HBSAG POZİTİFLİĞİ OLAN ERİŞKİN HASTALARDA HEPATİT A SEROPREVALANSININ DEĞERLENDİRİLMESİ

Year 2024, Volume: 25 Issue: 1 - OCAK 2024 SAYISI, 81 - 85, 17.01.2024

Filiz Bayar Oktay Demirtaş

https://doi.org/10.18229/kocatepetip.1225138

Abstract

AMAÇ: Hepatit A genel olarak kendini sınırlayan bir enfeksiyon olmakla birlikte fulminan hepatit nadir görülen en ciddi komplikasyonudur. Kronik hepatit B gibi kronik karaciğer hastalıklarının varlığında fulminan hepatit riski artmaktadır. Bu nedenle hastalarda Hepatit A Virüsüne (HAV) karşı bağışıklık durumunun araştırılması önem kazanmaktadır. Bu çalışmada HBsAg pozitif olan erişkin hastalarda HAV seroprevalansının değerlendirilmesi, seronegatif erişkinlerin saptanması ve bu bireylerin immünizasyonunun sağlanması amaçlanmıştır.
GEREÇ VE YÖNTEM: Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji polikliniğine 1 Ocak 2020 – 1 Ocak 2021 tarihleri arasında başvuran HBsAg pozitif, 18 yaş ve üzeri hastaların tümünde anti-HAV antikoru (Anti-HAV IgG) sonuçları değerlendirilmiştir. Hastalardan alınan kan örneklerinde HBsAg ve anti-HAV IgG kemilüminesans esasına dayanan “enzyme-linked immunosorbent assay” (ELISA) yöntemi kullanılarak çalışılmıştır.
BULGULAR: Çalışmaya 286 hasta dahil edilmiş olup bunların 113 (%39,5)’ünde Anti-HAV IgG araştırılmadığı tespit edilmiştir. HBsAg pozitifliği olan ve Anti-HAV IgG serolojisi araştırılan , yaş aralığı 24-88 arasında değişen 173 hasta ( 88 kadın, 85 erkek) çalışmaya dahil edilmiştir. Toplam 155 (%89,6) hastada Anti-HAV IgG pozitif olarak saptanmıştır. İstatistiksel olarak cinsiyet yönünden değerlendirildiğinde iki grup arasında bir fark saptanmamıştır (p= 0.938). Yaş grupları incelendiğinde Anti-HAV IgG pozitifliği en düşük ( %45,5) 18-29 yaş grubunda gözlenmiştir. 60 ve üzeri yaş grubunda anti-HAV IgG pozitifliği %100 olarak belirlenmiştir.
SONUÇ: HBsAg pozitif hastalarda HAV virüs enfeksiyonun mortalite ve morbiditeyi arttırması sebebi ile, anti-HAV IgG taramasının yapılması ve seronegatif bireylerin immünizasyonunun sağlanmasının gerekli olduğu düşünülmektedir.

Keywords

HBsAg, Hepatit A enfeksiyonu, Seroprevalans, İmmünizasyon

EVALUATION OF HEPATITIS A SEROPREVALENCE IN ADULT PATIENTS WITH HBSAG POSITIVITY

Abstract

OBJECTIVE: Although Hepatitis A is generally a self-limiting infection, fulminant hepatitis is the rare and most critical complication. The risk of fulminant hepatitis increases in the presence of chronic liver diseases such as chronic hepatitis B. Therefore, it is important to investigate the immune status of patients against Hepatitis A Virus (HAV). This study targets to evaluate the HAV seroprevalence in HBsAg positive adult patients, to determine the seronegative adults and to provide immunisation of these individuals.
MATERIAL AND METHODS: The results of anti-HAV antibody (Anti-HAV IgG) were evaluated in all HBsAg positive patients aged 18 years and over who applied to the Infectious Diseases and Clinical Microbiology outpatient clinic between 01.01.2020 and 01.01.2021. Blood samples of the patients were studied through enzyme-linked immunosorbent assay (ELISA) method based on HBsAg and anti-HAV IgG chemiluminescence.
RESULTS: The research comprised of 286 participants, of which 113 (39.5%) were not screened for anti-HAV IgG. A total of 173 patients (88 females, 85 males) with HBsAg positivity and anti-HAV IgG serology aged between 24-88 years were included in the study. Anti-HAV IgG positivity was detected in total of 155 (89.6%) patients. When statistically evaluated in terms of gender, no difference was found between the two groups (p= 0.938). When the age groups were examined, anti-HAV IgG positivity was specified at the lowest rate (45.5%) in the 18-29 age group. Anti-HAV IgG positivity was detected as 100% in the 60 and over age group.
CONCLUSIONS: Since HAV virus infection increases mortality and morbidity in HBsAg positive patients, it is thought that anti-HAV IgG screening and immunisation of seronegative individuals is necessary.

