RESUMEN
The objective of this study was to evaluate immunization delivery and determine reasons for low coverage among preschool-age public clinic attendees in Puerto Rico. In 25 randomly selected clinics, coverage and missed immunization opportunities were assessed in 273 children aged 2 to 59 months, exist interviews were conducted with parents, and providers were interviewed. Two neighborhoods close to the clinics were surveyed to determine parental knowledge about immunizations, and the vaccination status of children in these neighborhoods was assessed. Two hundred seventy-three clinic attendees were interviewed. Among 229 (84%) with vaccination cards, only 126 (55%) had received all indicated vaccines by completion of the clinic visit. Forty-five percent of children with cards in the household survey were not up-to-date. Of 171 (75%) clinic attendees eligible for vaccination at the visit, 118 (69%) missed one or more immunizations at the visit. In addition, half of all children had previously missed one or more immunizations when they had received another vaccine. Missed opportunities occurred because of nonavailability of vaccines, lack of integration of services, provider misconceptions about contraindications, and failure to administer vaccines simultaneously. Other problems included barriers to immunization services and lack of information and education activities. It is concluded that deficiencies in immunization delivery substantially delay immunization and reduce coverage.
Asunto(s)
Atención a la Salud/normas , Conocimientos, Actitudes y Práctica en Salud , Inmunización/normas , Padres , Servicios Preventivos de Salud/normas , Niño , Preescolar , Continuidad de la Atención al Paciente/normas , Atención a la Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Investigación sobre Servicios de Salud , Humanos , Inmunización/estadística & datos numéricos , Esquemas de Inmunización , Lactante , Padres/educación , Padres/psicología , Servicios Preventivos de Salud/estadística & datos numéricos , Puerto RicoRESUMEN
To define better the epidemiology and clinical impact of hepatitis delta virus (HDV) infection among hepatitis B virus (HBV) carriers in less developed countries, the authors prospectively studied a cohort of 216 Yucpa Indian HBV carriers in Venezuela. HBV carriers were followed regularly between 1983 and 1988 by physical examination, laboratory testing for liver enzymes and HBV and HDV markers, and epidemiologic history. Among the cohort, 74 (34%) were initially positive for HDV infection, and 35 additional persons became infected during the study. Risk factors for new HDV infection included living in southern Yucpa villages; being young adults (15-19 years) or young children (1-9 years), and living in a household with a person with acute HDV infection. Persons with HDV infection were at high risk of developing chronic liver disease; 56% of HDV-infected persons had moderate-to-severe chronic liver disease at the end of the study compared with none of the HBV carriers without HDV infection. Mortality rates were 6.9% and 8.8% per year, respectively, among initially HDV-positive HBV carriers and those with new HDV infection, because of rapidly progressive chronic liver disease and fulminant hepatitis; mortality was significantly lower in HBV carriers without HDV infection and in non-HBV carriers. HDV superinfection is a devastating disease in HBV carriers in tropical South America. Prevention of HBV infection with hepatitis B vaccine is the best available tool to reduce the impact of this problem.
Asunto(s)
Brotes de Enfermedades , Hepatitis D/epidemiología , Indígenas Sudamericanos , Enfermedad Aguda , Portador Sano/inmunología , Femenino , Hepatitis B/complicaciones , Hepatitis B/mortalidad , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/inmunología , Hepatitis D/etiología , Hepatitis D/mortalidad , Hepatitis Crónica/complicaciones , Hepatitis Crónica/mortalidad , Humanos , Incidencia , Masculino , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Venezuela/epidemiologíaAsunto(s)
Portador Sano/epidemiología , Hepatitis B/epidemiología , Hepatitis D/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Colombia/epidemiología , Femenino , Hepatitis B/complicaciones , Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis D/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores SexualesRESUMEN
Outbreaks of acute hepatitis occurred in Huitzililla and Telixtac, two rural villages 70 miles south of Mexico City, Mexico, in late 1986. The first outbreak began in Huitzililla in June of that year, 1 month after the start of the rainy season. A census revealed 94 icteric case subjects, for an attack rate of 5%; two women died. Attack rates were higher for persons older than 15 years (10%) than for younger persons. A case-control study showed that illness was highly associated with water-related factors. The second outbreak began in August 1986 in Telixtac. There were 129 case subjects, for an attack rate of 6%; one woman died. Epidemiologic findings were similar to those in Huitzililla, except that most disease transmission was not linked to unsafe water sources. None of 62 case subjects in Huitzililla and only 2 of 53 case subjects in Telixtac tested had serological evidence for recent infection with hepatitis A or B. Two of eight stool samples from Huitzililla and one of the eight stool samples from Telixtac were positive by immune electron microscopy for 32- to 34-nm viruslike particles similar to those seen in cases of enterically transmitted non-A, non-B hepatitis from Asia. To our knowledge, these investigations document for the first time the epidemic transmission of enterically transmitted non-A, non-B hepatitis virus in the Americas.
