Volume 87, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Individuals from three isolated, rural communities in the western Brazilian Amazon were evaluated for serological markers of hepatitis B virus (HBV) infection, HBV genotype, and the presence of risk factors for infection and transmission. Of the 225 individuals studied, 79.1% had serological evidence of HBV infection; 10.2% individuals were chronic carriers for HBV surface antigen (HBsAg-positive). Analysis of risk factors indicates that HBV is transmitted mainly horizontally within the family from a chronic “active” carrier for hepatitis B “e” antigen (HBeAg-positive), though a strong possibility of vertical transmission remains. The predominance of HBV genotype F, with a higher genomic similarity between the isolates, indicated a relatively recent introduction of HBV, from a common source, to the area. This study sheds light on the HBV epidemiology in the Brazilian Amazon region and highlights the need for greater emphasis on HBV control and immunization programs.


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  1. World Health Organization, 2002. Hepatitis B. Available at: http://www.who.int/csr/disease/hepatitis/HepatitisB_whocdscsrlyo2002_2.pdf. Accessed November 16, 2011.
  2. Braga WS, Brasil LM, Souza RA, Melo MS, Rosas MD, Castilho MC, Fonseca JC, , 2004. Prevalência da infecção pelos vírus da hepatite B (VHB) e da hepatite D (VHD) em Lábrea, Rio Purus, Estado do Amazonas. Epidemiologia e Serviços de Saúde 13: 3546.
  3. Parana R, Almeida D, , 2005. HBV epidemiology in Latin America. J Clin Virol 34 (Suppl 1): S130S133.[Crossref]
  4. Devesa M, Pujol FH, , 2007. Hepatitis B virus genetic diversity in Latin America. Virus Res 127: 177184.[Crossref]
  5. Bensabath G, Hadler SC, Soares MC, Fields H, Dias LB, Popper H, Maynard JE, , 1987. Hepatitis Delta virus infection and Lábrea hepatitis. Prevalence and role in fulminant hepatitis in the Amazon basin. JAMA 258: 479483.[Crossref]
  6. Brasil LM, da Fonseca JC, de Souza RB, Braga WS, Toledo LM, , 2003. Prevalence of hepatitis B virus markers within household contacts in the state of Amazonas. Rev Soc Bras Med Trop 36: 565570.[Crossref]
  7. Lobato C, Tavares-Neto J, Rios-Leite M, Trepo C, Vitvitski L, Parvaz P, Zoulim F, D'Oliveira A, Jr Paraná R, , 2006. Intrafamilial prevalence of hepatitis B virus in Western Brazilian Amazon region: epidemiologic and biomolecular study. J Gastroenterol Hepatol 21: 863868.[Crossref]
  8. Echevarria JM, Avellon A, , 2006. Hepatitis B virus genetic diversity. J Med Virol 78 (Suppl 1): S36S42.[Crossref]
  9. Kurbanov F, Tanaka Y, Mizokami M, , 2010. Geographical and genetic diversity of the human hepatitis B virus. Hepatol Res 40: 1430.[Crossref]
  10. Kao JH, , 2011. Molecular epidemiology of hepatitis B virus. Korean J Intern Med 26: 255261.[Crossref]
  11. Norder H, Couroucé AM, Coursaget P, Echevarri JM, Lee SD, Mushahwar IK, Robertson BH, Locarnini S, Magnius LO, , 2004. Genetic diversity of hepatitis B virus strains derived worldwide: genotypes, subgenotypes, and HBsAg subtypes. Intervirology 47: 289309.[Crossref]
  12. Campos RH, Mbayed VA, Pineiro y Leone FG, , 2005. Molecular epidemiology of hepatitis B virus in Latin America. J Clin Virol 34 (Suppl 2): S8S13.[Crossref]
  13. Candotti D, Danso K, Allain JP, , 2007. Maternofetal transmission of hepatitis B virus genotype E in Ghana, West Africa. J Gen Virol 88: 26862695.[Crossref]
  14. Veldhuijzen IK, Mes TH, Mostert MC, Niesters HG, Pas SD, Voermans J, de Man RA, Götz HM, van Doornum GJ, Richardus JH, , 2009. An improved approach to identify epidemiological and phylogenetic transmission pairs of source and contact tracing of hepatitis B. J Med Virol 81: 425434.[Crossref]
  15. Braga WS, Castilho MC, Borges FG, Martinho AC, Rodrigues IS, Azevedo EP, Scazufca M, Menezes PR, , 2012. Prevalence of hepatitis B virus infection and carriage after nineteen years of vaccination program in the Western Brazilian Amazon. Rev Soc Bras Med Trop 45: 1317.[Crossref]
  16. World Health Organization, 2011. Programmes and Projects – Immunization Service Delivery and Accelerated Disease Control – New Vaccines and Technologies – Hepatitis B. Available at: http://www.who.int/immunization_delivery/new_vaccines/hepb/en/index.html. Accessed November 16, 2011.
