Lifrarbólga A á Íslandi

Abstract

Inngangur: Faraldrar af völdum lifrarbólgu A veiru (hepatitis A virus, HAV) komu endurtekið upp á Íslandi á fyrrihluta 20. aldar en síðan þá hafa fá tilfelli greinst og engir þekktir faraldrar komið upp síðan 1952. Síðustu íslensku rannsóknir á lifrarbólgu A frá því um 1990 sýndu lágt nýgengi sýkingar og lækkandi algengi mótefna. Markmið rannsóknarinnar var að kanna nýgengi og birtingarmynd lifrarbólgu A á Íslandi og uppruna smits, er­lendis eða innanlands. Efniviður og aðferðir: Klínískum upplýsingum var safnað afturskyggnt úr sjúkraskrám um einkenni við greiningu, blóðprufuniðurstöður og mögulegar smitleiðir hjá öllum einstaklingum með jákvæð lifrarbólgu A IgM mótefni í gagnagrunni veirufræðideildar Landspítala á 11 ára tímabili, 2006-2016. Niðurstöður: Alls greindust 12 manns með bráða lifrarbólgu A á tímabilinu en framkvæmdar voru 6691 mæling á heildarmótefnum og 1984 mælingar á IgM mótefnum. Níu (75%) höfðu verið erlendis innan 7 vikna frá upphafi einkenna. Algengustu einkennin voru gula (10/12, 83%), hiti (67%) og ógleði og/eða uppköst (58%). Alls lögðust 50% inn á sjúkrahús og 42% fengu hækkun á INR/PT. Allir lifðu af sýkinguna án fylgikvilla. Ályktun: Að meðaltali greindist um eitt tilfelli af bráðri lifrarbólgu A árlega á Íslandi en mjög margar mótefnamælingar voru gerðar. Mikill meirihluti tilfella greindist hjá einstaklingum sem höfðu nýlega dvalið erlendis. Ef sjúklingar hafa gulu, hita og ógleði er ástæða til að kanna lifrarbólgu A sýkingu. Lifrarbólga A er ekki landlæg á Íslandi.

Introduction: Hepatitis A virus (HAV) epidemics occurred repeatedly in Iceland in the early 20th century, but since then few cases have been reported and no epidemics since 1952. The latest Icelandic studies on HAV from around 1990 showed low incidence of infection and de-creasing prevalence of antibodies. The objective of this study was to determine the incidence, clinical presentation and origin of HAV, abroad or in Iceland. Material and methods: A retrospective search was undertaken on all patients with positive anti-HAV IgM during the 11 years period of 2006-2016 in the virological database of the National University Hospital of Iceland. Clinical data was collected from medical records on symptoms at diagnosis, blood test results and possible route of transmission. Results: A total of 12 individuals were diagnosed with acute hepatitis A during the period and 6691 HAV total andibody tests and 1984 HAV IgM antibody tests were performed. Nine (75%) had been abroad within 7 weeks from initial symptoms. The most common symptoms were jaundice (83%), fever (67%) and nausea and/or vomiting (58%). 50% were admitted to a hospital. 42% had elevated INR/PT. Everyone survived without complications. Conclusion: Annually, approximately one case of acute hepatitis A was diagnosed in Iceland during the study period but a very high number of antibody tests were performed. The majority of cases occurred among individuals who had recently been abroad. If patients have jaundice, fever and nausea, testing for HAV infection should be undertaken. HAV is not endemic in Iceland.