hepatitis A

In 2013/2014, Italy experienced one of the largest community-wide prolonged outbreaks of hepatitis A virus (HAV) throughout the country. The article provides a comprehensive description of the outbreak and the investigation carried out by a multidisciplinary National Task Force, in collaboration with regional and local public health authorities. Control strategies of food-borne HAV infection in both the human and food sectors are also described. Enhanced human epidemiological and microbiological surveillance together with microbiological monitoring of HAV in food and trace-back investigation were conducted. A total of 1803 HAV cases were identified from 1 January 2013 to 31 August 2014, in Italy. Sequencing was possible for 368 cases (20.4 %), mostly collected between 1 January 2013 and 28 February 2014, and 246 cases (66.8 %) harboured an HAV outbreak strain. Imported frozen berries contaminated with HAV were identified as the vehicle of the outbreak which also involved many other ...

Hepatitis A virus (HAV) is an important cause of foodborne disease worldwide. The detection of this virus in naturally contaminated food products is complicated by the absence of a reliable culture method, low levels of contamination, and the presence of matrix-associated compounds which inhibit molecular detection. In this study, we report a novel method to concentrate HAV from foods prior to the application of reverse transcription-PCR (RT-PCR) for detection. Specifically, we used cationically charged magnetic particles with an automated capture system (Pathatrix TM ) to concentrate the virus from 25 g samples of artificially contaminated lettuce, strawberries, green onions, deli-turkey, oysters, and cake with frosting. Detection limits varied according to the product but in most cases, the virus could be consistently detected at input levels corresponding to 10 2 PFU/25 g food sample. For some products, detection was possible at levels as low as 10 −1 PFU/25 g. The assay was applied by a second independent laboratory and was also used to confirm viral contamination of produce items associated with a recent HAV outbreak. Parallel infectivity assays demonstrated that the cationically charged particles bound approximately 50% of the input virus. This is the first application of the automated magnetic capture technology to the concentration of viruses from foods, and it offers promise for facilitating the rapid detection of HAV from naturally contaminated products.

Manufacture of VAQTATM, an inactivated hepatitis A virus vaccine, includes extensive purification of the intact virus particle to remove endogenous components from the host cell culture lysate as well as compounds introduced in the upstream purification process. Analysis of the final purified hepatitis A virus product by SDS-PAGE prior to inactivation shows that greater than 95% of the protein in the preparation is found in four protein bands, which have been confirmed to be hepatitis A virus capsid proteins VP0, VP1, VP2 and VP3 based on Western blot and mass spectrometry analyses. Validation of the manufacturing process and direct analysis of the final product were used to demonstrate that no other specific host cell-derived components are detected and that process residuals are all below the limits of detection of the assays used. Establishment of a rigorous standard of high purity for this product was pursued to minimize the impact of impurities during clinical development of th...

Infection with hepatitis A virus (HAV) is the commonest viral cause of liver disease and presents an important public health problem worldwide. Several unique HAV properties and molecular mechanisms of its interaction with host were recently discovered and should aid in clarifying the pathogenesis of hepatitis A. Genetic characterization of HAV strains have resulted in the identification of different genotypes and subtypes, which exhibit a characteristic worldwide distribution. Shifts in HAV endemicity occurring in different parts of the world, introduction of genetically diverse strains from geographically distant regions, genotype displacement observed in some countries and population expansion detected in the last decades of the 20th century using phylogenetic analysis are important factors contributing to the complex dynamics of HAV infections worldwide. Strong selection pressures, some of which, like usage of deoptimized codons, are unique to HAV, limit genetic variability of the virus. Analysis of subgenomic regions has been proven useful for outbreak investigations. However, sharing short sequences among epidemiologically unrelated strains indicates that specific identification of HAV strains for molecular surveillance can be achieved only using whole-genome sequences. Here, we present up-to-date information on the HAV molecular epidemiology and evolution, and highlight the most relevant features of the HAV-host interactions.

The consumption of bivalve shellfish is a common cause of foodborne outbreaks of viral origin. The evaluation of the sanitary quality of these products, however, is still based on bacterial indicators of fecal contamination (Reg. (EC) No. 2073/2005 and No.1441/2007) even if it is known that they are not reliable indicators of viral contamination. In this study a duplex Real Time PCR method for quantitative detection of hepatitis A (HAV) in shellfish was developed. Feline Calicivirus (FCV) was used as a control for assessing the effectiveness of the concentration and extraction process and the ability to eliminate PCR inhibitors present in the food matrix. The specific primers and probes for detection of HAV and FCV, chosen respectively from the 5-UTR region and in the ORF1 region, were labeled with two different dyes and detected simultaneously. The method was applied on spiked and non-spiked shellfish from a local market. The amplification of HAV in the presence of FCV showed good linearity (R 2 = 0.994) and the sensitivity limit of the reaction was at least 5 × 10 2 TCID 50 g −1 of an hepatopancreas extract.