  17. Oliveira CM, Farias IP, Ferraz da Fonseca JC, Brasil LM, de Souza R, Astolfi-Filho S, , 2008. Phylogeny and molecular genetic parameters of different stages of hepatitis B virus infection in patients from the Brazilian Amazon. Arch Virol 153: 823830.[Crossref]
  18. Hall TA, , 1999. BioEdit: a user-friendly biological sequence alignment editor and analysis program. Nucleic Acids Symposium Series 41: 9598.
  19. Kumar S, Tamura K, Jakobsen IB, Nei M, , 2001. Mega2. Molecular 18 (Suppl 1): 1719.
  20. Centers for Disease Control and Prevention, 2005. Epi Info statistical software [computer program]. Version 3.3.2. Atlanta, GA.
  21. StataCorp, 2006. Stata Statistical software [computer program]. Release IC 10.0. College Station, TX: StataCorp.
  22. Bensabath G, Boshel J, , 1973. Presença do antígeno “Australia” (Ag) em populações do interior do Estado do Amazonas-Brasil. Rev Inst Med Trop Sao Paulo 15: 284288.
  23. Fonseca JC, Simonetti SR, Schatzmayr HG, Castejon MJ, Cesario AL, Simonetti JP, , 1988. Prevalence of infection with hepatitis delta virus (HDV) among carriers of hepatitis B surface antigen in Amazonas State, Brazil. Trans R Soc Trop Med Hyg 82: 469471.[Crossref]
  24. Braga WSM, Brasil LM, Souza RAB, Castilho MC, Fonseca JC, , 2001. Ocorrência da infecção pelo vírus da hepatite B (VHB) e delta (VHD) em sete grupos indígenas do Estado do Amazonas. Rev Soc Bras Med Trop 34: 349355.[Crossref]
  25. Paula VS, Arruda ME, Vitral CL, Gaspar AM, , 2001. Seroprevalence of viral hepatitis in riverine communities from the Western Region of the Brazilian Amazon Basin. Mem Inst Oswaldo Cruz 96: 11231128.[Crossref]
  26. Viana S, Parana R, Moreira RC, Compri AP, Macedo V, , 2005. High prevalence of hepatitis B virus and hepatitis D virus in the western Brazilian Amazon. Am J Trop Med Hyg 73: 808814.
  27. Tanaka J, , 2000. Hepatitis B epidemiology in Latin America. Vaccine 18 (Suppl 1): S17S19.[Crossref]
  28. Alvarado-Mora MV, Fernandez MF, Gomes-Gouvêa MS, de Azevedo Neto RS, Carrilho FJ, Pinho JR, , 2011. Hepatitis B (HBV), hepatitis C (HCV) and hepatitis delta (HDV) viruses in the Colombian population-how is the epidemiological situation? PLoS ONE 29: e18888.[Crossref]
  29. Zhang H, Li Q, Sun J, Wang C, Gu Q, Feng X, Du B, Wang W, Shi X, Zhang S, Li W, Jiang Y, Feng J, He S, Niu J, , 2011. Seroprevalence and risk factors for hepatitis B infection in an adult population in northeast China. Int J Med Sci 8: 321331.[Crossref]
  30. Liang X, Bi S, Yang W, Wang L, Cui G, Cui F, Zhang Y, Liu J, Gong X, Chen Y, Wang F, Zheng H, Wang F, Guo J, Jia Z, Ma J, Wang H, Luo H, Li L, Jin S, Hadler SC, Wang Y, , 2009. Epidemiological serosurvey of hepatitis B in China-declining HBV prevalence due to hepatitis B vaccination. Vaccine 27: 65506557.[Crossref]
