Hussain Zahid, Das Bhudev C, Husain Syed A, Murthy Nandagudi S, Kar Premashis
PCR Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, New Delhi, India.
J Gastroenterol Hepatol. 2006 Apr;21(4):689-93. doi: 10.1111/j.1440-1746.2006.04232.x.
Hepatitis A (HAV) is endemic in India and most of the population is infected asymptomatically in early childhood with lifelong immunity. Because of altered epidemiology and decreasing endemicity, the pattern of acute HAV infection is changing from asymptomatic childhood infection to an increased incidence of symptomatic disease in the 18-40 age group. The aims of the present study were to assess whether the proportion of adults with acute HAV infection has been increasing over the years and to analyze the seroprevalence of immunoglobulin G (IgG) anti-HAV antibodies in young adults above the age of 15 years as well as in cases of chronic liver disease.
Sera collected from 3495 patients with acute (1932) and chronic (1563) liver disease attending the Medical Outpatient Department of Lok Nayak Hospital during the previous five years (1999-2003) were tested for various serological markers of acute (HBsAg, HBcIgM, anti-HCV, HEV-IgM, and HAV-IgM) and chronic (HBsAg, HBcIgG, HBeAg, and anti-HCV) hepatitis. In addition, 500 normal healthy attendants of the patients above the age of 15 years were tested for IgG anti-HAV as controls.
Of 1932 patients with acute viral hepatitis, 221 (11.4%) were positive for immunoglobulin M (IgM) anti-HAV. The patients who were IgM anti-HAV negative included hepatitis B (321 patients), C (39 patients), E (507 patients) and unclassified (844 patients). Although the frequency of HAV infection among children had increased (10.6% to 22.0%) in the 5-year period, the frequency of HAV infection among adults had also increased (3.4% to 12.3%) during the same period. A total of 300 patients with chronic liver diseases that were etiologically related to hepatitis B (169), C (73) or dual infection (10) and alcoholic liver injury (48) were tested for the presence of IgG anti-HAV antibody; 98% (294/300) were positive for the antibody.
Although universal vaccination against HAV is not currently indicated, selective vaccination of the high-risk population, based on their serological evidence of HAV antibody, would be a rational and cost-effective approach.
甲型肝炎（HAV）在印度呈地方性流行，大多数人群在幼儿期无症状感染，并获得终身免疫。由于流行病学的改变和地方性流行程度的降低，急性甲型肝炎感染模式正从无症状的儿童期感染转变为18 - 40岁年龄组中症状性疾病发病率的增加。本研究的目的是评估多年来急性甲型肝炎感染的成年人比例是否一直在增加，并分析15岁以上年轻人以及慢性肝病患者中抗甲型肝炎病毒免疫球蛋白G（IgG）抗体的血清流行率。
收集了过去五年（1999 - 2003年）在洛克·纳亚克医院门诊部就诊的3495例急性（1932例）和慢性（1563例）肝病患者的血清，检测急性肝炎（乙肝表面抗原、乙肝核心IgM、抗丙型肝炎病毒、戊型肝炎病毒IgM和甲型肝炎病毒IgM）和慢性肝炎（乙肝表面抗原、乙肝核心IgG、乙肝e抗原和抗丙型肝炎病毒）的各种血清学标志物。此外，对500名15岁以上患者的正常健康陪同人员检测抗甲型肝炎病毒IgG作为对照。
在1932例急性病毒性肝炎患者中，221例（11.4%）抗甲型肝炎病毒IgM呈阳性。抗甲型肝炎病毒IgM阴性的患者包括乙型肝炎（321例）、丙型肝炎（39例）、戊型肝炎（507例）和未分类（844例）。尽管在这5年期间儿童甲型肝炎感染率有所增加（从10.6%增至22.0%），但同期成年人甲型肝炎感染率也有所增加（从3.4%增至12.3%）。对总共300例病因与乙型肝炎（169例）、丙型肝炎（73例）或双重感染（10例）以及酒精性肝损伤（48例）相关的慢性肝病患者检测抗甲型肝炎病毒IgG抗体的存在情况；98%（294/300）抗体呈阳性。
虽然目前尚无必要对甲型肝炎进行普遍接种，但根据甲型肝炎抗体的血清学证据对高危人群进行选择性接种将是一种合理且具有成本效益的方法。
