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Epidemiology & Research

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Presentation on theme: "Epidemiology & Research"— Presentation transcript:

1 Epidemiology & Research
Viral Hepatitis. Epidemiology & Research in ARGENTINA. South America. Jorge Enrique González

2 National Health Surveillance System
Modular System (since 2001) TBC Meningoencephalitis Immunizables Vaccines Medical consultations + Cards Programs Early Alert Specialized National Health Surveillance System Sentinel Laboratories Sentinel Units Lab Surveillance System Hepatitis STD Specific Networks Provinces Networks Diarrheas HUS Febrile Illness Pneumonies Nosocomial Infections Injuries

3 Posters at this meeting
SENTINEL UNITS (SU) for VIRAL HEPATITIS & population density (24 SU in 17 Provinces) 1 dot = 100 inhab / km2 *Common working protocol -Guidelines consensus -Web resident specific software *External Quality Control for Serology -Biannual Panel for HBV & HCV *Fluent communication - Monthly newsletter (electronic) - Annual meetings (n:17)(since 1992) Posters at this meeting #P-003 #P-004 Saturday 03/21 12-15 hrs

4 Sewage 42.5 % Area: 2 736 690 sq km Safe water 77 %
Access to Sanitation (% of population) 2001 Access to Tap water (% of population) 2001 Sewage 42.5 % Area: sq km Safe water 77 % Population : (mostly urban) Birth cohort (2008) : Urban population : 89.4 %

5 GEOGRAPHICAL DISTRIBUTION OF HEPATITIS A VIRUS INFECTION
HAV infection prevalence is high or intermediate in the areas noted in red, blue, and green. Hepatitis A vaccine is recommended for persons who travel or work in these areas. Yellow indicates the areas where HAV infection prevalence is low (including the United States). HAV infection prevalence is very low in the areas shown in tan. Note: This slide has been generalized from available data.

6 HAV infection in Argentina

7 Hepatitis A surveillance

8 Vaccination coverage against HAV in one-year-old children
Vaccination coverage against HAV in one-year-old children. Argentina 2007 Cobertura de Vacunación anti Hepatitis A en niños de 1 año de edad, según provincias. Argentina 2007 Country coverage 93.5% Cobertura país: 93,5% provinces % coverage Source : National Health Surveillance System Poster at this meeting #P-002 Saturday 03/21 12-15 hrs

9 Hepatitis E Fields Virology 2001 ; Rev Med Virol 2003

10 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 Phylogenetic relation between swine & human Argentinian strains
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 HEV & pediatrics FHF EFHFArg1 swArg, EFHArg3 EFHFArg2 Ar1 Ar2 US1 Ch3
3 HEV RNA +ve in 35 FHF ( ) Serum & feces samples 0.1 US1 swUS1 B1 M1 Ct1 Cs15 Ch3 Ar2 Ar1 EFHFArg1 swArg, EFHArg3 EFHFArg2 91 77 73 83 84 99 97 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) Liver International ALEH 2004; 24:Supp4 Munné et al. 2006 Acta Gastroenterológica Latinoamericana ; 36:

13 Sub diagnosis !!! Laboratory Diagnosis of Hepatitis E Problems
Solutions ??? Direct Markers Ag : in development RNA : -very unstable -short viremia *sampling improvement  *better handling of serum and stools *Local strains as capture Ag ?? Indirect Markers Ab : -low titer -low specificity *Diagnostic tests not required *Late sampling *Difficult accesibility of commercial tests *High costs for the tests. Poster at this meeting P-158 Saturday 03/21 12-15 hrs Sub diagnosis !!!

14 GEOGRAPHIC DISTRIBUTION OF CHRONIC HBV INFECTION

15 Rates of hepatitis B notification and trend.
Argentina 3.5 2.5 Rates / 0000 1.5 0.5 year Source : National Health Surveillance System

16 Total Controlled donors
HBsAg prevalence in Blood donors. 2006 2007 REGIONS Total Controlled donors Controlled HBsAg % +ve Controlled HBsAg % +ve CENTER 0.31 0.23 West CENTER 31 033 30 733 0.27 25 690 North EAST 38 401 37 692 0.40 37 272 36 634 0.46 North WEST 39 691 39 449 1.17 39 762 38 350 1.18 SOUTH 25 168 24 670 0.32 25 471 24 955 0.21 TOTAL 0.42 Source : Provinces communications to CNRL ANLIS “Dr C G Malbran”

17 antiHBc prevalence in Blood donors. 2006 2007
REGIONS Total Controlled donors Controlled antiHBc % +ve CENTER 1.67 1.86 West CENTER 31 033 30 492 1.75 25 690 1.92 North EAST 38 401 21 954 5.50 37 272 24 026 4.99 North WEST 39 691 38 613 7.39 39 762 38 127 6.65 SOUTH 25 168 23 889 1.37 25 471 24 512 1.53 TOTALS 3.39 2.52 Source : Provinces communications to CNRL ANLIS “Dr C G Malbran”

18 HEPATITIS B at the SUs

19 Vaccination coverage against HBV in newborns.
Argentina 2007 Cobertura de Vacunación antihepatitis Bantes de las 12 horas de recién nacidos Argentina 2007 Country coverage 83.7% Source : National Health Surveillance System

20 HBV genotypes Strong association between genotype F and …
Franca P, et al. J Clin Microbiol Nov;42(11) Poster at this meeting #P-038 Saturday 03/21 12-15 hrs

21 HEPATITIS C (World J Gastro 2007)

22 Rates of hepatitis C notification and trend.
Argentina 1998 – 2008 2.5 1.5 Rates / 0000 0.5 0.5 0.5 year Source : National Health Surveillance System

23 Total Controlled donors
antiHCV prevalence in Blood donors. REGIONS 2006 2007 Total Controlled donors antiHCV Controlled % +ve CENTER 0.66 0.75 WEST Center 31 033 30 733 25 690 0.60 North EAST 38 401 37 346 37 272 36 663 0.80 North WEST 39 691 39 391 1.16 39 762 38 312 1.00 SOUTH 25 168 24 659 0.52 25 471 24 685 0.53 TOTALS 0.70 Source : communications from the Provinces to the CNRL ANLIS “Dr C G Malbran”

24 HCV Prevalence studies
SOURCE n Prevalence *General population spontaneous-demand studies : Buenos Aires city (FAPHLE) (1996) (1) 7 107 2.8% Rosario city (Sta Fe Prov)(CTSP) ( ) (2) 5 460 3.4% Buenos Aires city (1996) (3) 666 5.6% Salta city (Salta Prov) (2000) (4) 722 3.3% *General population studies : Derqui city, (Bs As Prov) (2003) (5) 1 472 0.87% *General population with high endemicity studies : O´Brien city (Bs As Prov) (1999)(6) 1 817 (79% total population) Wheelright city (Sta Fe Prov) (2004) (7) 1 814 (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)

25 HEPATITIS C at the SUs

26

27 93% underlying cirrhosis
HCC in Argentina. *Retrospective survey – 2008 From 15 Centers located at 5 provinces 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. Fassio et al Acta G. Lat 2009 in press Median age : 62 years old 93% underlying cirrhosis

28 LIVER TRANSPLANTATION IN ARGENTINA 1998-2008.
*Evaluation of 3 causes among 20 recorded at (Access: March 2009) < 18 years old >= 18 years old Dn rate* Tx rate* * per M inhab Since 2006 all people are potential donors by federal law

29 LABORATORIO NACIONAL DE REFERENCIA “Dr. Carlos Gregorio Malbrán”
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 … ARGENTINA, offers much more than viral hepatitis … !!


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