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Ten children of the Heckmann family lining up for gamma globulin shots at the Children's Hospital, Pittsburgh, during an outbreak of jaundice (1954). Nurse administering an injection to a boy atop a table, with mother at the end of the line carrying an infant (partially out of view). (Credit: United Press.).
Source publication
Historical enquiry into diseases with morbidity or mortality predilections for particular demographic groups can permit clarification of their emergence, endemicity, and epidemicity. During community-wide outbreaks of hepatitis A in the pre-vaccine era, clinical attack rates were higher among juveniles rather than adults. In community-wide hepatiti...
Contexts in source publication
Context 1
... (<5 years) compared with older children (5-14 years). These characteristics define community-wide hepatitis A in the pre-vaccine era [10][11][12][13][14][15]. Through the greater duration of the 20th century, epidemics continued cyclically. They led to large-scale administration of pooled gamma globulin for prophylaxis of exposed contacts (Fig. 1). The epidemics were held in abeyance only in the 1990s with the introduction of routine vaccination against hepatitis A in children ...
Context 2
... (<5 years) compared with older children (5-14 years). These characteristics define community-wide hepatitis A in the pre-vaccine era [10][11][12][13][14][15]. Through the greater duration of the 20th century, epidemics continued cyclically. They led to large-scale administration of pooled gamma globulin for prophylaxis of exposed contacts (Fig. 1). The epidemics were held in abeyance only in the 1990s with the introduction of routine vaccination against hepatitis A in children ...
Context 3
... (<5 years) compared with older children (5-14 years). These characteristics define community-wide hepatitis A in the pre-vaccine era [10][11][12][13][14][15]. Through the greater duration of the 20th century, epidemics continued cyclically. They led to large-scale administration of pooled gamma globulin for prophylaxis of exposed contacts (Fig. 1). The epidemics were held in abeyance only in the 1990s with the introduction of routine vaccination against hepatitis A in children ...
Citations
... A disease with the characteristics of epidemic or infectious jaundice was described during the British-American War of 1812, but especially during the American Civil War, when 87,326 cases of jaundice were recorded by the Medical Corps of the Union Army [123]. In WWI, epidemic jaundice represented a relevant problem for the French, British, and German armies, whereas this was not the case for the US Army, and in WWII, the US Army registered over 180,000 cases of infectious jaundice, with a case-fatality rate of 0.3% [124]. ...
The environmental conditions generated by war and characterized by poverty, undernutrition, stress, difficult access to safe water and food as well as lack of environmental and personal hygiene favor the spread of many infectious diseases. Epidemic typhus, plague, malaria, cholera, typhoid fever, hepatitis, tetanus, and smallpox have nearly constantly accompanied wars, frequently deeply conditioning the outcome of battles/wars more than weapons and military strategy. At the end of the nineteenth century, with the birth of bacteriology, military medical researchers in Germany, the United Kingdom, and France were active in discovering the etiological agents of some diseases and in developing preventive vaccines. Emil von Behring, Ronald Ross and Charles Laveran, who were or served as military physicians, won the first, the second, and the seventh Nobel Prize for Physiology or Medicine for discovering passive anti-diphtheria/tetanus immunotherapy and for identifying mosquito Anopheline as a malaria vector and plasmodium as its etiological agent, respectively. Meanwhile, Major Walter Reed in the United States of America discovered the mosquito vector of yellow fever, thus paving the way for its prevention by vector control. In this work, the military relevance of some vaccine-preventable and non-vaccine-preventable infectious diseases, as well as of biological weapons, and the military contributions to their control will be described. Currently, the civil–military medical collaboration is getting closer and becoming interdependent, from research and development for the prevention of infectious diseases to disasters and emergencies management, as recently demonstrated in Ebola and Zika outbreaks and the COVID-19 pandemic, even with the high biocontainment aeromedical evacuation, in a sort of global health diplomacy.