Asunto(s)
Brotes de Enfermedades , Hepatitis C/transmisión , Hepatitis Viral Humana/transmisión , Enfermedad Aguda , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Brotes de Enfermedades/estadística & datos numéricos , Familia , Heces/microbiología , Femenino , Estudios de Seguimiento , Anticuerpos Antihepatitis/análisis , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Virus de Hepatitis/ultraestructura , Humanos , México/epidemiología , Oportunidad Relativa , Embarazo , Población Rural , Estaciones del Año , Microbiología del AguaRESUMEN
In a large hepatitis B prevention programme, hepatitis B vaccine was given in standard doses to greater than 1000 susceptible Yucpa Indians between 1983 and 1985. Thirteen months after the programme began, 373 vaccine recipients were tested using commercial radioimmunoassay to titre antibody response to the vaccine. Because of logistic difficulties, only 32% had received vaccine by the recommended schedule (second and third doses at one and six months after the first, respectively). The second and third doses were received early by 4 and 31%, respectively, and 27 and 16% received these doses later than intended. Overall response to vaccine was excellent: 98% of vaccinees developed anti-HBs greater than 10 mIU (geometric mean titre 688 mIU). Multivariate analysis showed that the response to vaccination was inversely related to the age of the vaccinee and directly related to the timing of the third vaccine dose. In particular, those receiving the third vaccine dose late (greater than 7 months after the first dose) developed antibody titres two-fold higher than those receiving the third dose on schedule (p less than 0.01). The response to vaccination was not significantly related to the timing of the second dose. A satisfactory response was obtained with various schedules of dose timing, including early second and third doses, late second and third doses and late second but normal third doses. These findings suggest that the response to hepatitis B vaccine is not highly dependent on timing of vaccine doses and that modest alterations in timing of doses, such as those necessary to integrate hepatitis B vaccine with other childhood vaccines, do not affect the excellent response to this vaccine.
Asunto(s)
Hepatitis B/prevención & control , Indígenas Sudamericanos , Vacunas contra Hepatitis Viral/administración & dosificación , Adolescente , Adulto , Niño , Preescolar , Relación Dosis-Respuesta Inmunológica , Esquema de Medicación , Femenino , Vacunas contra Hepatitis B , Humanos , Lactante , Masculino , Estadística como Asunto , Venezuela , Vacunas contra Hepatitis Viral/inmunologíaRESUMEN
To define more exactly the epidemiology of delta virus infection and confirm its role in causing fulminant Labrea hepatitis in the Amazon Basin, we studied the prevalence of delta virus infection among persons with acute and chronic hepatitis B virus infection in the Boca do Acre district of the southern Amazon Basin. Delta virus infection was found in 24% of asymptomatic hepatitis B virus carriers, 29% of acute nonfulminant hepatitis B cases, 74% of fulminant hepatitis B cases, and 100% of chronic hepatitis B cases. Chronic delta virus infection occurred primarily in older children and adults, while acute and fulminant delta virus infection occurred in young children as well. In fulminant hepatitis cases, delta virus superinfection of hepatitis B virus carriers was the most common serological pattern; histopathologic examination showed features identical to those described in fulminant hepatitis cases of similar etiology in Colombia and Venezuela. Delta virus infection is highly endemic in the southern Amazon Basin and is the principal cause of Labrea hepatitis.