SUMMARY Capture-recapture methodology, originally developed for estimating demographic parameters of ani- mal populations, has been applied to human populations. This tutorial reviews various closed capture- recapture models which are applicable to ascertainment data for estimating the size of a target population based on several incomplete lists of individuals. Most epidemiological approaches merging di;erent lists and eliminating duplicate cases are likely

Contents In 1996 there were 65,024 notifications to the National Notifiable Diseases Surveillance System. The record high number of Ross River virus infection notifications was of particular note. The highest rates were recorded in Western Australia, where an outbreak was documented in the South West, and in Queensland. Most cases occurred in the late summer and early autumn months. The

Acute liver failure is an uncommon condition associated with multi organ involvement, high morbidity and mortality. Etiology of acute liver failure varies with age and geographical location. Most cases of acute liver failure in India are due to infectious causes predominantly viral hepatitis. A significant group with indeterminate causation remains, despite careful investigation. The etiology of acute liver failure in infants is largely metabolic. The mainstay of management is supportive care in an intensive care unit. Monitoring of clinical and biochemical parameters is done frequently until the patient becomes stable. Mortality is predominantly due to raised intracranial pressure, infections and multi-organ failure. Liver transplant is an important life saving procedure for children with acute liver failure.

During an outbreak of hepatitis A predominantly among men who have sex with men (MSM) in Copenhagen, Denmark, in 2004, we did a case-control study to determine risk factors for infection. A case was an MSM >17 years, living in Copenhagen, with IgM positive hepatitis A infection diagnosed between June and August 2004, and without a household contact with a hepatitis A case before onset of illness. Controls were selected at the Copenhagen Pride Festival. The study included 18 cases and 64 controls. Sixteen of 18 cases and 36/63 controls had sex with casual partners (ORMH 5.6, 95% CI 1.2-26.9). Eleven of 18 cases and 14/62 controls had sex in gay saunas (ORMH 4.2, 95% CI 1.5-11.5). Sex at private homes appeared to be protective (ORMH 0.2, 95% CI 0.1-0.7). Casual sex including sex in gay saunas was an important risk factor for the spread of HAV among MSM in Copenhagen. The results are in accordance with findings in other European outbreaks. As the general immunity to hepatitis A decr...

In the present study, Aluminium quantification in immunobiologicals has been described using atomic absorption spectroscopy (AAS) technique. The assay was found to be linear in 25e125 mg/ml Aluminium range. The procedure was found to be accurate for different vaccines with recoveries of external additions ranging between 93.26 and 103.41%. The mean Limit of Variation (L.V.) for both intra-and inter-assay precision was calculated to be 1.62 and 2.22%, respectively. Further the procedure was found to be robust in relation to digestion temperature, alteration in acid (HNO 3 and H 2 SO 4 ) ratio used for sample digestion and storage of digested vaccine samples up to a period of 15 days. After validation, AAS method was compared for its equivalency with routinely used complexometric titration method. On simultaneously applying on seven different groups of both bacterial and viral vaccines, viz., DPT, DT, TT, Hepatitis-A and B, Antirabies vaccine (cell culture) and tetravalent DPT-Hib, a high degree of positive correlation (þ0.85e0.998) among AAS and titration methods was observed. Further AAS method was found to have an edge over complexometric titration method that a group of vaccines, viz., ARV (cell culture, adsorbed) and Hepatitis-A, in which Aluminium estimation is not feasible by pharmacoepial approved complexometric titration method (possibly due to some interference in the sample matrix), this newly described and validated AAS assay procedure delivered accurate and reproducible results.

