Hepatitis B in the United States: ongoing missed opportunities for hepatitis B vaccination, evidence from the Behavioral Risk Factor Surveillance Survey, 2007

Purpose

In the USA, the burden of hepatitis B disproportionately affects high-risk adults who alone account for more than 75% of newly reported hepatitis B virus infections each year. Despite the localization of new infections in identifiable high-risk groups, vaccination rates in this subgroup, with the exception of health care workers, remain consistently low. The purpose of this study was to characterize those at risk for hepatitis B transmission and quantify the association between missed opportunities and hepatitis B vaccination.

Methods

Data from the 2007 Behavioral Risk Factor Surveillance Survey (BRFSS) of adults aged 18?years and older who were at high risk for hepatitis B infection (n?=?15,432) were analyzed. Multivariate regression analysis was conducted to determine factors independently associated with vaccination.

Results

In a nationally representative sample, 51.4% of high-risk adults remained unvaccinated against hepatitis B and more than 50% had a missed opportunity for vaccination. High-risk adults who were vaccinated against pneumonia and influenza had a higher odds ratio of being vaccinated against hepatitis B than those not vaccinated against pneumonia and influenza (OR?2.27 and 1.67, respectively). Also, high-risk adults tested for human immunodeficiency virus (HIV) at a counseling and testing site or a drug treatment facility had a higher OR of being vaccinated than those who had not been tested for HIV (OR?1.78 and?1.73, respectively). The opposite relationship was true among individuals tested for HIV at a correctional facility (OR?0.60).

Conclusions

The findings of this study underscore the inadequacy of vaccination coverage in high-risk adults and highlight advantageous opportunities to bridge gaps in vaccination coverage.     

Serum Levels of Anti-Hepatitis B Surface Antibody Among Vaccinated Population Aged 1 to 18 Years in Ahvaz City Southwest of Iran

Background:

The duration of protection following primary series vaccination against hepatitis B is unknown in children and adolescents. It has been shown that the level of anti-hepatitis B surface antigen antibodies (anti HBs Ab) declines over years after vaccination.

Objectives:

The aim of this study was to estimate the long-term immunity against hepatitis B virus infection among children and adolescents who had received a complete hepatitis B vaccination series during infancy.

Patients and Methods:

In a cross-sectional study, the - anti-HBsAb levels of 840 vaccinated children and adolescents were determined by enzyme-linked immunosorbent assay.

Results:

Hepatitis B seroprotection rates (anti HBsAb ≥ 10 IU/L) among vaccinated children and adolescents aged 1 and 18 years were 90% and 48.9%, respectively. The declining trend of geometric mean titer of anti-HBsAb levels was observed as changed from 272.3 IU/L to 94.1 IU/L in 1 and 18-year-old population, respectively. A significant negative correlation was found between age and anti-HBsAb levels (r = - 0.220, P = 0.0001).

Conclusions:

The results showed a declining trend in anti-HBsAb titers over the time after vaccination against hepatitis B virus in our region. Further studies are warranted to establish the need for a booster dose in cases that are at risk of hepatitis B virus infection.     

Epidemiological impact of mandatory vaccination against hepatitis B in Italian young adults

Background

Viral hepatitis caused by hepatitis B virus (HBV) is a leading cause of acute and chronic liver diseases worldwide.

Objectives

In Italy, a mandatory vaccination policy was introduced in 1991 and was established for all newborns and 12-year-old individuals. In 2004, vaccination of 12-yearold adolescents was discontinued, and that of infants was maintained.

Patients and Methods

We evaluated the seroprevalence of HBV markers in 806 individuals, who were vaccinated at birth or at 12 years of age, to assess the effectiveness of the national policy against HBV.

Results

The overall prevalence of anti-HBs antibodies was 90.32% (95% confidence interval [CI]: 88.28–92.36%); 2.23% (95% CI: 1.21–3.25%) of the subjects were positive for both antibodies to HBsAg (anti-HBs) and antibodies to hepatitis B core antigen (anti-HBc), whereas 5.83% (95% CI 4.21–7.45) of the subjects were negative for all markers tested. Further, 1.61% (95% CI: 0.74–2.48%) of the subjects were positive for hepatitis B surface antigen (HBsAg).

Conclusions

Our data provide additional evidence that HBV vaccination can confer long-term immunity when performed at birth and when performed for healthy adolescents; moreover, the results show the effectiveness of the application of a national vaccination strategy.     

