Brazil is a country of continental dimension with a population of different ethnic backgrounds. Thus, a wide variation in the frequencies of hepatitis C virus (HCV) genotypes is expected to occur. To address this point, 1,688 sequential samples from chronic HCV patients were analyzed. HCV-RNA was amplified by the RT-PCR from blood samples collected from 1995 to 2000 at different laboratories located in different cities from all Brazilian States. Samples were collected in tubes containing a gel separator, centrifuged in the site of collection and sent by express mail in a refrigerated container to Laboratório Bioquímico Jardim Paulista, São Paulo, SP, Brazil. HCV-RNA was extracted from serum and submitted to RT and nested PCR using standard procedures. Nested PCR products were submitted to cycle sequencing reactions without prior purification. Sequences were analyzed for genotype determination and the following frequencies were found: 64.9% (1,095) for genotype 1, 4.6% (78) for genotype 2, 30.2% (510) for genotype 3, 0.2% (3) for genotype 4, and 0.1% (2) for genotype 5. The frequencies of HCV genotypes were statistically different among Brazilian regions (P = 0.00017). In all regions, genotype 1 was the most frequent (51.7 to 74.1%), reaching the highest value in the North; genotype 2 was more prevalent in the Center-West region (11.4%), especially in Mato Grosso State (25.8%), while genotype 3 was more common in the South (43.2%). Genotypes 4 and 5 were rarely found and only in the Southeast, in São Paulo State. The present data indicate the need for careful epidemiological surveys throughout Brazil since knowing the frequency and distribution of the genotypes would provide key information for understanding the spread of HCV.

Brazil was formerly considered a country with intermediate hepatitis B endemicity, with large heterogeneity between Brazilian regions and areas of high prevalence, especially in the Amazon basin. Systematic vaccination of children was initiated in 1998. Between 2004 and, a large population-based study reported decreased prevalence in all regions of Brazil. This review analyzed the current hepatitis B epidemiological situation in Brazil through a systematic search of the scientifi c literature in MEDLINE, LILACS, and CAPES thesis database, as well as disease notifi cations to the Information System for Notifi able Diseases. The search strategy identifi ed 87 articles and 13 theses, resulting in 100 total publications. The most recent results indicate reduced hepatitis B prevalence nationwide, classifying Brazil as having low endemicity. Most studies showed HBV carrier prevalence less than 1%. However, there are still isolated regions with increased prevalence, particularly the Amazon, as well as specifi c groups, such as homeless people in large cities and isolated Afro-descendant communities in the center of the country. This review alsao detected successful vaccination coverage reported in a few studies around the country. The prevalence of anti-HBs alone ranged from 50% to 90%. However, isolated and distant localities still have low coverage rates. This review reinforces the downward trend of hepatitis B prevalence in Brazil and the need to intensify vaccination strategies for young people and adults in specifi c regions with persisting higher HBV infection prevalence.

RESUMOIntrodução: A hanseníase é um importante problema de saúde pública. O Brasil responde por mais de 90% dos casos do continente americano. Aproximadamente, 23% dos pacientes hansenianos apresentam algum tipo de incapacidade após a alta. Métodos: Neste estudo, estimou-se a prevalência das incapacidades em 169 pacientes (94 homens e 75 mulheres) com qualquer das formas clínicas de hanseníase no município de Várzea Grande, MT, que já haviam concluído tratamento nos anos anteriores. Foi realizada entrevista e exame clínico da sensibilidade em mãos e pés mediante os filamentos de Semmes-Weinstein. Resultados: A prevalência de incapacidades na amostra analisada foi de 42,6% sendo 10,1% de grau dois. Encontrou-se relação estatisticamente significante entre maior prevalência de incapacidades e formas multibacilares de hanseníase. Desde o término do tratamento, 84 (50,2%) pacientes apresentaram piora evolutiva da sensibilidade, sendo esta piora associada à presença de lesão neural no momento do diagnóstico. Conclusões: Estes resultados enfatizam a importância de monitorar a função neural dos pacientes, muito além do momento de finalizar a poliquimioterapia, com o intuito de prevenir a aparição de incapacidades em pacientes que já receberam alta. Palavras-chaves:Hanseníase. Incapacidades. Prevalência. ABSTRACTIntroduction: Leprosy is a major public health concern. Brazil accounts for more than 90% of the cases in the Americas. Around 23% of leprosy patients present some kind of disability after discharge. Methods: In the present study, the prevalence of disabilities among 169 patients (94 men and 75 women) with any of the clinical forms of leprosy, in the municipality of Várzea Grande, Mato Grosso, was estimated. They had already completed treatment over previous years. Interviews were conducted and clinical examinations of hand and foot sensitivity using Semmes-Weinstein filaments were carried out. Results: The prevalence of disabilities among the study sample was 42.6%, among which 10.1% was grade 2. A statistically significant relationship was found between disabilities and multibacillary forms of leprosy. Since the end of the treatment, sensitivity had worsened in 84 patients (50.2%), and this was associated with presence of neural injury at the time of diagnosis. Conclusions: These results emphasize the importance of monitoring patients' neural functioning well beyond the time of concluding polychemotherapy, with the aim of preventing the appearance of disabilities among patients who have already been discharged.