is known to induce acute hypocalcemia in patients undergoing liver transplantation during the anhepatic phase. We describe the case of a 71-year-old woman with fulminant hepatic failure secondary to hepatitis A, who was started on continuous venovenous hemodialysis (CVVHD) for acute renal failure. Because anticoagulation with heparin was untenable, regional anticoagulation was accomplished by trisodium citrate (46.7%) infusion. Unfortunately, severe hypocalcemia developed when citrate accumulated because of impaired hepatic metabolism. Because of chelation by citrate, the ionized calcium concentration declined to values as low as 2.72 mg/dL (normal, 4.5 to 5.6 mg/dL), whereas the total calcium concentration remained in the normal range. With an unusually high calcium chloride infusion rate via a central line (up to 140 mL/h of 10 mEq/dL CaCl 2) and additional boli of CaCl 2 (for a total of 190 mEq), the ionized calcium concentration could be maintained at target levels. Nevertheless, the ionized calcium concentration was maintained in the normal range, and the total calcium concentration increased to a value as high as 15 mg/dL. Thus, the total to ionized calcium ratio was 3.5:1. After 24 hours of treatment, trisodium citrate infusion was gradually reduced from 15 mL/h to 7 mL/h, and the calcium chloride infusion was decreased to 50 mL/h. Nevertheless, persistence of the elevated total to ionized calcium ratio (3:1) indicated citrate accumulation likely secondary to decreased hepatic metabolism. Using this approach, the patient was successfully maintained on CVVHD with regional citrate anticoagulation for a total of 11 days without any additional complications. We conclude that CVVHD with regional citrate anticoagulation can be used in patients with acute hepatic failure if increased CaCl 2 requirements are anticipated and if citrate is infused at a lower rate compatible with decreased citrate metabolism. Citrate accumulation should be suspected in patients with an elevated total to ionized Ca ؉؉ ratio during CVVHD with citrate anticoagulation.

Acute liver failure (ALF) is a clinical condition with high mortality. The most common cause of death in ALF is cerebral edema. We present a 12-year-old boy with hepatitis A-related acute liver failure in grade IV hepatic encephalopathy successfully managed in the ICU using continuous hypertonic saline as the preferred osmotherapy.

Immunity to hepatitis A virus (HAV) is in first instance due to neutralizing antibodies. Neutralization assays are essential to evaluate new candidate vaccines against this pathogen. In this paper, an in vitro neutralization assay to evaluate HAV vaccine candidates using phage-display technology is described. 10 3 and 10 2 DICT 50 of HAV were incubated with different antibodies preparations and were inoculated onto plates with FRhK4 cells. After seven days of incubation, the neutralizing titer was determined as reciprocal of the serum dilution reducing HAV growth (inhibition of CPE) by 50%. 10 3 and 10 2 DICT50 were neutralized by 7E7 anti-HAV monoclonal antibody and anti-VHA positive human sera (A12 and A31). Negative controls of the assay did not neutralize viral infectivity. Sera from mice immunized with phages displaying VHA mimotopes had neutralizing titers from 4 -16. Neither negative control nor pre-immune and sera from mice immunized with M13 wild type phage neutralized HAV. A simple and faster in vitro neutralization assay was developed to evaluate new HAV vaccine candidates.

Giriş ve Amaç: Ekonomik ve çevre şartlarının düzeltilmesi ve eğitim düzeyinin artması ile hepatit A enfeksiyonuna duyarlılık ileri yaşlara kaymaktadır. Fakat hastalığın ciddiyeti de yaşla birlikte artmaktadır. Tıp fakültesi öğrencilerinin tıp eğitimleri süresince hepatit A enfeksiyonu olan hastalarla karşılaşma olasılıkları olduğu gibi, hepatit A enfeksiyonu olan öğrencilerin de hastalarla teması olmaktadır. Bu nedenle hepatit A geçirmemiş veya aşılaması olmayan tıp fakültesi öğrencileri hepatit A enfeksiyonu açısından risk altındadır . Bu çalışma Pamukkale Üniversitesi Tıp Fakültesi 6. sınıf öğrencilerinin hepatit A seroprevalansını ve etkileyen faktörleri incelemek amacıyla yapılmıştır.