A cross-sectional study on anti hepatitis B immune status in vaccinated healthcare workers in the west pomeranian region of poland

Background

Hepatitis B vaccination, recommended for medical staff, has a non-response rate of 5% to 32%. In Poland, there is no standardized postvaccination protocol to verify immunity.

Objectives

To determine the fraction of those who have been vaccinated against HBV (with a complete course followed/not followed by a booster) but not checked for serological evidence of hepatitis B immunity and to detect anti-HBs levels in this group by anonymous cross-sectional sero-survey.

Patients and Methods

Surgical/gynecological staff from 16 randomly selected hospitals in West Pomerania, Poland, were surveyed between July 2010-January 2011. EIA system version 3.0 was used to detect anti-HBs.

Results

Of 488 participants (439 females, median age 42 years) who were previously vaccinated (1-21 years ago), anti-HBs status was not determined after HBV vaccination in 361 individuals (74.0%; 95% CI: 69.9-77.7%), 5% (18/361) of whom had an anti-HBs titer of 0.0 mIU/ml (12/18 who were given booster doses developed anti-HBs > 10 mIU/ml) and 7.2% (26/361) of whom had an anti-HBs titer of 0.1-10 mIU/ml. The multivariate logistic regression model revealed that working in a teaching hospital was associated with lower odds of not being checked for anti-HBs after HBV vaccination (OR 0.22, 95% CI: 0.14-0.35; P = 0.0001).

Conclusions

The lack of a strict post-HBV vaccination policy to confirm immunity results in the majority of surgical/gynecological staff not checking their anti-HBs levels after HBV immunization. It is unknown whether the absence of current serological evidence of hepatitis B immunity can be attributed to non-response, the waning of vaccine-induced immunity, or preserved anamnestic response. The lack of a booster vaccination response in a fraction of subjects suggests that they are non-responders. Strict post-vaccination testing to document immunity remains the key practice to detect non-responders among medical staff.     

Epidemiology of hepatitis D virus (HDV) infection in an urban area of Northern Italy

Objectives

The introduction of vaccination against hepatitis B initially reduced the number of HBV (hepatitis B virus) and HDV (hepatitis delta virus) infections, but the decreasing trend of HDV infection seems to have stopped. The aim of this study was to assess the prevalence of HDV infection in the general population living in the catchment area of Legnano Hospital in northern Italy.

Methods

Of the 22,758 subjects tested in 2007?C2008, the 488 who were HBsAg (hepatitis B surface antigen)-positive [including 107 (21.9%) of non-Italian origin] were subsequently tested for anti-HDV antibodies.

Results

Of the 488 subjects who tested positive for HBsAg, 24 (4.9%) were anti-HDV positive, all aged between 30 and 60?years. The difference in prevalence between males (7.1%) and females (1.9%) was statistically significant (p?p?Conclusions In the catchment area of our hospital, the prevalence of HDV infection does not seem to be due to patients of non-Italian origin, but to Italian patients who are not vaccinated against HBV and who survived the HDV epidemic of the 1970s and 1980s. Nevertheless, the increase in the number of immigrants from non-EU countries in recent years is soon likely to lead to a change in the epidemiology of HDV.     

Clinical case review: A method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia

Background

In 2001, two hexavalent vaccines were licensed in Italy (Hexavac^®, Infanrix Hexa^®), and since 2002 were extensively used for primary immunization in the first year of life (at 3, 5, 11/12 months of age). In 2005, the market authorization of Hexavac^® was precautionary suspended by EMEA, because of doubts on long-term protection against hepatitis B virus. The objectives of this study were to evaluate the persistence of antibodies to anti-HBs, in children in the third year of life, and to investigate the response to a booster dose of hepatitis B vaccine.

Methods

Participant children were enrolled concomitantly with the offering of anti-polio booster dose, in the third year of life. Anti-HBs titers were determined on capillary blood samples. A booster dose of hepatitis B vaccine was administered to children with anti-HBs titers < 10 mIU/ml, with the monovalent precursor product of the previously received hexavalent vaccine. HBsAb titers were tested again one month after the booster.

Results

Sera from 113 children previously vaccinated with Hexavac^®, and from 124 vaccinated with Infanrix Hexa^® were tested for anti-HBs. Titers were ≥ 10 mIU/ml in 69% and 96% (p < 0,0001) respectively. The proportion of children with titers ≥ 100 mIU/ml did also significantly differ among groups (27% and 78%; p < 0,0001). Post-booster, 93% of children achieved titers ≥ 10 mIU/ml, with no significant difference by vaccine group.

