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November 1991, Volume 41, Issue 11

Short Reports

SPECTRUM OF VIRAL HEPATITIS

Sarwar J. Zuberi  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
Tariq Z. Lodi  ( PMRC Research centre, Jinnah Postgraduate Medical centre, Karachi. )
S. Ejaz Alam  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )

The frequency of different types of hepatitis varies in various countries1,2 and from one part of the country to the other. To evolve a strategy for the control of hepatitis variations in the pattern of disease should be known. Observed frequency of different types of hepatitis and the comparison with other series3,4 is presented in this report.

PATIENTS, METHODS AND RESULTS

One hundred and sixty three cases of sporadic acute viral hepatitis were included in this study. Clinical diagnosis in all cases was supported by laboratory evidence of hepatocellular necrosis (AST/ALT levels 2.5 times the upper limit of normal). Sera collected in acute phase and stored at -20°C were analysed for various seromarkers of hepatitis using radioimmunoassay techni­que (Abbott Laboratories, Chicago, Illinois). Hepatitis A was serologically diagnosed by the presence of 1gM antibody to hepatis A virus (1 gM anti HAV) and hepatitis B, if hepatitis B surface antigen (HBsAg) and 1gM antibody to hepatitis B core antigen (anti HBc1gM) were positive. If all markers were negative the disease was diagnosed as NANB hepatitis. Chi square and student’s 't' tests were used for statistical analysis. Frequency of various types of hepatitis in the present study is compared with reported series from northern Pakistan3,4 (Table).

There was no difference in the pattern of hepatitis in children but in adults, significant differences were observed. Hepatitis B was more frequent in Karachi and NANB in northern Pakis­tan.

COMMENTS

Early exposures to hepatitis A virus in Pakistan causes disease in children under 5 years. Ninety six to 100% of adults are immune to hepatitis A5,6. Pattern of hepatitis A is similar in children and adults throughout the country. Significant differences were however, ob­served in hepatitis B and NANB in northern Pakistan3,4 and Karachi. Lack of reliability and accessibility of drinking water, pattern of drainage and sewage disposal personal, domestic and food hygiene is similar throughout the country so the differences observed may be due to the difference in patients selected for the study, i.e., army personnel and their families in northern Pakistan and referred cases to a speciality unit in a general hospital. Living conditions of army personnel and injection and transfusion practices in army hospitals may be better than those of small clinics and general hospitals in Karachi. Seroepidemiological studies on a large popula­tion based samples of hepatitis cases from various areas of the country should be done to define the pattern and determine the causes of difference if any in various areas.

REFERENCES

1. Khuroo, M.S. Study of an epidemic of Non A Noo B hepatitis. Poasibility of another human hepatitis virus distinct from post. transfution Non A Non B type. Am. 3. Med., 1980;68:818.
2. Hoofnagle, J.H. Viral hepatitis, in currentconcepta ofinfectious disease. Edited by E.W. Hook etal. New York, Willy, 1977, p.243.
3. Malik, IA., Anwar, CM., Lutiman, M., Ahmad, A., Surfaraz, T. and Qamar, M.A. The pattern of acute viral hepatitis in children; a study based on seroepidemiology and biochemical profile. JPMA., 1987;37:314.
4. Malik, LA., Luqman, M., Ahmad, A., Khan, A. and Legters, L.J. SporadicNon A Non B hepatitis; a seroepidemiological study in urban population. JPMA., 1987;37:190.
5. Lodi,T.Z. and Zuberi, S.J. Cost effective approach forserological diagnosisofhepatitis. JPMA., 1988;38:199.
6. Malik, I.A.., Legters, Li., Luqman, M., Ahmad, A., Qamar, MA., Akhtar, K.A.K., Qureshi, M.S., Duncan, F. and Redfield, R.R. The serological markeraofhepatitiaAand B in healthy population in northern Pakistan. JPMA, 1988; 38:69.

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