Gereç ve Yöntem: Kesitsel tipteki bu çalışmanın evrenini, Pamukkale Üniversitesi Tıp Fakültesi 2012-2013 öğretim yılı içerisindeki 6. sınıf öğrencileri oluşturmuştur. Örneklem seçimine gidilmeden evren üzerinde çalışılmış, ancak anket formlarının uygulandığı günlerde devamsız olan ya da anket formunu doldurmak istemeyen 4 (%8,3) öğrencinin çalışma dışında tutulması nedeniyle 44 (%91,6) öğrenci çalışma kapsamına alınmıştır. Araştırmanın verileri Ekim 2012’de toplanmıştır. Çalışmaya katılan öğrencilere hepatit A seroprevalansı ve etkileyen faktörleri ortaya koymayı amaçlayan bir anket formu doldurtulmuştur. Veri toplama aracında araştırmacılar tarafından oluşturulan, 10 sorudan oluşan demografik verileri sorgulayan sorular, 4 sorudan oluşan sosyoekonomik düzeyi ölçen sorular ve 10 sorudan oluşan hepatit A risk faktörleri ile ilgili sorular vardır. Bu çalışmada anti-HAV IgG sonuçları retrospektif olarak değerlendirilmiştir. Olguların serum örneklerinde anti HAV IgG düzeyleri Pamukkale Üniversitesi Tıp Fakültesi Hastanesi Mikrobiyoloji Laboratuvarı’nda ELISA (Architect, i200oSR) yöntemiyle çalışılmıştır. Sonuçların yorumu üretici firmanın önerileri doğrultusunda; 1 s/co altındaki değerlere sahip numuneler negatif ve ≥ 1 s/co değerlerine sahip örnekler pozitif olarak değerlendirilmiştir. Verilerin analizi için SPSS paket programı kullanılmıştır. Veriler değerlendirilirken tanımlayıcı istatistikler, kategorik bağımsız değişkenlerin karşılaştırılması için ki-kare veya Fisher testi kullanılmıştır.

Bulgular: Çalışmaya katılan öğrencilerin yaş ortalaması 23,7±1,6 olup, % 59,1’i (n=26) kadındır. Katılımcıların %52,3’ünün (n=23) annesinin öğrenim durumu lise ve üzeri, % 61,4’ünün (n=27) babasının öğrenim durumu yüksekokuldur. Katılımcıların % 36,4’ünün (n=16) sosyoekonomik düzeyi düşük, % 45,5’inin (n=20) orta olarak bulunmuştur. Katılımcıların % 31,8’inin (n=14) 12 yaşına kadar yaşadığı evdeki kişi sayısı 5 ve üzeri olarak saptanmıştır. Katılımcıların %25’i (n=11) üniversite öğrenimi öncesi kreş ve/veya yurtta kaldığını, % 27,3’ü (n=12) çocukluk dönemindeki el yıkama alışkanlığının orta-kötü olduğunu belirtmiştir. Katılımcıların %4,5’inin (n=2) çocukluk döneminde evindeki kullandığı içme suyunun kuyu/tulumba suyu olduğu, %56,8’inin (n=25) ise şebeke suyu olduğu saptanmıştır. Katılımcıların %20,5’i (n=9) çocukluk dönemindeki evinin atık sisteminin foseptik olduğunu belirtmiştir. Serum örneklerinin sadece 12’sinde (%27,3) anti HAV IgG pozitif olarak bulunmuştur. Baba öğrenim durumu ve en uzun süre yaşanılan bölge anti HAV seropozitifliğini etkileyen bağımsız faktörler olarak belirlenmiştir.

Sonuç ve Öneriler: Çalışmamız hepatit A enfeksiyonuna duyarlılığın ileri yaşlara kaydığını göstermektedir. Hastalığın ileri yaşta daha ağır ve komplikasyonlu seyredebileceği göz önüne alındığında risk altındaki bir grup olarak tıp fakültesi öğrencilerinin tıp eğitimine veya en azından klinik çalışmalara başlamadan önce hepatit B’de olduğu gibi, hepatit A infeksiyonu açısından serolojik olarak taranması ve yakalama (catch up) bağışıklama programlarının oluşturulması uygun görünmektedir.

Anahtar Kelimeler: Hepatit A, seroprevalans, tıp fakültesi öğrencileri

Viral hepatitis A is still common in Italy, especially in Southern regions. In this study, a metapopulation model for hepatitis A virus (HAV) transmission is proposed and analyzed. Analytical results on the asymptotic and transient behaviors of the system are carried out. Based on the available Italian movement data, a national spatial contact matrix at the regional level, which could be used for new studies on the transmission dynamics of other infectious diseases, is derived for modeling fluxes of individuals. Despite the small number of fitted parameters, model simulations are in good agreement with the observed average HAV incidence in all regions. Our results suggest that the mass vaccination program introduced in one Italian region only (Puglia, the one with the highest endemicity level) could have played a role in the decline of HAV incidence in the country as a whole. The only notable exception is represented by Campania, a Southern region showing a high endemicity level, which is not substantially affected by HAV dynamics in Puglia. Finally, our results highlight that the continuation of the vaccination campaign in Puglia would have a relevant impact in decreasing long-term HAV prevalence, especially in Southern Italy.