Discussion

Fifteen months after third dose administration, a significant difference in anti-HBs titers was noted in the two vaccine groups considered. Monovalent hepatitis B vaccine administration in 3-year old children induced a proper booster response, confirming that immunologic memory persists in children with anti-HBs titers < 10 mIU/ml. However, long-term persistence of HBV protection after hexavalent vaccines administration should be further evaluated over time.     

Long-Term Persistence of Seroprotection by Hepatitis B Vaccination in Healthcare Workers of Southern Italy

Background

The impact of hepatitis B virus (HBV) vaccination campaigns on HBV epidemiology needs to be evaluated, in order to assess the long-term immunity offered by vaccines against HBV.

Objectives

To evaluate the current status of anti-HBV vaccine coverage among healthcare workers (HCWs) in Southern Italy, and to determine the long-term persistence of antibodies to hepatitis B surface antigens (anti-HBs) in such a cohort of subjects.

Patients and Methods

A longitudinal, retrospective seroepidemiological survey was conducted among 451 HCWs, who were working at or visiting, the Occupational Health Department of a city hospital, in Catania, Italy, between January 1976 and December 2010.

Results

At the 30-year follow-up (mean follow-up 10.15 ± 5.96 years, range 0.74-30), 261 HCWs had detectable anti-HBs titers indicating a persistence of seroprotection of 89.4% (out of 292 anti-HBs positive results, three months after vaccination). An inadequate vaccination schedule was the strongest predictor of antibody loss during follow-up (OR = 8.37 95% CI: 5.41-12.95, P < 0.001). A Kaplan-Maier survival curve revealed that the persistence of anti-HBs 30 years after vaccination, was 92.2% for high responders, while it was only 27.3% for low responders (P = 0.001).

Conclusions

A good level of seroprotection persisted in 57.9% of the subjects after 30 years. Factors related to this immunization status confirmed the importance of vaccinating HCWs early in their careers and ensuring an adequate vaccination schedule. However, with particular reference to the low rate of hepatitis B vaccine coverage among HCWs in Southern Italy, the implementation of a new educational intervention as part of an active vaccination program is needed.     

Prevalence of antibodies and humoral response after seasonal trivalent vaccination against influenza B lineages in an elderly population of Spain

Introduction

The aim of this study was to analyze the presence of antibodies against both Yamagata and Victoria influenza B lineages and to check the response after seasonal trivalent vaccination.

Immunogenicity of recombinant hepatitis B vaccine: comparison of two different vaccination schedules

Background  

Neonatal immunization with hepatitis B (HB) vaccine induces protective levels of antibody (anti-HBs ≥10 IU/L) in a majority of vaccines. However, the duration of protection after HB vaccination in infants is unknown. A smaller proportion of children vaccinated beginning at birth with three doses of HB vaccine were found to have protective titers 5–10 years after initial vaccination. Long-term efficacy of HB vaccine depends mainly on peak antibody levels after vaccination, and subjects were observed to have lower levels of antibodies if they received the first dose of vaccine immediately after birth. The aim of our study was to compare the immunogenicity of two different HB vaccine schedules in infants born to HB surface antigen-negative mothers.     

The impact of intraoperative vaccination with IL-12 modified autologous tumor cells in the Lewis lung carcinoma mouse model

Purpose

To improve immunological defense of tumors, we investigated the effect of intraoperative vaccination with IL-12 cDNA transfected cells in an autologous mouse tumor model.

Methods

Tumors derived from autologous Lewis lung carcinoma cells were established in C57/BL6 mice. At day seven, the tumors were surgically removed. Simultaneously, the mice were vaccinated intraoperatively with Lewis lung carcinoma cells transfected with an IL-12-encoding pRSC construct or with the empty plasmid, or with dead cells either intrasplenically (i.s.) or subcutaneously (s.c.). Control mice did not obtain vaccination. Tumor re-growth, survival, and metastasis were monitored. Mice with no tumor re-growth underwent a second tumor implantation. The same parameters were examined.

Results

After tumor resection and vaccination tumors reappeared in 60.0% of the animals of the control group. Lowest tumor reoccurrence rates of 41.4 and 43.5% were seen in animals receiving IL-12 pRSC cells either i.s. or s.c. Survival tended to be enhanced in all vaccinated animals compared with the control group. Following R0 tumor resection, the rate of tumor-free survivors was highest when IL-12 pRSC cells were given i.s. (73%, control 45%). 37–59% of the mice of the therapy groups did not develop a tumor, that is, they were tumor-free survivors. These mice underwent a second tumor implantation 120?days after tumor resection and vaccination. Tumor growth was significantly delayed in mice receiving IL-12 pRSC cells.

