exudates and Hepatitis-A

Foodborne outbreaks of hepatitis A virus (HAV) are most commonly associated with fresh and frozen produce and with various types of shellfish. Alcoholic beverage-borne outbreaks of hepatitis A are extremely rare. Here, we report an outbreak of hepatitis A associated with the consumption of a traditional wine at a funeral ceremony in the Sabah state of Malaysian Borneo. Confirmed cases were determined by serum anti-HAV immunoglobulin M and/or for fecal HAV by reverse transcription polymerase chain reaction (RT-PCR). The amplicons of RT-PCR were subjected to nucleotide sequencing followed by phylogenetic analysis. We conducted a 1:2 case-control study to identify the possible exposure that led to the outbreak. Sixteen patients met the case definition, they were 18 to 58 years old and 90% of them were males. The case-control study showed that the consumption of nipa palm wine during the ceremony was significantly associated (P = 0.0017) with hepatitis A infection (odds ratio, 5.44; 95% CI, 1.80-16.43). Untreated river water was used to dilute the traditional wine, which was assumed to be the source of the infection. Phylogenetically, these viruses belonged to genotype IA and formed an independent cluster with strains from Taiwan, Japan, and the Philippines. This strain might be an emerging HAV in Asian countries. Environmental assessments were performed and environmental samples were negative for HAV. The incidence of hepatitis A in Sabah was also determined and it was 0.795/100,000 population. Strict monitoring of traditional wine production should be implemented by the local authority to prevent future outbreaks.

Topics: Adolescent; Adult; Arecaceae; Ceremonial Behavior; Disease Outbreaks; Female; Funeral Rites; Hepatitis A; Humans; Malaysia; Male; Middle Aged; Rivers; Viral Structural Proteins; Wine; Young Adult

To determine the seroprevalence of anti-hepatitis A virus (HAV) antibodies in patients with chronic liver disease (CLD) and to justify the need for hepatitis A vaccination.. Patients (n = 119) were enrolled between July and September 2009. The diagnosis of CLD was based on the presence of viral markers for more than 6 mo. The diagnosis of liver cirrhosis was based on clinical, biochemical and radiological profiles. Patient serum was tested for anti-HAV IgG.. The overall anti-HAV seroprevalence was 88.2%. The aetiology of CLD was hepatitis B in 96 patients (80.7%) and hepatitis C in 23 patients (19.3%). Mean age was 44.4 ± 14 years. Patients were grouped according to age as follows: 24 (20.2%) patients in the 21-30 years age group, 22 (18.5%) in the 31-40 years age group, 31 (26.1%) in the 41-50 years age group, 23 (19.3%) in the 51-60 years age group and 19 (16.0%) patients aged greater than 60 years, with reported seroprevalences of 66.7%, 95.5%, 93.5%, 91.3% and 94.7%, respectively. There was a marked increase of seroprevalence in subjects older than 30 years (P = 0.001).. Our study demonstrated that patients aged greater than 30 years of age were likely to have natural immunity to hepatitis A. Therefore, hepatitis A vaccination may not be routinely required in this age group.

Topics: Adult; Aged; Female; Hepatitis A; Hepatitis A Antibodies; Hepatitis A Vaccines; Hepatitis, Chronic; Humans; Malaysia; Male; Middle Aged; Seroepidemiologic Studies; Young Adult

The MLF since its inception in 1996 has endeavored to develop a coordinated approach towards the improved care and treatment of liver diseases in Malaysia. Its close liaison with the Malaysian MOH, local medical associations, and corporate bodies has contributed to the success of its many programs. Educating the public, research, and training have been important elements of successful hepatitis disease control programs. Hepatitis Days have been proven to be very successful in raising the awareness of the general public to hepatitis disease. Rapid screening and vaccination has also helped to remove the social stigma associated with the disease, eliminated the need for numerous clinic appointments, and rendered vaccination more accessible to the public. The MLF perspective emphasizes the need for collaborative effort between Government bodies and other agencies, such as non-governmental organizations, laboratories, and the medical fraternity, to ensure the overall success of hepatitis disease management programs.

Topics: Disease Management; Hepatitis A; Hepatitis B; Humans; Incidence; Malaysia; Prevalence

A Hepatitis A outbreak occurred in Mukim Hulu Langat, Hulu Langat district from April 2002 to October 2002. Of the 51 cases notified, most were among students and the ethnic groups involved were Malays and the Orang Asli (local indigenous community). Epidemiological investigations revealed that the cases were localized along rivers used for recreational activities in this area. River water analysis indicated human faecal contamination and it was believed that the contamination was due to the Orang Asli community living upstream. This occurred due to lack of toilet facilities, water at point of use and the existing traditional practices of the Orang Asli community. Control measures instituted were intense health education to the Orang Asli to avoid using the rivers for defecation, multi agency efforts to provide sanitary toilets and adequate water to the villages affected. Future measures include conducting a sero- prevalence survey to determine the feasibility of Hepatitis A immunization to the susceptible population in this area. The outbreak that began in April 2002 was controlled by October 2002.

