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Viral Hepatitis. Epidemiology & Research in ARGENTINA. South America. Jorge Enrique González. Specific Networks. Provinces Networks. Modular System (since 2001). TBC. Meningoencephalitis. Immunizables. Vaccines. Medical consultations . Cards. Programs. +. Early Alert.

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slide1

Viral Hepatitis.

Epidemiology & Research

in ARGENTINA.

South America.

Jorge Enrique González

slide2

Specific Networks

Provinces Networks

Modular System

(since 2001)

TBC

Meningoencephalitis

Immunizables

Vaccines

Medical consultations

Cards

Programs

+

Early Alert

Specialized

National Health Surveillance System

Sentinel

Laboratories

Sentinel Units

Lab Surveillance System

Hepatitis

STD

Diarrheas

HUS

Febrile Illness

Pneumonies

Nosocomial Infections

Injuries

slide3

SENTINEL UNITS (SU)

for VIRAL HEPATITIS

& population density

(24 SU in 17 Provinces)

1 dot = 100 inhab / km2

*Common working protocol

-Guidelines consensus

-Web resident specific software

*External Quality Control for Serology

-Biannual Panel for HBV & HCV

*Fluent communication

- Monthly newsletter (electronic)

- Annual meetings (n:17)(since 1992)

Posters at this meeting

#P-003

#P-004

Saturday 03/21

12-15 hrs

slide4

Access to Sanitation

(% of population) 2001

Access to Tap water

(% of population) 2001

Sewage 42.5 % Area: 2 736 690 sq km Safe water 77 %

Population : 39 000 000 (mostly urban)

Birth cohort (2008) : 700 000 Urban population : 89.4 %

slide8

Vaccination coverage against HAV in one-year-old children. Argentina 2007

Cobertura de Vacunación anti Hepatitis A en niños de 1 año de edad,

según provincias. Argentina 2007

Cobertura país: 93,5%

Country coverage 93.5%

provinces

% coverage

Source : National Health Surveillance System

Poster at this meeting

#P-002

Saturday 03/21

12-15 hrs

slide9

Hepatitis E

Fields Virology 2001 ; Rev Med Virol 2003

identification of 2 novel isolates of hepatitis e virus in argentina
Identification of 2 Novel Isolates of Hepatitis E Virus in Argentina

Schlauder GG, Frider B, Sookoian S, Castaño G & Mushawar I.

Virus Discovery Group Abbott Laboratories, Chicago. USA

Unidad de Hígado. Hospital Argerich. Buenos Aires Argentina.

Ar 1

Male, 80 years

Ar 2

Male, 65 years

JID 2000;182:294-7

slide11

Identification of the first strain of Swine Hepatitis E virus in South

America and prevalence of anti-HEV antibodies in swine in Argentina.

Munné et al. 2006. Journal of Medical Virology; 78: 1579-83.

HEV

Phylogenetic relation

between swine & human Argentinian strains

slide12

EFHFArg1

1. FHF (Quilmes Pcia Bs As)

2. FHF (S Martín Pcia Bs As)

3. FHF (Pcia Corrientes)

Swine strain (Pergamino Pcia Bs As)

swArg, EFHArg3

EFHFArg2

Ar1

Ar2

91

77

US1

Ch3

73

83

97

Cs15

swUS1

99

84

Phylogenetic tree

ORF 2 Region

Ct1

B1

0.1

M1

HEV & pediatrics FHF

3 HEV RNA +ve in 35 FHF (2003-2004)

Serum & feces samples

Liver International

ALEH 2004; 24:Supp4

Munné et al. 2006

Acta Gastroenterológica

Latinoamericana ; 36: 125-130.

slide13

Laboratory Diagnosis of Hepatitis E

Problems

Solutions ???

  • Direct MarkersAg : in development
  • RNA : -very unstable
  • -short viremia

*sampling improvement 

*better handling of serum

and stools

*Local strains as

capture Ag ??

  • Indirect Markers Ab : -low titer
  • -low specificity

*Diagnostic tests not required *Late sampling

*Difficult accesibility of commercial tests *High costs for the tests.