Asunto(s)
Hepatitis B/epidemiología , Hepatitis D/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Brasil , Niño , Preescolar , Enfermedad Crónica , Femenino , Hepatitis B/complicaciones , Anticuerpos contra la Hepatitis B/análisis , Antígenos de la Hepatitis B/análisis , Antígenos de la Hepatitis B/inmunología , Hepatitis D/complicaciones , Antígenos de Hepatitis delta , Humanos , Lactante , Estudios Longitudinales , Masculino , Persona de Mediana EdadAsunto(s)
Hepatitis Viral Humana/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Brasil , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pruebas SerológicasAsunto(s)
Brotes de Enfermedades , Hepatitis D/patología , Hígado/patología , Brasil , Colombia , Hepatitis D/epidemiología , Humanos , VenezuelaRESUMEN
Stimulated by observations in an outbreak of hepatitis delta-virus infection among Yucpa Indians in Venezuela, in which unusual histologic features were found, we studied 100 cases of fatal hepatitis from Colombia, South America, which had been obtained by autopsy or viscerotomy. These cases were considered to be "Santa Marta hepatitis," or "hepatitis of the Sierra Nevada de Santa Marta," which has been observed in this region for more than 40 years. Of the 100 cases, 19 had a variety of histologic lesions or were normal, and hepatitis delta-virus antigen was not demonstrated immunocytochemically in any of them. By contrast, 81 cases had a characteristic histologic picture with intense microvesicular steatosis associated with conspicuous eosinophilic necrosis of the hepatocytes, which apparently were sluggishly removed by cytolysis. Hepatitis delta-virus antigen was detected in 70% of the 81 cases, and the absence of detection of this antigen was often associated with poor tissue preservation and more extensive hepatocyte necrosis. A smaller percentage of patients had hepatitis B virus antigens detectable in liver tissue. The characteristic lesion in these 81 cases could be distinguished from other causes of microvesicular steatosis by the extensive eosinophilic necrosis. Other variable accompanying features included intraacinar, mainly macrophagic, scavenger cell inflammation, intense portal inflammation, a parenchymal regeneration, and ductular and arteriolar proliferation. Santa Marta hepatitis as a severe form of hepatitis delta-virus infection differs markedly from fulminant delta-hepatitis in Europe and the United States in which the microsteatosis with marked eosinophilic degeneration is not found. The causes for these differences are unknown but may relate to nutritional factors or environmental toxins.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Hepatitis D/patología , Hígado/patología , Antígenos Virales/aislamiento & purificación , Colombia , Eosinófilos/patología , Hígado Graso/patología , Antígenos de Superficie de la Hepatitis B/análisis , Hepatitis D/epidemiología , Virus de la Hepatitis Delta/inmunología , Humanos , Indígenas Sudamericanos , Necrosis/patología , VenezuelaRESUMEN
"Santa Marta" hepatitis has been recognized as an unusual type of severe hepatitis occurring in northern Colombia since 1930. Liver specimens from a historic viscerotomy series, used by Gast-Galvis to identify cases and describe epidemiologic features of this disease, were available for review and histopathologic staining for delta-virus. Of 86 liver specimens examined from cases of fulminant Santa Marta hepatitis, 81 showed a distinct histopathologic picture, in various stages of progression, with features of eosinophilic necrosis, microvesicular fat infiltration of the liver parenchyma and morula cells; 69% were positive for delta-antigen by immunoperoxidase staining. This disease occurred predominantly in several small towns within 50 km of Santa Marta, with mortality reaching 1.25 per 1,000 inhabitants per year during the 1940's. Children under age 15 were most commonly affected and males affected twice as frequently as females. Liver specimens obtained from children, or within 15 hr of death, or which showed early histologic stages of disease were most likely to be positive for delta-antigen. This and the accompanying study confirm the existence of a distinct type of fulminant hepatitis in Colombia for over 50 years. The epidemiologic and histopathologic features are comparable to severe hepatitis in Venezuela Indians and in the Amazon basin of Brazil, suggesting that all are caused by delta-superinfection of hepatitis B virus carriers.
