Mathur P, Arora N K, Panda S K, Kapoor S K, Jailkhani B L, Irshad M
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Community Medicine and Laboratory Medicine, All India Institute of Medical Sciences, New Delhi - 110 029, India.
Indian Pediatr. 2001 May;38(5):461-75.
To estimate the prevalence of anti-HEV IgG and IgM antibodies to ORF3 peptide of Hepatitis E virus genome in an age stratified urban and rural population of children.
Cross sectional survey.
Pediatric out-patient clinics in a tertiary hospital and a rural dispensary.
Study subjects between 6 months and 10 years with minor, non-hepatic illnesses were recruited for the study from March to December 1996. Baseline demographic details, drinking water source, sewage disposal methods, reasons for attending the hospital, histories of parenteral exposure in the past 12 months and acute hepatitis in the subjects and the family in the previous six months were obtained. Serum anti-HEV IgG antibodies were screened in all subjects, and in those who were positive, anti-HEV IgM antibodies were assayed as an indicator of recent infection. Serum aminotransferase (ALT) was estimated in those who were anti-HEV IgM antibody positive.
Out of 2160 subjects recruited, 2070 samples could be screened for anti-HEV IgG antibodies. In the urban population (n = 1065) anti-HEV IgG antibodies were detected in 306 subjects (28.7%; 95% CI 26.0-31.6) and of these 131 (42.8%; 95%CI 37.2-48.6) were anti-HEV IgM antibody positive. Amongst 1005 rural children, anti-HEV IgG antibodies were present in 239 (23.8%; 95% CI 21.1-26.4) and IgM antibodies in 113 (47.3%; 95% CI 40.9-53.7) children. The antibodies were present since the first year of age till 10 years of age and, increased with advancing age. Serum transaminases were raised in 7.5% (9/120) and 5.5% (5/88) of subjects with anti-HEV IgM antibodies in urban and rural centers respectively. Overall the seroprevalence of IgG antibodies against HEV were significantly more in urban as compared to that in rural subjects (p = 0.011). However, proportion of children with anti-HEV IgG carrying IgM antibodies was similar in the two study groups (p = 0.298). A model for estimating expected prevalence of anti-HEV IgG antibodies was developed. The observed antibody prevalence in both urban and rural subjects at each age interval after 48 months was less as compared to the expected levels and this gap increased with advancing age categories. It appeared that there was a decay of HEV antibodies with time.
Children are susceptible to HEV infection since early infancy. The probability of exposure to HEV during childhood was higher in urban than rural population. Seropositivity to HEV antibodies increased by over 2 times beyond 4 years of age as compared to younger age. Anti-HEV IgG antibodies appear to wean off with increasing age.
评估戊型肝炎病毒基因组ORF3肽的抗HEV IgG和IgM抗体在不同年龄分层的城乡儿童人群中的流行率。
横断面调查。
一家三级医院的儿科门诊和一个农村诊所。
1996年3月至12月，招募6个月至10岁患有轻微非肝脏疾病的研究对象。获取基线人口统计学细节、饮用水源、污水处理方法、就医原因、过去12个月的非肠道暴露史以及研究对象及其家庭在过去六个月内的急性肝炎病史。对所有研究对象进行血清抗HEV IgG抗体筛查，对阳性者检测抗HEV IgM抗体作为近期感染指标。对抗HEV IgM抗体阳性者检测血清转氨酶（ALT）。
在招募的2160名研究对象中，2070份样本可进行抗HEV IgG抗体筛查。在城市人群（n = 1065）中，306名研究对象（28.7%；95%可信区间26.0 - 31.6）检测到抗HEV IgG抗体，其中131名（42.8%；95%可信区间37.2 - 48.6）抗HEV IgM抗体阳性。在1005名农村儿童中，239名（23.8%；95%可信区间21.1 - 26.4）存在抗HEV IgG抗体，113名（47.3%；95%可信区间40.9 - 53.7）存在IgM抗体。这些抗体从1岁到10岁均有存在，并随年龄增长而增加。城市和农村中心抗HEV IgM抗体阳性的研究对象中，血清转氨酶升高的分别占7.5%（9/120）和5.5%（5/88）。总体而言，城市抗HEV IgG抗体的血清流行率显著高于农村研究对象（p = 0.011）。然而，两个研究组中携带抗HEV IgM抗体的抗HEV IgG儿童比例相似（p = 0.298）。建立了一个估计抗HEV IgG抗体预期流行率的模型。48个月后各年龄区间城市和农村研究对象中观察到的抗体流行率均低于预期水平，且这种差距随年龄组增加而增大。似乎HEV抗体随时间衰减。
儿童自婴儿早期就易感染戊型肝炎病毒。儿童期接触戊型肝炎病毒的概率城市高于农村人群。与年幼者相比，4岁以后抗HEV抗体血清阳性率增加超过2倍。抗HEV IgG抗体似乎随年龄增长而减弱。
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