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We investigated the seroprevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) infection in subjects living in the community of Manguinhos, Rio de Janeiro, Brazil, and assisted Key words: hepatitis A virus -hepatitis E virus -seroprevalence -epidemiology -Rio de Janeiro -Brazil Viral hepatitis is a public health problem worldwide. Two of the agents that cause viral hepatitis are enterically transmitted: hepatitis A virus (HAV) and hepatitis E virus (HEV).In the last years, improvements in environmental sanitation and hygienic conditions, such as piped water and sewage system, have been responsible for a decrease in the endemicity level of hepatitis A in several developing countries. In Brazil, although hepatitis A is considered an endemic disease (Pannuti et al. 1985, Abuzwaida et al. 1987, Bensabath et al. 1987, Queiroz et al. 1995, data published in recent investigations carried out in the State of Rio de Janeiro revealed a shift in the hepatitis A epidemiological pattern. Improvements in life standards of some urban populations are responsible for a decrease in antibody prevalence among children and adolescents (Vitral et al. 1998a,b).HEV infection is quite common in some geographic areas like India, Africa and Southeast Asia, where it can represent the main cause of acute hepatitis (Arankalle et al. 1995 reported in these areas (Shakhgildyan et al. 1986, CDC 1987, Belyakov et al. 1990, Zuang 1992. On the other hand, epidemiological investigations in non-endemic areas show a low, but constant presence of anti-HEV antibodies (about 1.2%) in normal human populations (Balayan et al. 1996, Psichogiou et al. 1996, Irshad 1999.In 1986, the occurrence of outbreaks of HEV infection in the Americas was recognized in Mexico (Velazquez et al. 1990). More recently, two acute cases of hepatitis E were described in Argentina (Schlauder et al. 2000). In Brazil, outbreaks of hepatitis E have never been reported, although some authors found antibodies in some population groups (Focaccia et al. 1995, Parana et al. 1997, Souto & Fontes 1998, Trinta et al. 2001.Nowadays, hepatitis A can be prevented by active immunoprophylaxis and, for a better control of infection, it is necessary to investigate its current prevalence in different areas. On the other hand, further data are needed in order to evaluate the importance of HEV infection in our country. The aim of the present study was to evaluate the prevalence of HAV and HEV infections in an area where sanitary conditions were improved over the last few years. MATERIALS AND METHODSCalculation of sample size -The minimum sample size was estimated using the formula: n = Z² P Q / d², considering as n = estimated sample size; Z = reduced variable, which value is 1,96 when alpha = 0,05; P (estimated prevalence) = probability to achieve the studied phenomenon; Q (1-P) = complement of the estimated prevalence; d (desired precision) = margin of error.

The prevalence of hepatitis A virus (HAV)

Preventing hepatitis B virus and other transfusiontransmitted infectious diseases relies on stringent blood-donor qualifications and on serological screening for infectious disease markers among potential donors. Several studies have evaluated the reduced risk of transfusion-transmitted infections that comes from screening for hepatitis B core antibody (anti-HBc) in addition to testing for hepatitis B surface antigen (HBsAg), using the currently available serologic tests (1-7) or the newly developed molecular biology assays (8-10). However, most of these analyses were based on data from regions with low hepatitis B endemicity and/or from blood banks from developed countries, where repeat donors account for the majority of the blood supply. In South America, screening for hepatitis B surface antigen (HBsAg) is mandatory (11-13). Brazil, Venezuela, and Ecuador have also introduced anti-HBc testing in recent years (11, 14).Evaluating the usefulness of anti-HBc screening is critical, particularly for Brazil and other countries that have intermediate and high hepatitis B endemicity. Reasons for this include: 1) a residual risk of transfusion hepatitis B is still present, despite the progressive improvement in the quality of the blood supply; 2) anti-HBc is the most prevalent marker among donors; and 3) anti-HBc seropositivity is the main cause of donor deferral (15, 16). Safe and affordable screening policies should be based on an analysis of the economic burden and possible blood supply shortages due to discarding anti-HBcpositive units. The epidemiologic context, donor characteristics, hepatitis B vaccine coverage, and availability and cost of serologic tests are key elements to be considered.In order to discuss the pros and cons of antiHBc screening in Brazil, we present an analysis of results from hepatitis B virus (HBV) and hepatitis C virus (HCV) serology in blood banks in that country. First, a brief description of the history and interpretation of the screening tests adopted to prevent posttransfusion hepatitis is presented. Second, hepatitis B screening data for all the regions of Brazil are reported. This overall analysis of anti-HBc screening among Brazilian blood donors can indicate the appropriateness of deferring blood units and also provide insights for research priorities to guide evidence-based policies on blood screening.