Skip to main content
Log in

The aetiology of acute hepatitis in Taiwan: Acute hepatitis superimposed on HBsAg carrier state as the main aetiology of acute hepatitis in areas with high HBsAg carrier rate

Ätiologie der akuten Hepatitis in Taiwan: In Gegenden mit hoher HBsAg-Carrier-Rate ist die auf den Trägerstatus aufgepfropfte akute Hepatitis am häufigsten

  • Originalia
  • Published:
Infection Aims and scope Submit manuscript

Summary

The aetiology of sporadic acute hepatitis in Taiwan was studied in a consecutive series of 273 patients, 209 males and 64 females, aged from <1 to 73 years. Only eight patients (2.9%) had acute hepatitis A, 36 (13.2%) acute hepatitis B and 57 (20.9%) had acute non-A, non-B hepatitis (NANB). The remaining 172 patients (63.0%) were HBsAg positive but anti-HBc IgM negative and were classified as acute hepatitis in chronic HBsAg carriers. Age-specific analysis revealed that acute hepatitis types A and B accounted for 35% and 47%, respectively of acute hepatitis in patients below age 10, but their prevalence decreased dramatically with increasing age and remained quite low in patients over age 40. In contrast, acute hepatitis NANB occurred predominantly in the older patients. The prevalence of acute hepatitis NANB was 11 to 15% in patients below age 40, but increased gradually with increasing age thereafter. Of the patients over age 60, 58% had acute hepatitis NANB. Acute hepatitis in chronic HBsAg carriers accounted for 59 to 76% of acute hepatitis episodes in patients over age 10 and below age 60. Sex-specific analysis revealed that the prevalence of acute hepatitis A or B showed no significant sex difference, whereas acute hepatitis in chronic HBsAg carriers occurred predominantly in males and acute hepatitis NANB occurred predominantly in females. Of the acute hepatitis episodes in chronic HBsAg carriers about one-third was due to hepatitis Delta virus superinfection, while the remaining two-thirds were most likely acute exacerbations of the underlying hepatitis B virus infection and a few were due to non-A, non-B hepatitis superinfection.

Zusammenfassung

Bei 273 aufeinanderfolgenden Patienten wurde eine Studie zur Ätiologie der sporadisch auftretenden akuten Hepatitis in Taiwan durchgeführt. 209 Patienten waren Männer, 64 waren Frauen, das Alter lag zwischen 1 und 73 Jahren. Nur acht Patienten (2.9%) hatten eine akute Hepatitis A, 36 (13.2%) eine akute Hepatitis B und 57 (20.9%) eine akute Non-A, Non-B (NANB)-Hepatitis. Die übrigen 172 Patienten (63.0%) waren HBsAg positiv, aber anti-HBc IgM negativ und wurden als Fall von akuter Hepatitis bei chronischem HBsAg-Trägerstatus eingeordnet. Die altersbezogene Analyse deckte auf, daß 35% der akuten Hepatitisfälle bei Patienten unter zehn Jahren durch HAV und 47% durch HBV ausgelöst waren. Die Prävalenz dieser Formen nahm mit zunehmendem Alter rasch ab, sie blieb bei Patienten über 40 in einem niedrigen Bereich. Dagegen trat die akute NANB-Hepatitis vorwiegend bei älteren Patienten auf. Bei den Patienten unter 40 Jahren wurden 11 bis 15% der akuten Hepatitiden durch NANB-Viren ausgelöst, danach trat eine allmähliche Zunahme auf. Bei Patienten über 60 Jahre waren NANB-Viren für 58% der Fälle von akuter Hepatitis verantwortlich gemacht worden. Bei Patienten zwischen 10 und 60 Jahren wurde die akute Hepatitis in 59 bis 76% der Fälle als akute Hepatitis bei chronischem HBsAg-Trägertum klassifiziert. Für die akute Hepatitis A oder B ergaben sich keine signifikanten geschlechtsspezifischen Unterschiede; die akute Hepatitis bei chronischem HBsAg-Trägertum trat vorwiegend bei Männern und die akute NANB-Hepatitis vorwiegend bei Frauen auf. Als Ursache für die akute Hepatitis bei chronischen HBsAg-Trägern wurde in etwa einem Drittel der Fälle eine Superinfektion mit dem Hepatitis-Delta-Virus erkannt, zwei Drittel waren höchstwahrscheinlich akute Exazerbationen der Grundkrankheit durch HBV, und nur wenige waren auf eine Superinfektion durch NANB-Viren zurückzuführen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dienstag, J. L., Alaama, A., Mosley, J. W., Redeker, A. G., Purcell, R. Etiology of sporadic hepatitis B surface antigen-negative hepatitis. Ann. Intern. Med. 87 (1977) 1–6.

    Google Scholar 

  2. Norkrans, G., Frösner, G., Hermodsson, S., Nenonen, N., Iwarson, S. The epidemiological pattern of hepatitis A, B and non-A, non-B in Sweden. Scand. J. Gastroenterol. 13 (1978) 873–877.

    Google Scholar 

  3. Mathiesen, L. R., Skinhoj, P., Hardt, F., Neilsen, J. O., Sloth, K., Zoffmann, H., Moller, A. M., Wong, D., Purcell, R. H. Epidemiology and clinical characteristics of acute hepatitis type A, B and non-A, non-B. Scand. J. Gastroenterol. 14 (1979) 849–856.

