HEPATITIS B GENOTYPE F IN THE AMAZON BASIN THE EXAMPLE OF LBREA WESTERN BRAZILIAN AMAZON

WORNEI BRAGA

LIMA - 2012

7 MILLION de Km2

60% OF THE BRAZILIAN TERRITORY

20 MILLION INHABITANTS

Transmission early in childhood Outbreaks of fulminant hepatitis

HEPATITIS B GENOTYPE F IN THE AMAZON BASIN THE EXAMPLE OF LBREA WESTERN BRAZILIAN AMAZON

Background
Lbrea Hepatitis - Lbrea Black Fever HBsAg prevalence around 15% before vaccination First area in Brazil to receive hepatitis B vaccine in 1989

68.229 Km 27.295 Inhabitants 10.000 Rural Area

LABREA

Urban area survey 2000 Rural area survey 2005-2006 Indigenous population survey 2009-2010 Surveillance of icteric syndromes - 2010

URBAN AREA SURVEY2000

ELISA Methods

Population based crosssectional study

HBV Prevalence among age groups

Age <1 1-5 5-15 15-30 30-50 50+ Total Sample N % 18 94 182 158 98 55 605 3,0 15,5 30,1 26,1 16,2 9,1 100 HBsAg + N %c 0 0 5 9 6 0 20 0 0 2,7 5,7 6,1 0 3,3 Anti-HBc total + N %c IC95% 0 6 49 123 80 44 302 0 6,4 26,9 77,8 81,6 80 49,9 --1,5-11,3 20,5-27,3 71,3-84,3 74-89,2 69,4-90,5 45,9-53,8

IC95% ----0,4-5,0 2,1-9,3 1,4-10,8 --1,9-4,7

Mean age

HBsAg + 26 years HBeAg + 16 years

G C B D

F Oliveira CM, Teses 2007

HBV Prevalence acording to the place of birth

Birthplace Lbrea

Sample N %a 269 44,5

HBsAg N %b 5 14 1,9 4,3

IC95% 0,3-3,5 2,1-6,4 0,0-31,6

anti-HBc total N %b IC95% 75 222 5 302 27,9 67,9 22,5-33,2 62,8-72,9

Rural Zone 327 54,0 Others Total 9 605 1,5 100

1 11,1 20

55,6 23,1-88,1 49,9 45,9-53,8

3,3 1,9-4,7

Braga, et al. REPSUS, 2003

RURAL AREA SURVEY 2005-2006

Prevalncia de marcadores sorolgicos do VHB por grupo de idade

298 Idade1.510 individuals reativo Amostra AgHBs N % N %c IC95%

<1 1-5 5-15

families

Anti-HBs
18 3,0

70,4% (IC95% 68,1 a 72,7)

--0 0

55 communities Anti-HBc total reativob N %c IC95%

--1,5-11,3 20,5-27,3 71,3-84,3 74-89,2 69,4-90,5 45,9-53,8

Anti-HBc total 0 52,1% (IC95% 49,5 a 54,7) 94 15,5 0 --6 6,4

182 30,1 HBsAg 5 9 6 2,7 5,7 0,4-5,0 49 26,9 6,2% (IC95% 5,1 a 7,6) 2,1-9,3 123 80 44 302 77,8

15-30 30-50 50+ Total

HBeAg
98

158

26,1 16,2

20,9% (IC95% 13,1 a 30,7)

1,4-10,8 81,6 80 49,9

6,1

Mean age HBsAg + 22 years 55 9,1 0 0 --Mean age HBeAg + 15 years

605 100 20 3,3 1,9-4,7

Anti-HD total HBV+ 13,3% (IC95% 11,0 a 15,9) HBsAg+ 41,5% (IC95% 30,5 a 51,5) Idade mdia HBsAg reativos 26 anos
HBeAg reativos 16 anos

Braga, et al. REPSUS, 2003

HBV Distribution by location

Braga, et al., 2012

Three communities survey All individuals surveyed Serology Viral load Molecular epidemiology Phylogenetic analysis

Castilho, MC et al., 2012

Castilho, MC et al., 2012

Castilho, MC et al., 2012

REMARKS

1. HOW?
Vertical ? YES, but not the main mechanism!

Horizontal in early ages? YES, the most important, but how? It doesnt matter!
Increased risk for chronic liver diseases maintained! Others factors could by involved! Genetics Very unlike HBeAg + in the family culture Environment Social

2. WHY? Poor impact of the vaccination program

Important residual pockets of HBsAg carriers

Endemicity pattern maintained high prevalent area Program should emphasizes on screening high risk groups

CHALLENGES
1- PREVENTION

2- CARE

3- NATIVES

Photo: Purus River

THANK YOU.