Injection drug use accounts for most of the incident infections with hepatitis C virus (HCV) in the United States and other developed countries. HCV infection is a complex and challenging medical condition in injection drug users (IDUs). Elements of care for hepatitis C in illicit drug users include prevention counseling and education; screening for transmission risk behavior; testing for HCV and human immunodeficiency virus infection; vaccination against hepatitis A and B viruses; evaluation for comorbidities; coordination of substance-abuse treatment services, psychiatric care, and social support; evaluation of liver disease; and interferon-based treatment for HCV infection. Caring for patients who use illicit drugs presents challenges to the health-care team that require patience, experience, and an understanding of the dynamics of substance use and addiction. Nonetheless, programs are successfully integrating hepatitis C care for IDUs into health-care settings, including primary...

Hepatitis A infections are influenced by environmental and socioeconomic factors. Epidemiologic studies regarding hepatitis A virus (HAV) infection in Turkey have not previously examined these factors. We investigated HAV seroprevalence and its association with sociodemographic factors among children of various ages in the Eastern Mediterranean region of Turkey. The study included 1142 children (603 male and 539 female) between ages of 6 months and 18 years. Seropositivity in the whole group was 57.2%. HAV prevalence rates according to age groups were as follows: 35.5% in 6-23 months group, 19.2% in 2-5 years group, 74.3% in 6-10 years group, 83.0% in 11-14 years group, 92.8% in 15-18 years group. Risk factors that influenced seropositivity were; dense population, over-crowded families, excessive number of siblings, low socioeconomic status and low education of the mother. As HAV seroprevalence in children older than 6 years of age is high, we recommend hepatitis A vaccination in this region after the first year of life.

We carried out a multicentre study on 2830 patients with chronic liver disease from 79 liver units (25 in northern, 24 in central and 30 in southern Italy) to evaluate naturally acquired immunity against hepatitis A virus (HAV) in relation to age, sex, geographical area of origin and entity of liver disease, and to define the strategy for specific vaccination. Antibody to HAV (anti-HAV) was detected in 1514 (53.5%) of the 2830 patients tested; the prevalence was 50.4% in males and 59.1% in females. Both in central and southern Italy the prevalence of anti-HAV positive subjects increased with increasing age from 43.3 and 44.7%, respectively, in the 0-30-year-old subjects to 80.1 and 68.3%, respectively, in those aged over 60 years. The overall prevalence was much lower in northern Italy, as were the variations from one age group to another, from 28.4% in the 0-30-year-old subjects to 38% in those aged over 60 years. 40.6% of patients with cirrhosis lacked naturally acquired protection against HAV; this percentage was higher in northern (60.5%) than in central (34.9%, P < 0.0001) and southern Italy (27.6%, P < 0.0001). The high prevalence of patients in Italy with chronic hepatitis or cirrhosis who lack naturally acquired immunity to HAV warrants the implementation of vaccination programmes against hepatitis A in such patients.

Eight weeks or more of combination treatment has been fulfilled in 63 patients. HCV RNA was negative at both week 4 and 8 in 4.5 (71%) and treatment is therefore discontinued at week 14 in these. The remaining 18 patients are receiving 24 weeks treatment. The preliminary results show that 80% of those who receive short combination treatment obtain sustained virological response 24 weeks after treatment stop .

Hepatitis A virus (HAV) is the most common cause of acute viral hepatitis in the world. Rarely, acute infection may persist for a long time. Autoimmune hepatitis (AIH) may provide anti-HAV IgM positivity detection for a prolonged time. On the other hand, HAV as an infectious agent may also trigger AIH. Here we presented a case which seemed like a simple acute viral hepatitis A infection at the beginning but turned out to be an AIH according to the International Autoimmune Hepatitis Group's system. A 21-year-old female was diagnosed as symptomatic acute HAV infection with anti-HAV IgM positivity and elevated aminotransferase levels. The other viral serological tests were negative. On the 6 th , 12 th and 18 th months of the follow up, her anti-HAV IgM positivity still continued and transaminase levels were also 3 to 7 times high of the upper limit of normal. In addition, antinuclear antibody was positive. However, on the 19 th month anti-HAV IgM could be detected as negative. Liver histology was prominent. The patient had a score of 16 according to the International Autoimmune Hepatitis Group's system. She was given prednisolone (10 mg/day) and azathioprine (100 mg/day). The aminotransferase levels were detected within normal ranges at the end of the first month of therapy. She was in remission during follow up for 6 years. In conclusion, prolonged HAV infection and AIH may not only trigger each other but also deterio-rate the liver histology. AIH should be investigated in cases of long-lasting HAV infection in order to begin the treatment earlier. On the other hand, AIH patients should also be vaccinated for both HBV and HAV to avoid more severe diseases.

