Epidemiology of acute hepatitis in the Stann Creek District of Belize, Central America
Bryan, J.P.; Reyes, L.; Hakre, S.; Gloria, R.; Kishore, G.M.; Tillett, W.; Engle, R.; Tsarev, S.; Cruess, D.; Purcell, R.H.
American Journal of Tropical Medicine and Hygiene 65(4): 318-324
2001
ISSN/ISBN: 0002-9637 PMID: 11693876 Document Number: 244638
Hepatitis is common in the Stann Creek District of southern Belize. To determine the aetiologies, incidence, and potential risk factors for acute jaundice, we conducted active surveillance for cases between 15 January 1994 and 10 May 1995. Cases of jaundice diagnosed by a physician within the previous 6 weeks were enrolled. Evaluation included a questionnaire and laboratory tests for hepatitis A, B, C, D, and E, a blood film for malaria, and a serological test for syphilis. Aetiologies of jaundice among 62 evaluable patients included acute hepatitis A, 6 (9.7%), acute hepatitis B, 49 (79.0%), hepatitis non-A-E, 2 (3.2%), and malaria, 5 (8.1%). There were no cases of acute hepatitis E. One patient each with antibody to hepatitis C and D were detected. The annualized incidence of hepatitis A was 0.26 per 1000. All cases of hepatitis A were in children 4-16 years of age. The annualized incidence of hepatitis B, 2.17 per 1000, was highest in adults aged 15-44 years (4.4 per 1000) and was higher in men (36 cases; 3.09 per 1000) than women (13 cases; 1.19 per 1000). Four (31%) of the women with hepatitis B were pregnant. The annualized incidence was significantly higher in Mestizo (6.18 per 1000) and Maya (6.79 per 1000) than Garifuna (0.38 per 1000) or Creole (0.36 per 1000). Persons with hepatitis B were significantly more likely to be born outside of Belize (82%), had been in Belize <5 years (73%), and lived and worked in rural areas (96%) than was the general population. Of those >=14 years of age with hepatitis B, only 36% were married. Few persons admitted to transfusions, tattoos, IV drug use, multiple sexual partners, visiting prostitutes, or sexually transmitted diseases. Only 1 of 49 had a reactive test for syphilis. Six patients were hospitalized (including 3 with acute hepatitis B and one with hepatitis A), and none to our knowledge died. Acute hepatitis B is the most common cause of viral hepatitis in the Stann Creek District, but the modes of transmission remain obscure. Infants, women attending prenatal clinics, and new workers are potential targets for immunization with hepatitis B vaccine.