    Google Scholar 

  4. Farrow, L. J., Stewart, J. S., Stern, H., Clifford, R. E., Smith, H. G., Zuckerman, A. J. Non-A, non-B hepatitis in West London. Lancet I (1981) 982–984.

    Google Scholar 

  5. Caredda, F., D'Arminio Monforte, A., Rossi, E., Lopez, S., Moroni, M. Non-A, non-B hepatitis in Milan. Lancet II (1981) 48.

    Google Scholar 

  6. Chan, S. H., Oon, C. J., Seah, C. S. Acute viral hepatitis in Singapore. Lancet II (1981) 469.

    Google Scholar 

  7. Liaw, Y. F., Chu, C. M., Huang, M. J., Chen, T. J., Lin, D. Y. The etiology of acute viral hepatitis in an endemic area of hepatitis A and B. Am. J. Trop. Med. Hyg. 32 (1983) 1401–1406.

    Google Scholar 

  8. Kryger, P., Mathiesen, L. R., Aldershvile, J., Nielsen, J. O., andThe Copenhagen Hepatitis Acuta Programme. Presence and meaning of anti-HBc IgM as determined by ELISA in patients with acute type B hepatitis and healthy HBsAg carriers. Hepatology 1 (1981) 233–237.

    Google Scholar 

  9. Bortolotti, F., Bertaggia, A., Crivellaro, C., Armigliato, M., Alberti, A., Pontisso, P., Chemello, C., Realdi, G. Chronic evolution of acute hepatitis type B: Prevalence and predictive markers. Infection 14 (1986) 64–67.

    Google Scholar 

  10. Roumeliotou-Karayannis, A., Tassopoulo, N., Richardson, S. C., Kalafatas, P., Papaevangelou, G. How often does chronic liver disease follow acute hepatitis B in adults. Infection 14 (1985) 174–176.

    Google Scholar 

  11. Hoofnagle, J. H., Ponzetto, A., Methiesen, L. R., Waggoner, J. E., Bales, Z. B., Seeff, L. B. Serological diagnosis of acute viral hepatitis. Dig. Dis. Sci. 30 (1985) 1022–1027.

    Google Scholar 

  12. Hoofnagle, J. H. Serodiagnosis of acute viral hepatitis. Hepatology 3 (1983) 267–268.

    Google Scholar 

  13. Chu, C. M., Liaw, Y. F., Yang, C. S., Sheen, I. S. Diagnosis of acute type B hepatitis by a solid phase u-antibody capture radioimmunoassay for IgM antibody to hepatitis B core antigen: A diagnostic proposal based on a prospective study. Liver 7 (1987) 182–187.

    Google Scholar 

  14. Wu, J. S., Chen, C. H., Chiang, Y. H., Lee, Y. C., Lee, M. H., Ko, Y. C., Hu, H. T. Hepatitis A virus infection in Taiwan. J. Formosan Med. Assoc. 79 (1980) 694–699.

    Google Scholar 

  15. Sung, J. L., Chen, D. S., Lai, M. Y., Yu, J. Y., Wang, T. H., Wang, C. Y., Lee, C. Y., Chen, S. H., Ko, T. M. Epidemiological study on hepatitis B virus infection in Taiwan. Chin. J. Gastroenterol. 1 (1984) 1–9.

    Google Scholar 

  16. Chu, C. M., Farci, P., Liaw, Y. F., Balestrieri, A., Thomas, H. C. The role of delta superinfection in acute exacerbations of chronic type B hepatitis. Liver 6 (1986) 26–29.

    Google Scholar 

  17. Farci, P., Gerin, J. L., Argona, M., Lindsey, I., Crivelli, O., Balestrieri, A., Smedile, A., Thomas, H. C., Rizzetto, M. Diagnostic and prognostic significance of IgM antibody to hepatitis Delta virus. J. Amer. Med. Assoc. 255 (1986) 1443–1446.

    Google Scholar 

  18. Liaw, Y. F., Lin, H. H., Chu, C. M., Sheen, I. S., Huang, M. J. Hepatitis delta virus infection in Taiwan. In:Rizzetto, M., Gerin, J. L., Purcell, R. H. (eds). The hepatitis delta virus and its infection. Alan R. Liss, Inc., New York, 1987, pp. 479–483.

    Google Scholar 

  19. Chu, C. M., Liaw, Y. F., Sheen, I. S., Chen, T. J. Correlation of age with the status of hepatitis B virus replication and histological changes in chronic type B hepatitis. Liver 5 (1985) 117–122.

    Google Scholar 

  20. Chu, C. M., Karayannis, P., Fowler, M. J. F., Monjardino, J., Liaw, Y. F., Thomas, H. C. Natural history of chronic hepatitis B virus infection in Taiwan: Studies of hepatitis B virus DNA in serum. Hepatology 5 (1985) 431–434.

    Google Scholar 

  21. Chu, C. M., Liaw, Y. F., Sheen, I. S., Lin, D. Y., Huang, M. J. Sex difference in chronic hepatitis B virus infection: An appraisal based on the status of hepatitis B e antigen and antibody. Hepatology 3 (1983) 947–950.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chu, C.M., Sheen, I.S. & Liaw, Y.F. The aetiology of acute hepatitis in Taiwan: Acute hepatitis superimposed on HBsAg carrier state as the main aetiology of acute hepatitis in areas with high HBsAg carrier rate. Infection 16, 233–237 (1988). https://doi.org/10.1007/BF01650760

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01650760

Keywords

Navigation