P-selectin (CD62P) is an adhesion molecule that mediates the initial attachment of leukocytes to activated platelets and endothelial cells in damaged tissues. We evaluated the role of P-selectin in concanavalin A (Con A)-induced hepatitis, a model characterized by CD4(+) T cell activation and infiltration of the liver. Con A injection induced transient P-selectin expression on hepatic venules and platelets. Mice lacking P-selectin showed impaired lymphocyte adhesion to liver venules and sinusoids, a striking reduction in intrasinusoidal occlusion, and decreased lymphocyte infiltration of liver parenchyma. The reduction in transaminase levels and the almost complete abolition of necrotic injury demonstrated that liver damage was lower in P-selectin-deficient mice. In wild-type mice, pretreatment with the P-selectin-blocking monoclonal antibody attenuated the sinusoidal occlusion and reduced the rise in transaminases after Con A treatment. These results implicate P-selectin in the dev...

The immunogenicity, tolerability and interchangeability of two hepatitis A vaccines, Vaqta (Merck and Co.) and Havrix (SmithKline) were studied in a randomized, crossover, controlled clinical trial. Vaccine was administered to 201 volunteers at 0 and 26 weeks in one of four vaccine regimens: Havrix-Havrix; Havrix-Vaqta; Vaqta-Havrix or Vaqta-Vaqta. Seroconversion rates (] 10 mIU/ml) for those whose first dose was Vaqta or Havrix, respectively, were: 41/96 (43%) versus 30/95 (32%) (P =0.15) at 2 weeks and 91/98 (93%) versus 84/97 (87%) (P= 0.43) at 4 weeks, and 100% at 26 weeks. Geometric mean concentrations (GMC) of total antibody to hepatitis A virus (anti-HAV) for Vaqta and Havrix were 189 and 114 mIU/ml (P = 0.011) at 4 weeks and 234 and 136 mIU/ml (P B0.001) at 26 weeks. At 30 weeks, the GMC after two doses of Havrix was 2612 mIU/ml compared with 5497 after two doses of Vaqta (PB0.001). The GMC in the Havrix-Vaqta group was 5672 mIU/ml compared with 3077 mIU/ml in the Vaqta-Havrix group (P B0.001). Less than half of vaccine recipients reported tenderness or pain. In this study, seroconversion rates of the two vaccines were similar. Vaqta produces significantly higher anti-HAV antibody than Havrix. Crossover immunization is well tolerated and results in high antibody concentrations, especially when Vaqta is the booster dose. The significance of higher anti-HAV antibody concentrations in terms of long-term protection is unknown.

There is an increasing demand for diagnostic testing for Giardia intestinalis (G. lamblia) and Cryptosporidium parvum, with a priority being placed on obtaining diagnostic results in an efficient and timely manner. Several commercial companies have developed rapid diagnostic tests that are simple to perform and can be completed in less time than traditional methods for detecting Giardia and Cryptosporidium. We compared one of these rapid tests, the ImmunoCard STAT! (Meridian Bioscience, Inc.) lateral-flow immunoassay, with the MERI-FLUOR direct fluorescent-antibody (DFA) test, the ProSpecT EZ microplate assay for Giardia and the ProSpecT microplate assay for Cryptosporidium, and modified Kinyoun's acid-fast stained smears for the detection of Cryptosporidium using 246 specimens. The MERIFLUOR DFA (Meridian Bioscience, Inc.) test detected the largest number of cases (32 Giardia and 37 Cryptosporidium) infections and was used to calculate the sensitivity and specificity of the other tests. For Giardia, the sensitivities of the ImmunoCard STAT! and the ProSpecT Giardia EZ microplate assay (Alexon-Trend, Inc.) were 81 and 91%, respectively. For detection of Cryptosporidium, the sensitivities of the ImmunoCard STAT!, the ProSpecT Cryptosporidium microplate assay (Alexon-Trend, Inc.), and modified Kinyoun's acid-fast stained smears were 68, 70, and 78%, respectively. Test specificities were equal to or greater than 99%. Specimens with very small numbers of organisms were not detected by the ImmunoCard STAT!, the ProSpecT microplate assay or modified Kinyoun's acid-fast stained smears.