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Viral Hepatitis. Epidemiology & Research in ARGENTINA. South America.

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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Viral Hepatitis. Epidemiology & Research in ARGENTINA. South America.

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  1. Viral Hepatitis. Epidemiology & Research in ARGENTINA. South America. Jorge Enrique González

  2. 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

  3. 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

  4. 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 %

  5. GEOGRAPHICAL DISTRIBUTION OF HEPATITIS A VIRUS INFECTION

  6. HAV infection in Argentina

  7. Hepatitis A surveillance

  8. 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

  9. Hepatitis E Fields Virology 2001 ; Rev Med Virol 2003

  10. 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

  11. 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

  12. 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.

  13. 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 !!!

  14. GEOGRAPHIC DISTRIBUTION OF CHRONIC HBV INFECTION

  15. 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

  16. HBsAg prevalence in Blood donors. Source : Provinces communications to CNRL ANLIS “Dr C G Malbran”

  17. antiHBc prevalence in Blood donors. Source : Provinces communications to CNRL ANLIS “Dr C G Malbran”

  18. HEPATITIS B at the SUs

  19. 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

  20. 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

  21. HEPATITIS C (World J Gastro 2007)

  22. 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

  23. antiHCV prevalence in Blood donors. Source : communications from the Provinces to the CNRL ANLIS “Dr C G Malbran”

  24. 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)

  25. HEPATITIS C at the SUs

  26. 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

  27. 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

  28. 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

  29. … ARGENTINA, offers much more than viral hepatitis … !!

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