Topics: Causality; Disease Outbreaks; Hepatitis A; Humans; Malaysia; Rivers; Water Supply

This paper examines the trend and possible contributing factors for the occurrence of the food borne diseases outbreaks in Malaysia. These diseases mainly are cholera, typhoid fever, hepatitis A, dysentery and food poisoning. The outbreaks still occur sporadically in certain high risk areas throughout the country. The incidence rate of all the other three major food borne diseases steadily declined from the year 1988 to 1997 except for food poisoning and cholera. Statistic of food poisoning from the year 1996 to 1997 showed that 66.5% of the outbreak occurred in schools whereas only 0.4% originated from the contaminated food sold at various public food outlets. The school age group is always more affected than the general population. Amongst the contributing factors identified are related to unhygienic food handling practices followed by inadequate safe water supply and poor environmental sanitation. A multisectoral approach between Ministry of Health and other government agencies or private agents needs to be undertaken in the management of the food borne diseases in order to curb the incidences of food borne diseases in Malaysia.

Topics: Adolescent; Adult; Child; Child, Preschool; Cholera; Cross-Sectional Studies; Disease Outbreaks; Dysentery; Food Contamination; Foodborne Diseases; Hepatitis A; Humans; Incidence; Malaysia; Risk Factors; Time Factors; Typhoid Fever

Icteric patients with clinical and biochemical evidence of liver disease, admitted into various hospitals in Malaysia, were investigated to determine the cause of their infection. Of these patients, 11.0% (16/145) were found positive for IgM anti-HAV (EIA), 4.1% (6/145) for IgM anti-HBc (EIA), 1.0% (1/102) for IgM anti-CMV (ELISA), 17.2% (16/64) for rising titres of leptospiral agglutinin, and none for heterophile antibody of EBV. Hepatitis NANB accounted for 67.9% of cases. The mean serum transaminases (ALT and AST) values in patients with hepatitis A and B were higher (more than 500IU) than in patients with leptospirosis or non-A, non-B hepatitis, whereas serum bilirubin levels were higher in patients with hepatitis A and leptospirosis than in patients with hepatitis B.

Topics: Acute Disease; Alanine Transaminase; Aspartate Aminotransferases; Cytomegalovirus Infections; Hepatitis; Hepatitis A; Hepatitis B; Hepatitis C; Humans; Infectious Mononucleosis; Leptospirosis; Malaysia

Sera from 494 non-icteric patients admitted with illnesses other than overt hepatitis into the various hospitals in rural and urban Malaysia were tested for IgG antibody to hepatitis A virus. The overall antibody prevalence rate was 67.0% with rates increasing steadily from childhood 10 years old and under (39.4%) to middle-age and above (96.0%). No significant differences were noted between males (68.4%) and females (65.3%). The highest rate was in the Indians (80.6%), the lowest in the Chinese (55.9%) with Malays occupying intermediate position (70.3%). The rate in the rural patients (74.7%) was higher than that in the urban patients (65.5%) especially in the 21 to 40 year age-group where the rural patients had a rate of 96.7% compared with that in urban patients (61.1%). A comparison of antibody prevalence rates in different countries was made.

Topics: Adolescent; Adult; Age Factors; Child; Female; Hepatitis A; Hepatitis A Antibodies; Hepatitis Antibodies; Humans; Immunoenzyme Techniques; Immunoglobulin G; Malaysia; Male; Middle Aged; Rural Population; Sex Factors; Urban Population

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cytomegalovirus Infections; Female; Hepatitis A; Hepatitis B; Hepatitis C; Hepatitis, Viral, Human; Herpesvirus 4, Human; Humans; Infant, Newborn; Malaysia; Male; Middle Aged; Tumor Virus Infections

Naturally occurring malaria, arbovirus infection and hepatitis in monkeys can be a hazard for the investigator and might interfere with the outcome of experiments. 63 young adult Macaca fascicularis from Malaysia were screened for these infections. About 1 year after their arrival in France, parasitaemia due to Plasmodium spp., was present in 6.4% of the animals and specific antibodies in 55.5%. 19 of 35 initially positive monkeys were tested again 2 years later. Parasitaemia was found in 1 of 4 monkeys and antibodies in 11 of 19 monkeys which were initially positive. 9 of the monkeys initially tested had low titres of antibodies to the Flavivirus genus. All animals were negative for the hepatitis B surface antigen and anti-HBc. The prevalence of IgG antibodies against hepatitis A was 46.0%. The implications in terms of control are discussed.

Topics: Animals; Arbovirus Infections; Female; Hepatitis A; Hepatitis B; Macaca fascicularis; Malaria; Malaysia; Male; Monkey Diseases; Parasitemia; Prevalence

Topics: Adolescent; Adult; Hepatitis A; Hepatitis A Antibodies; Hepatitis Antibodies; Hepatovirus; Humans; Immunoglobulin G; Immunoglobulin M; Malaysia