  31. Komas NP, Baï-Sepou S, Manirakiza A, Léal J, Béré A, Le Faou A, , 2010. The prevalence of hepatitis B virus markers in a cohort of students in Bangui, Central African Republic. BMC Infect Dis 10: 226.[Crossref]
  32. Chongsrisawat V, Yoocharoen P, Theamboonlers A, Tharmaphornpilas P, Warinsathien P, Sinlaparatsamee S, Paupunwatana S, Chaiear K, Khwanjaipanich S, Poovorawan Y, , 2006. Hepatitis B seroprevalence in Thailand: 12 years after hepatitis B vaccine integration into the national expanded program on immunization. Trop Med Int Health 11: 14961502.[Crossref]
  33. Ni YH, Huang LM, Chang MH, Yen CJ, Lu CY, You SL, Kao JH, Lin YC, Chen HL, Hsu HY, Chen DS, , 2007. Two decades of universal hepatitis B vaccination in Taiwan: impact and implication for future strategies. Gastroenterology 132: 12871293.[Crossref]
  34. Hoz F, Perez L, Neira M, Hall AJ, , 2008. Eight years of hepatitis B vaccination in Colombia with a recombinant vaccine: factors influencing hepatitis B infection and effectiveness. Int J Infect Dis 12: 183189.[Crossref]
  35. Hu ZH, Qu ZY, Jing Q, Ding ZR, Bai ZY, Cao LZ, , 1986. The overall infection rate of HBV in Chinese general population by sampling investigation. Chin J Microbiol Immunol 6: S70S77.
  36. Arboleda M, Castilho MC, Fonseca JC, Albuquerque BC, Saboia RC, Yoshida CF, , 1995. Epidemiological aspects of hepatitis B and D virus infection in the northern region of Amazonas, Brazil. Trans R Soc Trop Med Hyg 89: 481483.[Crossref]
  37. Guan R, , 1996. Hepatitis B virus infection in Singapore. Gut 38 (Suppl 2): S13S17.[Crossref]
  38. Tavares-Neto J, Almeida D, Soares MC, Uchoa R, Viana S, Darub R, Farias E, Rocha G, Vitvitski L, Parana R, , 2004. Seroprevalence of hepatitis B and C in the Western Brazilian Amazon region (Rio Branco, Acre): a pilot study carried out during a hepatitis B vaccination program. Braz J Infect Dis 8: 133139.[Crossref]
  39. Scheiblauer H, El-Nageh M, Diaz S, Nick S, Zeichhardt H, Grunert H-P, Prince A, , 2010. Performance evaluation of 70 hepatitis B virus (HBV) surface antigen (HBsAg) assays from around the world by a geographically diverse panel with an array of HBV genotypes and HBsAg subtypes. Vox Sang 98: 403414.[Crossref]
  40. Zhou Y, Wang H, Zheng J, Zhu X, Xia W, Hipgrave DB, , 2009. Coverage of and influences on timely administration of hepatitis B vaccine birth dose in remote rural areas of the People's Republic of China. Am J Trop Med Hyg 81: 869874.[Crossref]
  41. Torbenson M, Thomas DL, , 2002. Occult hepatitis B. Lancet Infect Dis 2: 479486.[Crossref]
  42. Biswas D, Borkakoty BJ, Mahanta J, Jampa L, Deouri LC, , 2007. Hyperendemic foci of hepatitis B infection in Arunachal Pradesh, India. J Assoc Physicians India 55: 701704.