Keywords

HBsAg, Hepatitis A infection, Seroprevalence, Immunization

References

• 1. Zheng B, Wen Z, Pan J, Wang W. Epidemiologic trends of hepatitis A in different age groups and regions of China from 1990 to 2018: observational population based study. Epidemiol. Infect. 2021;149:e186.
• 2. WHO. WHO position paper on hepatitis A vaccines – June 2012. https://apps.who.int/iris/bitstream/handle/10665/241938/WER8728_29_261-276.PDF?sequence=1, Erişim Tarihi : 20.08.2022.
• 3. WHO. Hepatitis A- Key facts. https://www.who.int/news-room/fact-sheets/detail/hepatitis-a, Erişim Tarihi: 20.08.2022.
• 4. Murray PR, Rosenthal KS, Pfaller MA. Evolve Resources for Medical Microbiology. 9 th Edition, Amsterdam: Elsevier Health Sciences, 2021;551-54.
• 5. Castaneda D, Gonzalez AJ, Alomari M, Tandon K, Zervos XB. From hepatitis A to E: A critical review of viral hepatitis. World J Gastroenterol 2021;27(16):1691-1715.
• 6. Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm, Erişim Tarihi: 23.08.2022.
• 7. Fiore AE. Hepatitis A transmitted by food. Clin Infect Dis. 20041;38(5):705-15.
• 8. Foster MA, Haber P, Nelson NP. Hepatitis A (Edited by). Centers for Disease Control and Prevention. In: Hall E, Wodi AP, Hamborsky J, et al. Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th Edition, Washington: Public Health Foundation.
• 9. Celen MK, Kamuran Turker K, Nefise Oztoprak N, Alper Sener A. The evaluation of exposure to hepatitis A virus in HBsAg-positive persons:A multicentre study from Turkey. JPAM. 2014; 8(4):3063-68.
• 10. Herzoga C, Herckc KV, Damme PV, Hepatitis A vaccination and its immunological and epidemiological long-term effects – a review of the evidence. Hum. Vaccines Immunother. 2021;17(5):1496–1519.
• 11. Düzenli T, Köseoğlu H, Üçer Ş, et al. Seroprevalence of hepatitis A virus according to age groups in Northern Anatolia of Turkey. The Turkish Journal of Academic Gastroenterology. 2021;20:136-42.
• 12. Coalition for Global Hepatitis Elimination. Turkish viral hepatitis prevention and control program 2018-2023. https://www.globalhep.org/evidence-base/turkish-viral-hepatitis-prevention-and-control- program-2018-2023, Erişim Tarihi: 10.09.2022.
• 13. Shin EC, Jeong SH. Natural history, clinical manifestations, and pathogenesis of hepatitis A. Cold Spring Harb Perspect Med. 2018;8(9):a031708.
• 14. Cao G, Jing W, Liu J, Liu M. The global trends and regional diferences in incidence and mortality of hepatitis A from 1990 to 2019 and implications for its prevention. Hepatol. Int. 2021;15:1068–82.
• 15. Pramoolsinsap C. Acute hepatitis A and acquired immunity to hepatitis A virus in hepatitis B virus (HBV) carriers and in HBV- or hepatitis C virus-related chronic liver diseases in Thailand. J Viral Hepat. 2000;7(1):11–12.
• 16. Chu CM, Liaw YF. Increased incidence of fulminant hepatic failure in previously unrecognized HBsAg carriers with acute hepatitis independent of etiology. Infection. 2005;33:136–39.
• 17. Yılmaz, A. Hepatitis A seroprevalence in Erzurum, Turkey. Annals of Agricultural and Environmental Medicine. 2020;27: 481-84.
• 18. Kula Atik T, Çetin Duran A , Avcu G. Balıkesir ilinde çeşitli yaş gruplarında hepatit A seropozitifliğinin retrospektif olarak değerlendirilmesi. Bozok Tıp Dergisi. 2021;11:7-14.
• 19. Çeviker SA, Günal Ö, Kılıç SS, Tahmaz A. Erişkin HBsAg pozitif hastalarda Hepatit A seroprevansı. Genel Tıp Derg. 2020;30(3):157-161.
• 20. Bekçibaşı M. Hepatitis A seroprevalence in chronic hepatitis B patients in Diyarbakir. Turkey. Klimik Derg. 2020;33(1):36-38.
• 21. Alpay Y. Evaluation of seroprevalence of hepatitis A virus infection among patients with chronic hepatitis B virus infection. Klimik Derg. 2019;32(1):19-21.
• 22. Özden HT, Hepatitis A seroprevalence in patients with chronic viral hepatitis in Konya, Turkey. Eur. J. Gastroenterol. Hepatol. 2016;28:333–37.
• 23. Öner SZ, Türkoğlu E. Kronik hepatit B virüs enfeksiyonu olan hastalarda hepatit A virüs seroprevalansı. KSÜ Tıp Fak Der. 2020;15(3): 37-39.
• 24. Türkoğlu E, Demirtürk N. Hepatit B virusu ile infekte hastalarda hepatit A serolojisinin araştırılması. Bakırköy Tıp Der. 2015;11(3):116-19.
• 25. Öden Akman A, Yalçın Burhan B, Uzun AK, Taş D. Hepatitis A virus age-specific seroprevalence after the implementation of a Toddlers’ Vaccination in Turkey: Shifting susceptibility to adolescents. Turk Pediatri Ars. 2020;55(4):370–75.
• 26. Cho HC, Paik SW, Kim YJ et al. Seroprevalence of anti-HAV among patients with chronic viral liver disease. World J Gastroenterol. 2011;17(2):236-41.
• 27. Sagnelli E, Stroffolini T, Almasio P et al. Exposure to HAV infection in patients with chronic liver disease in Italy, a multicentre study. J Viral Hepat. 2006;13: 67–71.
• 28. Lee SH, Kim HS, Park KO et al. Prevalence of IgG anti-HAV in patients with chronic hepatitis B and in the general healthy population in Korea. Korean J Hepatol. 2010;16:362-68.
• 29. Cho HC, Kim YJ, Choi MS, Lee JH at al. The seroconversion rate of hepatitis A virus vaccination among patients with hepatitis B virus-related chronic liver disease in Korea. Gut and Liver. 2011;5(2):217-20.
• 30. Türker K, Balcı E, Batı S, Hasçuhadar M, Savaş E. Ülkemizde hepatit A enfeksiyonunun değişen epidemiyolojisi. Türk Mikrobiyol Cem Derg. 2011;41(4):143-48