The aim of this study was to determine the prevalence and the incidence of hepatitis B virus (HBV) among haemodialysis (HD) subjects and to evaluate whether testing for serological markers at the time of admission is suitable for HBV screening in this population. One hundred twenty-three patients belonging to two HD centres from São Paulo, Brazil, were tested prospectively. HBV DNA was detected by polymerase chain reaction (PCR) in each of the prospective subjects (n = 123) during one year. Additionally, all samples (n = 1,476) were analysed for HBV serological markers. The prevalence of hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (HBsAg) and HBV DNA were 34.1%, 15.4% and 8.1%, respectively, while the incidence was null. Fluctuation in HBV serology was observed in one patient. Only 37.8% (17/45) of cases responded to the HBV vaccine. Our results suggest that employing more than one HBV marker and repeated follow-up evaluations may improve HBV screening in HD units.

A possibilidade de identificar infecções presentes ou passadas utilizando fluidos corpóreos que seriam mais facilmente coletados do que o sangue, principalmente em crianças, facilitaria grandemente a investigação e o acompanhamento de surtos de hepatite A, que ocorrem com muita freqüência em nosso meio. Nosso estudo foi desenvolvido com a finalidade de avaliar a detecção dos anticorpos anti-VHA, da classe IgA, IgM, e anticorpos totais em amostras de saliva, usando amostras de soro como padrão. Foram estudadas 43 amostras pareadas de saliva e de soro, colhidas de 24 crianças e de um adulto durante um surto de hepatite A, e de 18 funcionários do Instituto Adolfo Lutz. Empregando saliva como amostra clínica, a sensibilidade para a detecção de anti-VHA IgM foi de 100,0%, de anti-VHA IgA foi de 80,8% e de anti-VHA total foi de 82,1%. Não houve nenhum resultado falso-positivo, sendo a especificidade de 100%. A concordância foi alta entre os resultados das amostras de saliva e soro na detecção dos anticorpos, indicando que amostras de saliva podem ser utilizadas no diagnóstico de infecção aguda pelo VHA e na seleção de indivíduos para vacinação contra o VHA, para conter surtos.

The possibility of detecting acute infection and immunity using body fluids that are easier to collect than blood, mainly in children, would facilitate the investigation and follow-up of outbreaks of hepatitis A (HAV). Our study was carried out to evaluate the detection of anti-HAV IgM, IgA and total antibodies in saliva using serum samples as reference. Forty three paired serum and saliva samples were analyzed. From this total, 24 samples were obtained from children and 1 from one adult during the course of acute hepatitis A; an additional 18 samples were obtained from health professionals from Adolfo Lutz Institute. The sensitivity to detect anti-HAV IgM was 100% (95%CI: 79.1 to 100.0%), employing saliva as clinical samples. In detecting anti-HAV IgA, the sensitivity was 80.8% (95%CI: 60.0 to 92.7%) and for the total antibodies was 82.1% (95%CI: 62.4 to 93.2%). The specificity was 100% for each. The rate of agreement was high comparing the results of serum and saliva samples for detecting HAV antibodies. We conclude that saliva is an acceptable alternative specimen for diagnosing acute hepatitis A infection, and for screening individuals to receive hepatitis A vaccine or immunoglobulin.

A hepatite B é doença de graves consequências quando adquirida no período neonatal. No entanto, a identificação das gestantes, com risco de transmitirem a infecção a seus filhos, pode prevenir essas consequências através da imunização, passiva e ativa, dos bebês logo após o nascimento. Foram estudadas 477 gestantes de primeira consulta atendidas no período de abril a outubro de 1988 nos oito Centros de Saúde da rede estadual que abrangem o subdistrito do Butantan, região oeste do município de São Paulo, considerada carente de infra-estrutura básica. As 477 amostras de soro foram ensaiadas quanto à presença do marcador anti-HBc total, que permite detectar os casos assintomáticos, crônicos e em fase de convalescença. As 44 (9,2%) gestantes positivas para esse marcador foram ensaiadas para os marcadores anti-HBs e HbsAg. Dessas 44 amostras, 2 (0,4%) foram positivas para o HBsAg e 37 (7,7%) positivas para anti-HBs. Do universo de 477 gestantes, 47 apresentaram no inquérito a que foram submetidas respostas indicativas de fatores de risco para hepatite, mas apenas 8 (17,0%) delas faziam parte do grupo de gestantes anti-HBc positivas, 2 delas HBsAg positivas

Hepatitis B is a severe disease when acquired during the neonatal period. The identification of the infected pregnant women allows prevention of newborn infection by active and passive immunization soon after birth. We studied pregnant women in their first visit to eight different primary medical centers in Butantan, a subdistrict of S. Paulo city. 477 samples were tested for anti-HBc. From 44 (9.2%) anti-HBc positive samples, 2 (0.4%) were HBsAg positive and 37 (7.7%) were anti-HBs positive. A risk factor for hepatitis B could only be detected in 8 (18.9%) of the 44 anti-HBc positive samples