Cs15 Ch3 Ar2 Ar1 EFHFArg1 swArg, EFHArg3 EFHFArg Phylogenetic tree ORF 2 Region Phylogenetic tree ORF 2 Region 1. FHF (Quilmes Pcia Bs As) 2. FHF (S Martín Pcia Bs As) 3. FHF (Pcia Corrientes) Swine strain (Pergamino Pcia Bs As) Munné et al Acta Gastroenterológica Latinoamericana ; 36: HEV & pediatrics FHF 3 HEV RNA +ve in 35 FHF ( ) Serum & feces samples

13 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Laboratory Diagnosis of Hepatitis E Direct Markers Ag : in development Direct Markers Ag : in development RNA : -very unstable RNA : -very unstable -short viremia -short viremia Indirect Markers Ab : -low titer Indirect Markers Ab : -low titer -low specificity -low specificity *Diagnostic tests not required *Late sampling *Diagnostic tests not required *Late sampling *Difficult accesibility of commercial tests *High costs for the tests. *Difficult accesibility of commercial tests *High costs for the tests. Sub diagnosis !!! *samplingmprovement *sampling improvement *better handling of serum and stools and stools *Local strains as capture Ag ?? Problems Solutions ??? Poster at this meeting P-158 Saturday 03/ hrs

14 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 GEOGRAPHIC DISTRIBUTION OF CHRONIC HBV INFECTION

15 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Source : National Health Surveillance System Rates of hepatitis B notification and trend. Argentina year Rates /

16 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March REGIONS Total Controlled donors ControlledHBsAg % +ve Total Controlled donors Controlled HBsAg % +ve CENTER West CENTER North EAST North WEST SOUTH TOTAL HBsAg prevalence in Blood donors. Source : Provinces communications to CNRL ANLIS Dr C G Malbran

17 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March REGIONS Total Controlled donorsControlledantiHBc % +ve Total Controlled donorsControlledantiHBc % +ve CENTER West CENTER North EAST North WEST SOUTH TOTALS antiHBc prevalence in Blood donors. Source : Provinces communications to CNRL ANLIS Dr C G Malbran

18 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 HEPATITIS B at the SUs

19 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 Source : National Health Surveillance System Country coverage 83.7% Cobertura de Vacunación antihepatitis Bantes de las 12 horas de recién nacidos Argentina 2007 Vaccination coverage against HBV in newborns. Argentina 2007 Argentina 2007

20 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 HBV genotypes Poster at this meeting #P-038 Saturday 03/ hrs Strong association between genotype F and … Franca P, et al. J Clin Microbiol Nov;42(11)

21 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 (World J Gastro 2007) HEPATITIS C

22 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March Source : National Health Surveillance System Rates of hepatitis C notification and trend. Argentina 1998 – 2008 year Rates /

23 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 REGIONS Total Controlled donors antiHCV Controlled % +ve Total Controlled donors antiHCV Controlled % +ve CENTER WEST Center North EAST North WEST SOUTH TOTALS antiHCV prevalence in Blood donors. Source : communications from the Provinces to the CNRL ANLIS Dr C G Malbran

24 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 SOURCEnPrevalence *General population spontaneous-demand studies : Buenos Aires city (FAPHLE) (1996) ( 1 ) Buenos Aires city (FAPHLE) (1996) ( 1 ) % Rosario city (Sta Fe Prov)(CTSP) ( ) ( 2 ) Rosario city (Sta Fe Prov)(CTSP) ( ) ( 2 ) % Buenos Aires city (1996) ( 3 ) Buenos Aires city (1996) ( 3 )6665.6% Salta city (Salta Prov) (2000) ( 4 ) Salta city (Salta Prov) (2000) ( 4 )7223.3% *General population studies : Derqui city, (Bs As Prov) (2003) (5) Derqui city, (Bs As Prov) (2003) (5) % *General population with high endemicity studies : O´Brien city (Bs As Prov) (1999) (6) O´Brien city (Bs As Prov) (1999) (6) (79% total population) 5.6% Wheelright city (Sta Fe Prov) (2004) (7) Wheelright city (Sta Fe Prov) (2004) (7) (31 % total pop) (31 % total pop)4.9% 1.-Htal de Clínicas, Htal Ramos Mejía; Htal J. Méndez (Bs.As.) 2.- Sur de Santa Fe y E. Rios (Gualeguay) 3.- H. Argerich, H.Muñiz, H.Udaondo, y LNR-INEI-ANLIS C.G.Malbrán (Bs As) 4.-Htal del Milagro (Salta), Htal Muñiz, y LNR-INEI- ANLIS C.G.Malbrán (Bs As) (Referenciados en el Consenso Argentino Hepatitis C – AAEEH (2004) 5.- O¨Flaherty et al. XIII Congreso Arg de Hepatología (2005) 6.-Soria et al, XI Congreso Arg de Hepatología (2001) ( Referenciado en el Consenso Arg Hepatitis C. AAEEH (2004) 7.-Bessone et al, XIII Congreso Arg de Hepatología (2005) 3.- H. Argerich, H.Muñiz, H.Udaondo, y LNR-INEI-ANLIS C.G.Malbrán (Bs As) 4.-Htal del Milagro (Salta), Htal Muñiz, y LNR-INEI- ANLIS C.G.Malbrán (Bs As) (Referenciados en el Consenso Argentino Hepatitis C – AAEEH (2004) 5.- O¨Flaherty et al. XIII Congreso Arg de Hepatología (2005) 6.-Soria et al, XI Congreso Arg de Hepatología (2001) ( Referenciado en el Consenso Arg Hepatitis C. AAEEH (2004) 7.-Bessone et al, XIII Congreso Arg de Hepatología (2005) HCV Prevalence studies

25 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 HEPATITIS C at the SUs

26 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009

27 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 HCC in Argentina. Etiology of chronic liver disease in 551 cases with diagnosis of HCC. Etiology n Percentage Alcohol HCV HBV Cryptogenic HCV + alcohol Hemochromatosis HBV + alcohol PBC HCV + HBV AIH HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HBV, hepatitis B virus; PBC, primary biliary cirrhosis; AIH, autoimmune hepatitis. PBC, primary biliary cirrhosis; AIH, autoimmune hepatitis. Fassio et al Acta G. Lat 2009 in press *Retrospective survey 2005 – 2008 From 15 Centers located at 5 provinces Median age : 62 years old 93% underlying cirrhosis

28 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 LIVER TRANSPLANTATION IN ARGENTINA < 18 years old >= 18 years old Since 2006 all people are potential donors by federal law (Access: March 2009) *Evaluation of 3 causes among 20 recorded at Dn rate* Tx rate* * per M inhab * per M inhab

29 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 SERVICIO HEPATITIS Y GASTROENTERITIS DEPARTAMENTO VIROLOGIA LABORATORIO NACIONAL DE REFERENCIA INSTITUTO NACIONAL DE ENFERMEDADES INFECCIOSAS (INEI) ADMINISTRACION NACIONAL DE LABORATORIOS E INSTITUTOS DE SALUD (ANLIS) Dr. Carlos Gregorio Malbrán

30 Servicio Hepatitis y Gastroenteritis Laboratorio Nacional de Referencia INEI-ANLIS Dr. C. G. MALBRAN Sunrise Symposium at 13 th ISVHLD Washington USA. March 2009 … ARGENTINA, offers much more than viral hepatitis … !!


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