疑似急性肝炎患者中甲型肝炎病毒的综合分子和血清学调查：一项巴西研究。
A Comprehensive Molecular and Serological Investigation of Hepatitis A Virus Among Patients With Suspected Acute Hepatitis: A Brazilian Study.
作者信息
de Oliveira Ketty Gleyzer, Vasconcelos Mariana Pinheiro Alves, Ton Julia Teixeira, Uehara Silvia Naomi de Oliveira, Sitnik Roberta, Ornelas Pereira Salvador de Oliveira Denize, Castberg Layze, Siqueira Ricardo Andreotti, Robinson Peter James, Domingues Thaís Senna de Paula, Panico Caroline Thomas, Inoue César Augusto, Maluf Maira Marranghello, de Mello Malta Fernanda, Amgarten Deyvid, Dorlass Erick, Sebe Pedro, Pinto Arlene S, Lobato Cirley M D O, Ferreira Adalgisa, Hyppolito Elodie, Paraná Raymundo, Schinoni Maria Isabel, Lopes Edmundo Pessoa de Almeida, Luiz Magali C, Garcia Raquel F L, Bertolini Dennis Armando, Álvares-da-Silva Mário Reis, Arrojo Raul Salinas, Emerim Eduardo, Coral Gabriela P, Acosta Paulo R, Lucena Marcello, Teixeira Rosângela, Guedes Mônica da Costa, Villar Livia Melo, Ximenez Lia Lewis, Gdalevici Clarice, Mendes-Correa Maria Cássia Jacintho, Carrilho Flair José, de Oliveira Gerson Sobrinho Salvador, Ferreira Paulo Roberto A, Ferraz Maria Lucia Gomes, Nastri Ana Catharina de Seixas Santos, Munoz Torres Pablo Andres, Selegatto Glória, Casadio Luciana Vilas Boas, Tenore Simone, Leite Olavo Henrique Munhoz, Souza Fernanda Fernandes, Reuter Tania, Souto Francisco, Nascimento-Sales Michele, Gurski Ana Paula Maciel, Salomão Andréa, Fanis Bruna Emanuelle Alvarenga, Pimenta Maria Cristina, de Almeida Elton Carlos, de Souza Flávia Moreno Alves, Pereira Gerson Fernando Mendes, Gonzalez Mario Peribañez, Gomes-Gouvea Michele Soares, de Azevedo Raymundo Soares, Pinho João Renato Rebello
机构信息
Laboratório de Patologia Clínica e de Anatomia Patológica, Hospital Israelita Albert Einstein, São Paulo, Brazil.
LIM07, Instituto de Medicina Tropical, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
出版信息
J Med Virol. 2025 Jun;97(6):e70449. doi: 10.1002/jmv.70449.
Hepatitis A Virus (HAV) infects millions of individuals annually and is a major cause of acute viral hepatitis worldwide. This study aims to (1) assess HAV infection in suspected acute hepatitis patients at public healthcare institutions in Brazil; (2) evaluate the proportion of immunized individuals against HAV; (3) identify HAV genotypes; (4) examine the association between HAV infection and demographic data, as well as exposure to risk factors. This is a prospective, observational multicenter study conducted in primary health services in Brazil from October 2019 to May 2023, involving 1721 patients with suspected acute hepatitis. Acute HAV infection was identified in 108 (6.3%) patients, predominantly in young men (80%) and from South and Southeast regions of Brazil (97%). Anti-HAV IgG, indicating previous exposure or vaccination, was detected in 78.6% of individuals (74% in the South to 91% in the North). Genotype I.A was found in all cases and approximately 450 mutations were identified, most of them in the structural proteins VP1-3. Two viral groups were identified and related to two introductions of the virus: cosmopolitan sequences from North America, South America, and Europe, and a minor group of Brazilian sequences similar to Asian and South American ones. The high incidence of acute HAV infections highlights the need for targeted prevention and vaccination strategies. The characterization of HAV genetic diversity and molecular epidemiology contributes to monitoring and identifying emerging outbreaks.
甲型肝炎病毒（HAV）每年感染数百万人，是全球急性病毒性肝炎的主要病因。本研究旨在：（1）评估巴西公共医疗机构疑似急性肝炎患者中的HAV感染情况；（2）评估甲型肝炎疫苗接种者的比例；（3）鉴定HAV基因型；（4）研究HAV感染与人口统计学数据以及危险因素暴露之间的关联。这是一项前瞻性、观察性多中心研究，于2019年10月至2023年5月在巴西的初级卫生服务机构开展，纳入了1721例疑似急性肝炎患者。108例（6.3%）患者被确诊为急性HAV感染，主要为年轻男性（80%），来自巴西南部和东南部地区（97%）。78.6%的个体检测到抗HAV IgG，表明既往有暴露或接种史（南部为74%，北部为91%）。所有病例均发现I.A基因型，共鉴定出约450个突变，其中大多数位于结构蛋白VP1 - 3。鉴定出两个病毒组，与病毒的两次引入有关：来自北美、南美和欧洲的世界性序列，以及一小群与亚洲和南美序列相似的巴西序列。急性HAV感染的高发病率凸显了针对性预防和疫苗接种策略的必要性。HAV遗传多样性和分子流行病学特征有助于监测和识别新出现的疫情。
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