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[DYSPHAGIA] Hepatitis B
--- SuzMorris@aol.com wrote:
>
> Irene,
>
> Any idea why there is a high incidence of
> individuals with Down syndrome
> being carriers of Hepatitis B? Is this related in
> some way to the
> genetic aspects of the syndrome? Are you talking
> more about individuals
> who are in a hospital or residential care facility?
>
> Does this also apply to infants and young children
> with Down syndrome who
> live at home? If I'm working only with babies and
> other relative young
> kids with Downs is it important to get Hepatitis B
> shots?
>
> Suzanne
When I worked constantly in a centre for persons with
developmental disabilities - infants through old age -
we were all required to have Hep B shots, mainly
because of the risk with infants, children and older
persons with Down syndrome. This group has
significantly higher incidence of hepatititis B (and
C) as well as leukemia, related to the chromosomal
abnormality. Nowm when I work in nursing hoems that
often have adults with Down and probable Alxheimer, to
which they are also susceptible, I find I have to
notify nursing staff of the need for immunization.
The following are some references more or less at
random as this is a chronic and well-recognized
condition in Down along with atlanto-axial
dislocation, abnormal cerebellar size etc.
Cellular immunity is altered in Down syndrome and
significantly increases the susceptibility to
Hepatitis B (and C though not as much.)
May P; Kawanishi H. Chronic hepatitis B infection and
autoimmune thyroiditis in Down syndrome. J Clin
Gastroenterol 1996 Oct;23(3):181-4
Although it is well known that viral hepatitis can be
complicated by autoimmune phenomena, the evidence for
a pathogenetic role of viral hepatitis in the etiology
of autoimmune thyroiditis is unclear. Because both
hepatitis B and autoimmune thyroiditis occur
frequently in Down syndrome, we decided to determine
whether a cause-and-effect relationship might exist.
Such a relationship might provide insight into basic
mechanisms that could generalize to other populations.
Accordingly, the frequency of hepatitis B surface
antigen (HBsAg) positivity and thyroiditis was
determined in 57 adults with Down syndrome and
compared with frequencies in 450 age-, sex-, and
environmentally matched mentally retarded patients
without Down syndrome. We found no relationship of
HBsAg positivity and thyroiditis in those mentally
retarded patients without Down syndrome. On the other
hand, the frequency of thyroiditis in those Down
syndrome patients who were also carriers of HBsAg was
threefold higher than the frequency of thyroid disease
in those patients with Down syndrome who were not
carriers of HBsAg (65% vs. 23%, p < 0.01). This
relationship of hepatitis B and thyroid disease in
Down syndrome might be explained by cytokine and/or
cellular immune abnormalities linked to extra genetic
material in trisomy 21. Clinically, patients with Down
syndrome who are also hepatitis B carriers should be
closely monitored for development of thyroid disease.
Decoq P; Vinckier F. Down syndrome: 1. Medical
aspects. Rev Belge Med Dent 995;50(3):43-52
Every organ of a patient with Down's Syndrome (trisomy
21) shows pathology . One notices specific features
in infancy. Obstruction of the gastroenteric tract can
cause problems from the prenatal phase onwards. The
main endocrinological difficulties are dysfunction of
the thyroid gland and also infertility. Ocular
disorders like refraction disorders occur frequently.
Due to decreased conduction, there isa hearing loss.
Cellular immunity is clearly reduced, hence, the
susceptibility to infections like hepatitis B.
Vellinga A; Van Damme P; Meheus A . Hepatitis B and C
in institutions for individuals with intellectual
disability. increases. J Intellect Disabil Res 1999
Dec;43 ( Pt 6):445-53
People with intellectual disability are a well-known
high-risk group for hepatitis B virus (HBV) infection.
Hepatitis B virus is a major public health problem,
but it is often neglected because of its largely
asymptomatic course with long-term complications. Safe
and effective vaccines have been available for over 15
years. However, universal vaccination strategies have
not or have not completely been implemented to date,
even though epidemiological data have indicated the
effectiveness and efficacy of vaccination, and
economic evaluations have shown that it is cost
effective. Hepatitis C virus (HCV), which was
discovered in 1989, has similar risk factors and is
also a cause of chronic hepatitis. The prevalence of
HCV amongst individuals with intellectual disability
has not been clearly established. An overview of the
literature on the prevalence of HBV and HCV in this
population, as well as risk factors, transmission and
prevention is presented in the present review. The
literature cited in the present article was obtained
by searches in MedLine using the following keywords
and keyword combinations: hepatitis, hepatitis B
virus, hepatitis C virus, mentally retarded, mentally
handicapped, developmentally retarded, intellectual
disability, institutionalization, Down's syndrome and
hepatitis B vaccination. The search was done from 1980
to 1998. Beside this, the older articles found in the
references were included if these were considered
necessary for completeness.
=====
www.dricampbell-taylor.com
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