... 3,4 HAV is mainly (but not exclusively) transmitted through the fecal-oral route and causes epidemics, as well as sporadic, anicteric, or icteric hepatitis. 2,[5][6][7][8][9][10][11][12][13][14] The disease burden of HAV infection in industrial countries has been declining during the past two decades (Fig. 2) because of improved sanitary and socioeconomic conditions, as well as the introduction of several efficacious vaccines in regions where immunization rates are relatively high. 15 Despite a global trend for a declining incidence of acute HAV infection, HAV still infects millions of people annually worldwide, frequently causing temporary disability but rarely liver failure with significant health care expense. ...
... Less likely, although possible, some of those outbreaks may have been caused by the hepatitis E virus. 5,40 Hepatitis A outbreaks were, however, not limited to the military. Several epidemics were noted in the United States during the 19th century. ...
... Several epidemics were noted in the United States during the 19th century. 2,5 One of the largest recorded epidemics of HAV in modern times occurred in 1988 in Shanghai, where almost 300,000 subjects experienced clinical symptoms of hepatitis A after ingestion of contaminated raw clams. 41,42 Other outbreaks were reported in the past three decades, that is, in patients with hemophilia who received factor VIII concentrates, 43,44 in MSM, 18 as well as in patients with HIV. ...
Hepatitis A is a vaccine-preventable infection caused by the hepatitis A virus (HAV). Over 150 million new infections of hepatitis A occur annually. HAV causes an acute inflammatory reaction in the liver that usually resolves spontaneously without chronic sequelae. However, up to 20% of patients experience a prolonged or relapsed course and <1% experience acute liver failure. Host factors, such as immunological status, age, pregnancy and underlying hepatic diseases, can affect the severity of disease. Anti-HAV IgG antibodies produced in response to HAV infection persist for life and protect against re-infection; vaccine-induced antibodies against hepatitis A confer long-term protection. The WHO recommends vaccination for individuals at higher risk of infection and/or severe disease in countries with very low and low hepatitis A virus endemicity, and universal childhood vaccination in intermediate endemicity countries. To date, >25 countries worldwide have implemented such programmes, resulting in a reduction in the incidence of HAV infection. Improving hygiene and sanitation, rapid identification of outbreaks and fast and accurate intervention in outbreak control are essential to reducing HAV transmission.
Infection with the hepatitis E virus (HEV) is globally seen a leading cause of hepatitis. Now increasingly recognized also in industrialized countries, hepatitis E constitutes a significant health problem worldwide. The patient's immune status determines the clinical course and histopathology of hepatitis E. In immunocompetent patients, hepatitis E usually follows an asymptomatic or subclinical course, but may also present with acute hepatitis. In contrast, immunocompromised patients may develop chronic hepatitis, and patients with preexisting liver diseases are at risk for liver decompensation with potentially fatal outcome. Whereas pathologists only occasionally encounter liver biopsies from immunocompetent individuals with hepatitis E, they are more likely exposed to biopsies from patients with preexisting liver disease or immunocompromised individuals. Histopathologic hallmarks of hepatitis E in immunocompetent patients comprise lobular disarray, lobular, and portal inflammation, as well as hepatocyte necrosis of varying extend and regeneration. Thus, it is similar to acute non-E viral hepatitis, yet further differential diagnoses include autoimmune hepatitis and drug-induced liver injury. Histopathologic findings of hepatitis E in preexisting liver disease are determined by the underlying pathology, but may be more severe. Histopathologic presentation of hepatitis E in immunocompromised patients is highly variable, ranging from minimal active hepatitis to chronic hepatitis with severe activity and progressive fibrosis. Taken together, the variability of the histologic features depending on the clinical context and the overlap with other liver diseases make the histopathologic diagnosis of hepatitis E challenging. Immunohistochemistry for HEV open reading frame 2 protein and molecular testing for HEV RNA are useful tissue-based ancillary tools.