Asunto(s)
Hepatitis D/epidemiología , Adolescente , Adulto , Antígenos Virales/análisis , Niño , Preescolar , Colombia , Femenino , Hepatitis D/patología , Virus de la Hepatitis Delta/inmunología , Humanos , Hígado/patología , MasculinoRESUMEN
A study was conducted to determine the incidence of hepatitis B (HB) in a prison population. Forty-seven per cent of 455 male prisoners had evidence of past HB infection. HB seropositivity was most strongly correlated with: 1) a history of IV drug abuse; 2) age; 3) total time in any prison; and 4) race. During a one-year study period there were no clinical cases of HB in the prison and the seroconversion rate was 0.8 per cent among prisoners still incarcerated.
Asunto(s)
Hepatitis B/epidemiología , Prisioneros , Adolescente , Adulto , Factores de Edad , Anciano , Métodos Epidemiológicos , Hepatitis/complicaciones , Hepatitis B/sangre , Hepatitis B/etiología , Antígenos de Superficie de la Hepatitis B/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , New Mexico , Grupos Raciales , Riesgo , Trastornos Relacionados con Sustancias , Tatuaje , Factores de Tiempo , Reacción a la TransfusiónRESUMEN
Over a 3-year period, 149 Yucpa Indians in Venezuela developed hepatitis; 34 persons died and at least 22 developed chronic hepatitis. Children and young adults were primarily affected, especially males. Serologic testing showed that hepatitis B virus infection was highly endemic in this population, but also that 65% of patients had hepatitis B virus surface antigen (HBsAg) during or after illness. Most patients had evidence of delta-agent superinfection; 86% of HBsAg-positive patients had delta antibody, and delta antigen was found in specimens taken during autopsies on 7 of 9 patients. Serologic data suggested that most infections were due to delta superinfection of hepatitis B carriers, and that more than 60% of these infections progressed to chronic disease. Delta agent infection, and particularly delta superinfection of hepatitis B carriers, appears to be an ominous occurrence that may develop in populations among whom hepatitis B virus infection is endemic, and who have no other risk factor for delta infection.
Asunto(s)
Brotes de Enfermedades/epidemiología , Hepatitis Viral Humana/microbiología , Adolescente , Adulto , Portador Sano , Niño , Preescolar , Femenino , Hepatitis B/complicaciones , Antígenos de Superficie de la Hepatitis B/análisis , Hepatitis Crónica/etiología , Hepatitis Viral Humana/epidemiología , Hepatitis Viral Humana/patología , Humanos , Indígenas Sudamericanos , Lactante , Masculino , VenezuelaRESUMEN
To supplement a detailed epidemiologic study of an outbreak of viral hepatitis in Venezuelan Indians in isolated valleys, apparently resulting from delta agent infection, 10 autopsy specimens were studied histologically and immunocytochemically, and five biopsy specimens were examined. The patients were children and young adults and predominantly males. A sequence of hepatitis from focal necrosis with conspicuous small-droplet steatosis, through massive necrosis, prolonged postnecrotic collapse to early cirrhosis with massive collapse was postulated. The histologic changes tentatively suggest a cytopathic effect of the delta agent without significant indication of lymphocytotoxicity, at least in the parenchyma. Delta agent was demonstrated in hepatocyte nuclei in moderate amounts in the focal-necrotic stage and in isolated cells in the massive-necrotic stage, but in large amounts during the transition to cirrhosis. Whether these patients, in whom neither HBcAg nor HBsAg were demonstrable in the liver, suffered exclusively from superinfection of hepatitis B virus carriers and/or coinfection of hepatitis B virus with the delta agent remains to be resolved. Delta infection may occur in isolated settings with no relation to Italian origin, drug addiction, or polytransfusion. The infection is far more widely spread than previously assumed.