Zakaria Soheir, Fouad Rabab, Shaker Olfat, Zaki Sami, Hashem Ahmed, El-Kamary Samer S, Esmat Gamal, Zakaria Serag
Department of Tropical Medicine, Cairo University, Al-Azhar University, Cairo, Egypt.
Clin Infect Dis. 2007 Feb 15;44(4):e30-6. doi: 10.1086/511074. Epub 2007 Jan 17.
Changes in the viral etiology of hospitalized patients can inform us of changes in the overall epidemiology of acute viral hepatitis infections. We hypothesized that improvements in health care and sanitation in the past 2 decades in Egypt have significantly impacted the viral causes of acute viral hepatitis in hospitalized patients. We compared the viral causes of acute viral hepatitis at a major urban referral center with results reported from the same center 20 years earlier.
Over a period of 10 months, 200 consecutive inpatients with clinical acute viral hepatitis were enrolled in the study, and serum samples were tested for hepatitis A through E, cytomegalovirus, and Epstein-Barr virus.
The frequency of acute hepatitis B virus infection as a cause of symptomatic hepatitis decreased from 43.4% in 1983 to 28.5% in 2002 (P<.01), and acute hepatitis A virus infection increased from 2.1% in 1983 to 34% in 2002 (P<.01), and occurred at older ages. In 1983, non-A, non-B hepatitis virus infection caused acute viral hepatitis in 38.7% of cases, compared with 31% in the present study (P=.12). The mean alanine aminotransferase level was highest in patients with combined infections, and clinical presentation did not distinguish between different viral etiologies of hepatitis.
A significant decrease in hepatitis B virus infection and an increase in hepatitis A virus infection have occurred since the earlier study was performed in 1983. The decrease in hepatitis B virus infection is attributable to the steep decrease in hepatitis B virus infection among children that resulted from the universal hepatitis B virus immunization of infants that was initiated in 1991. The increase in clinical hepatitis A virus infection occurred in older patients and could be attributed to improved sanitation that delayed individuals' initial exposures to the virus.
住院患者病毒病因的变化能够让我们了解急性病毒性肝炎感染总体流行病学的变化情况。我们推测，过去20年埃及医疗保健和卫生条件的改善对住院患者急性病毒性肝炎的病毒病因产生了重大影响。我们将一家主要城市转诊中心急性病毒性肝炎的病毒病因与20年前该中心报告的结果进行了比较。
在10个月的时间里，连续纳入200例临床诊断为急性病毒性肝炎的住院患者，对其血清样本进行甲型至戊型肝炎病毒、巨细胞病毒和EB病毒检测。
作为有症状肝炎病因的急性乙型肝炎病毒感染频率从1983年的43.4%降至2002年的28.5%（P<0.01），急性甲型肝炎病毒感染从1983年的2.1%增至2002年的34%（P<0.01），且发病年龄更大。1983年，非甲非乙型肝炎病毒感染导致38.7%的病例发生急性病毒性肝炎，而本研究中这一比例为31%（P=0.12）。合并感染患者的平均丙氨酸转氨酶水平最高，且临床表现无法区分不同病毒病因的肝炎。
自1983年进行早期研究以来，乙型肝炎病毒感染显著减少，甲型肝炎病毒感染增加。乙型肝炎病毒感染的减少归因于1991年开始对婴儿普遍接种乙型肝炎病毒疫苗后儿童中乙型肝炎病毒感染的急剧下降。临床甲型肝炎病毒感染的增加发生在老年患者中，可能归因于卫生条件改善，使个体初次接触该病毒的时间推迟。