Poster at this meeting

P-158

Saturday 03/21

12-15 hrs

Sub diagnosis !!!

slide15

Rates of hepatitis B notification and trend.

Argentina 1998 - 2008

3.5

2.5

Rates / 0000

1.5

0.5

year

Source : National Health Surveillance System

slide16

HBsAg prevalence in Blood donors.

Source : Provinces communications to CNRL ANLIS “Dr C G Malbran”

slide17

antiHBc prevalence in Blood donors.

Source : Provinces communications to CNRL ANLIS “Dr C G Malbran”

slide19

Vaccination coverage against HBV in newborns.

Argentina 2007

Cobertura de Vacunación antihepatitis Bantes de las 12 horas de recién nacidos

Argentina 2007

Country coverage 83.7%

Source : National Health Surveillance System

hbv genotypes
HBV genotypes

Strong association between genotype F and …

Franca P, et al. J Clin Microbiol. 2004 Nov;42(11)

Poster at this meeting

#P-038

Saturday 03/21

12-15 hrs

slide21

HEPATITIS C

(World J Gastro 2007)

slide22

Rates of hepatitis C notification and trend.

Argentina 1998 – 2008

2.5

1.5

Rates / 0000

0.5

0.5

0.5

year

Source : National Health Surveillance System

slide23

antiHCV prevalence in Blood donors.

Source : communications from the Provinces to the CNRL ANLIS “Dr C G Malbran”

slide24

HCV Prevalence studies

1.-Htal de Clínicas, Htal Ramos Mejía; Htal J. Méndez (Bs.As.) 2.- Sur de Santa Fe y E. Rios (Gualeguay)

3.- H. Argerich, H.Muñiz, H.Udaondo, y LNR-INEI-ANLIS C.G.Malbrán (Bs As) 4.-Htal del Milagro (Salta), Htal Muñiz, y LNR-INEI- ANLIS C.G.Malbrán (Bs As) (Referenciados en el Consenso Argentino Hepatitis C – AAEEH (2004) 5.- O¨Flaherty et al. XIII Congreso Arg de Hepatología (2005) 6.-Soria et al, XI Congreso Arg de Hepatología (2001) ( Referenciado en el Consenso Arg Hepatitis C. AAEEH (2004) 7.-Bessone et al, XIII Congreso Arg de Hepatología (2005)

hcc in argentina
HCC in Argentina.

*Retrospective survey 2005 – 2008

From 15 Centers located at 5 provinces

Etiology of chronic liver disease in 551 cases with diagnosis of HCC.

Etiology n Percentage

Alcohol 182 33.0

HCV 181 32.8

HBV 55 10.0

Cryptogenic 51 9.2

HCV + alcohol 35 6.3

Hemochromatosis 15 2.7

HBV + alcohol 12 2.2

PBC 12 2.2

HCV + HBV 7 1.3

AIH 1 0.2

HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HBV, hepatitis B virus;

PBC, primary biliary cirrhosis; AIH, autoimmune hepatitis.

Fassio et al Acta G. Lat 2009 in press

Median age : 62 years old

93% underlying cirrhosis

slide28

LIVER TRANSPLANTATION IN ARGENTINA 1998-2008.

1998 2008

Dn rate* 6.81 13.06

Tx rate* 3.72 6.82

* per M inhab

*Evaluation of 3 causes among 20 recorded at

www.incucai.gov.ar (Access: March 2009)

< 18 years old

>= 18 years old

Since 2006 all people are potential

donors by federal law

slide29

SERVICIO HEPATITIS Y GASTROENTERITIS

DEPARTAMENTO VIROLOGIA

LABORATORIO NACIONAL DE REFERENCIA

INSTITUTO NACIONAL DE ENFERMEDADES INFECCIOSAS (INEI)

ADMINISTRACION NACIONAL DE LABORATORIOS E INSTITUTOS DE SALUD (ANLIS)

“Dr. Carlos Gregorio Malbrán”

www.anlis.gov.ar/INEI/virolog/hepatitis