Conclusions

Intraoperative autologous whole-cell vaccination is practicable and proved to have anti-tumor potential, and therefore, it could be an additional option in adjuvant cancer therapy.     

HBV Vaccination Status and Response to Hepatitis B Vaccine Among Iranian Dentists,Correlation With Risk Factors and Preventive Measures

Background:

Studies showed that HBV vaccination and consequent level of antibody are not completely adequate among dentists despite performance of highly exposure prone procedures.

Objectives:

The objectives of the study were to evaluate the levels of responsiveness to HBV vaccine and to determine the occupational factors associated among dental staff.

Materials and Methods:

In total, 1612 dental health care workers were recruited. The level of anti-HBs was tested using a commercially enzyme-linked immunosorbent assay (ELISA). Data on demographic, risk factors associated with dental practice and level of protective procedures and occupational exposure aspects were collected through self-reported questionnaires.

Results:

Of 1538 vaccinated individuals, 55 (3.7%), 126 (8.4%) and 1309 (87.9%) had received one, two and full three doses of vaccine, respectively. One-hundred-seventy-six (11.5%) were nonimmune (anti-HBs < 10 IU/mL) and 1362 (88.5%) were immune (anti-HBs > 10 IU/ mL). 392/542 (72.3%) of dentists who received their third dose of vaccination less than five years before the commencement of study were completely immune compared to those who had completed all three recommended doses in a longer period (308/491, 64.3%) (P = 0.001). Fifty-eight (3.59%) of participants did not receive any HBV vaccine at all; however, they had positive results for anti-HBs, indicating a past HBV infection. Statistically, the levels of anti-HBs were significantly associated with gender, age, duration of dental practice engagement and regularly use of mask, glasses and shield.

Conclusions:

Since dental care workers have a high risk of exposure to hepatitis virus, they should be advised to receive hepatitis B vaccine and it should be confirmed if they have acquired immunity to HBV by testing the level of anti-HBs.     

Persistence of Protective Hepatitis B Surface Antibody Titers after Successful Double-Dose Hepatitis B Virus Rescue Vaccination in HIV-Infected Patients

Background/Aims

To assess the durability of protective hepatitis B surface antibody (anti-HBs) titers in HIV-infected patients who responded to double-dose hepatitis B virus (HBV) rescue vaccination.

Methods

A retrospective chart review was performed for HIV-infected patients who received the double-dose HBV rescue vaccination at 0-, 1-, and 2-month intervals after they had failed conventional HBV vaccination series. A protective antibody response was defined as an anti-HBs titer ≥10 mIU/mL.

Results

Of 54 HIV-infected patients who received a double-dose HBV rescue vaccination, 44 patients (81.5%) had a positive response and achieved protective anti-HB titers. Of the 44 patients who developed protective anti-HB titers, 33 patients received an evaluation of their anti-HB titers 12 months later. Of the 33 patients, 19 (57.6%) had persistent protective anti-HB titers (persistent responders, PR), and 14 patients (42.4%) lost their protective anti-HB titers (nonpersistent responders, NPR). There were significantly more patients who had an undetectable HIV viral load (<50 copies/mL) at baseline and follow-up in the PR group (11/19, 57.9%) than in the NPR group (3/14, 21.4%, p=0.036). Logistic regression analysis showed that an undetectable HIV viral load at baseline and follow-up (odds ratio, 12.973; 95% confidence interval, 1.189 to 141.515; p=0.036) was associated with PR.

Conclusions

Protective anti-HB titers may decrease over time after successful double-dose HBV rescue vaccination in HIV-infected patients. HIV viral load suppression could improve the persistence of anti-HB titers.     

Seroprevalence of hepatitis B virus among hemodialysis patients in Bushehr province, southern Iran: HBV seroprevalence in hemodialysis patients

Background

Hepatitis B virus (HBV) infection is still reported from adult hemodialysis units.

Objectives

To determine the prevalence of anti-HBs antibody in hemodialysis patients and the correlation between levels of anti-HBs antibody with other factors.

Patients and Methods

HBsAg, anti-HBs and anti-HBc antibodies level in 119 hemodialysis patients were evaluated by enzyme-linked immunosorbent assay.

