Intra-familial spread of acute hepatitis B virus infection.
OBJECTIVE
The prevalence and incidence rates of hepatitis B virus (HBV) infection in our general population, have been assessed as in countries with intermediate endemicity. The geographical variation in the prevalence rate of HBV infection is also known. The aim of this study was to estimate the incidence rate of HBV infection among family contacts of patients suffering from acute hepatitis B and to determine the need for immunoprophylaxis i.e. prevalence rate of HBV markers.


METHODS
In the prospective study 757 acute hepatitis B cases and their families were included. In 118 families all members were tested for HBV markers at the time of verification of HBV infection in the index case and subsequently 4 times bimonthly. Serum samples were tested for ALT/AST, and HBsAg, antiHBc IgM, anti HBs (Behring, Abbott).


RESULTS
Among 1877 family contacts of 757 index cases within a surveillance period of 1 year, 163 cases of icteric acute hepatitis B have been registered. The prevalence of HBV markers and anicteric infection were determined among 286 family contacts of 118 index cases as a representative sample for intra-familial transmission of infection. The families with other risk factors such as drug-addiction, haemodialysis, transfusion and others, were excluded. In these families we found 56 (19.58%) carriers of HBV markers and 58 (20.27%) cases of acute hepatitis B were verified, 33 (56.89%) unicteric and 25 (43.10%) icteric. When wives were taken as index cases, we found that they transmitted the infection to their husbands in 44.73% of cases vice versa 9.67%. In our study 44.56% of secondary cases were children when their mothers were suffering from acute hepatitis B.


CONCLUSIONS
According to socio-economic, ethnic and cultural characteristics of the familial way of living in Macedonia, we noticed that acute HBV infection can be transmitted within members of one family. Only a small proportion of family members, as carriers of HBV markers are considered resistant to infection. Most family members are non-resistant and immunization i.e. vaccination is seen as a very reasonable action.
Department of Viral Hepatitis, Clinic for Infectious Diseases, Sts Cyril and Methodius University, Skopje, Macedonia. ljubomiri@zim.org.mk
L J
LJ
Ivanovski
D
D
Dimitriev