  43. Ranger-Rogez S, Denis F, , 2004. Hepatitis B mother-to-child transmission. Expert Rev Anti Infect Ther 2: 133145.[Crossref]
  44. Walz A, Wirth S, Hucke J, Gerner P, , 2009. Vertical transmission of hepatitis B virus (HBV) from mothers negative for HBV surface antigen and positive for antibody to HBV core antigen. J Infect Dis 200: 12271231.[Crossref]
  45. Devesa M, Loureiro CL, Rivas Y, Monsalve F, Cardona N, Duarte MC, Poblete F, Gutierrez MF, Botto C, Pujol FH, , 2008. Subgenotype diversity of hepatitis B Virus American genotype F in Amerindians from Venezuela and the general population of Colombia. J Med Virol 80: 2026.[Crossref]
  46. Alvarado Mora MV, Romano CM, Gomes-Gouvêa MS, Gutierrez MF, Botelho L, Carrilho FJ, Pinho JR, , 2011. Molecular characterization of the hepatitis B virus genotypes in Colombia: a Bayesian inference on the genotype F. Infect Genet Evol 11: 103108.[Crossref]
  47. Kiesslich D, Crispim MA, Santos C, Ferreira FL, Fraiji NA, Komninakis SV, Diaz RS, , 2009. Influence of hepatitis B virus (HBV) genotype on the clinical course of diseases in patients coinfected with HBV and hepatitis Delta virus. J Infect Dis 199: 16081611.[Crossref]
  48. Santos AO, Alvarado-Mora MV, Botelho L, Vieira DS, Pinho JR, Carrilho FJ, Honda ER, Salcedo JM, , 2010. Characterization of hepatitis B virus (HBV) genotypes in patients from Rondônia, Brazil. Virol J 7: 315.[Crossref]
  49. Dias AL, Oliveira CM, Castilho MC, Silva MS, Braga WS, , 2012. Molecular characterization of the hepatitis B virus in autochthonous and endogenous populations in the Western Brazilian Amazon. Rev Soc Bras Med Trop 45: 912.[Crossref]
  50. Hadziyannis SJ, , 2011. Natural history of chronic hepatitis B in Euro-Mediterranean and African countries. J Hepatol 55: 183191.[Crossref]
  51. Karam JT, , 2004. A cultural politics of entrepreneurship in nation-making: Phoenicians, Turks, and the Arab Commercial Essence in Brazil. J Lat Am Anthropol 9: 319351.[Crossref]
  52. Casey JL, Niro GA, Engle RE, Vega A, Gomez H, McCarthy M, Watts DM, Hyams KC, Gerin JL, , 1996. Hepatitis B virus (HBV)/hepatitis D virus (HDV) coinfection in outbreaks of acute hepatitis in the Peruvian Amazon basin: the roles of HDV genotype III and HBV genotype F. J Infect Dis 174: 920926.[Crossref]
  53. Manock SR, Kelley PM, Hyams KC, Douce R, Smalligan RD, Watts DM, Sharp TW, Casey JL, Gerin JL, Engle R, Alava-Alprecht A, Martínez CM, Bravo NB, Guevara AG, Russell KL, Mendoza W, Vimos C, , 2000. An outbreak of fulminant hepatitis delta in the Waorani, an indigenous people of the Amazon basin of Ecuador. Am J Trop Med Hyg 63: 209213.
  54. Rizzetto M, , 2009. Hepatitis D: thirty years after. J Hepatol 50: 10431050.[Crossref]
  55. Hughes SA, Wedemeyer H, Harrison PM, , 2011. Hepatitis delta virus. Lancet 378: 7385.[Crossref]
  56. Braga WS, Castilho MC, Borges FG, Leão JR, Martinho AC, Rodrigues IS, Azevedo EP, Parana R, , 2012. Hepatitis D virus infection in the western Brazilian Amazon – far from a vanishing disease. Rev Soc Bras Med Trop (in press).
  57. Pollicino T, Raffa G, Santantonio T, Gaeta GB, Iannello G, Alibrandi A, Squadrito G, Cacciola I, Calvi C, Colucci G, Levrero M, Raimondo G, , 2011. Replicative and transcriptional activities of hepatitis B virus in patients coinfected with hepatitis B and hepatitis delta viruses. J Virol 85: 432439.[Crossref]
  58. Mumtaz K, Ahmed US, Memon S, Khawaja A, Usmani MT, Moatter T, Hamid S, Jafri W, , 2011. Virological and clinical characteristics of hepatitis delta virus in South Asia. Virol J 8: 312.[Crossref]
  59. Yuen MF, Tanaka Y, Fong DY, Fung J, Wong DK, Yuen JC, But DY, Chan AO, Wong BC, Mizokami M, Lai CL, , 2009. Independent risk factors and predictive score for the development of hepatocellular carcinoma in chronic hepatitis B. J Hepatol 50: 8088.[Crossref]
  60. Kim YO, , 2004. Access to hepatitis B vaccination among Korean American children in immigrant families. J Health Care Poor Underserved 15: 170182.[Crossref]
  61. Macpherson DW, Gushulak BD, Macdonald L, , 2007. Health and foreign policy: influences of migration and population mobility. Bull World Health Organ 85: 200206.[Crossref]
  62. Gushulak BD, MacPherson DW, , 2004. Globalization of infectious diseases: the impact of migration. Clin Infect Dis 38: 17421748.[Crossref]

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  • Received : 04 Feb 2012
  • Accepted : 21 Jul 2012

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