Results

Seroconversion (anti-HBs antibody >10 IU/L) was found in 22 patients. Minimum protective antibody level was found in patients aged ≥60 years. Statistically significant correlation was not found between anti-HBs antibody and gender. Ten (8.4%) patients had abnormal ALT and/or AST. Prevalence of HBsAg, anti-HBc antibody, HBeAg and anti-HBe antibody were found in 8 (6.72%), 24 (25.16%), 2 (1.68%) and 3 (2.52%) patients, respectively.

Conclusions

Periodic assessment of anti-HBs antibody level is strongly recommended in patients undergoing hemodialysis.     

Immunity from Smallpox Vaccine Persists for Decades: A Longitudinal Study

Purpose

The threat of smallpox resulting from bioterrorist action has prompted a reassessment of the level of immunity in current populations.

Methods

We have examined the magnitude and duration of antiviral antibody immunity conferred by smallpox vaccination in 246 participants of the Baltimore Longitudinal Study of Aging. Of this population, 209 subjects were vaccinated one or more times 13 to 88 years before this evaluation, and stored serum samples were available at various intervals after vaccination. An additional 8 subjects who had documented childhood smallpox infection and 29 subjects with no history of infection or vaccination were included. We quantified the total vaccinia IgG and neutralizing antibody titers in each of these subgroups of participants over time.

Results

Vaccinated participants maintained antivaccinia IgG and neutralizing antibody titers above 3 natural logs essentially indefinitely. The absolute titer of antivaccinia antibody was only slightly higher after multiple vaccinations. In 97% of the participants, no decrease in vaccinia-specific antibody titers was noted with age over a follow-up period of up to 88 years. Moreover, Baltimore Longitudinal Study of Aging participants who survived active smallpox infections in their youth retained antivaccinia antibody titers that were similar to the levels detected in vaccinated subjects.

Conclusion

These data suggest that multiple or recent vaccinations are not essential to maintain vaccinia-specific antibody responses in human subjects. Scarce vaccine supplies should be applied first to individuals who have not previously been vaccinated.     

Which patients respond best to hepatitis B vaccination after a hepatitis B virus-related liver transplantation?

Background

A combination of hepatitis B immunoglobulin and nucleos(t)ide analogues is the current standard of care for controlling hepatitis B recurrence after orthotopic liver transplantation (OLT). However, frequent immunoglobulin treatment is expensive and inconvenient. This study investigated the efficacy of hepatitis B virus (HBV) vaccination in preventing the recurrence of hepatitis B after living donor OLT.

Methods

Twenty-seven patients who had undergone living donor OLT participated in the study; five had acute HBV infected liver failure (ALF-OLT) and 22 had HBV related liver cirrhosis (LC-OLT). Hepatitis B surface antigen (HBsAg)-containing vaccine was administered to them for at least 1 year after transplantation and continued once monthly for up to 36 months post-OLT. Patients who had anti-HBs antibody titers above 100 mIU/mL for a minimum of 6 months without immunoglobulin administration were defined as good responders; the others were defined as poor responders. Interferon-γ enzyme-linked immunospot assays against HBs and HBc antigens were used to assay cellular immune responses.

Results

All five of the ALF-OLT patients had good responses after a median of four (range 2.5–5) vaccinations. Nine of the 22 LC-OLT patients had good responses after a median of 19 (range 11.5–30) vaccinations. Among the LC-OLT group, those with livers donated by relatively higher-aged, marital and high-titer anti-HBs antibody donors were good responders. LC-OLT patients classed as good responders showed interferon-γ responses comparable to those of the ALF-OLT patients.

Conclusions

The ALF-OLT and LC-OLT patients who received livers from relatively higher-aged, marital, high-titer anti-HBs antibody donors were the best candidates for HBV vaccine administration. Boosting donors before transplantation may facilitate later vaccine response of the recipients.     

Adherence and factors associated with influenza vaccination among subjects with asthma in Spain

Purpose

Influenza has a high morbidity and mortality rate and an increased risk of complications in vulnerable individuals. Children and adults with asthma have a high risk of complications, hospitalisation and even death. The objectives of this study were as follows: to compare influenza vaccination coverage in Spain in a population of asthmatics aged ≥16 years with an equivalent population of non-asthmatics; to identify the factors that influence vaccination coverage among patients with asthma; and to compare coverage during the period 2006/2007 with that of 2009/2010.

Methods

We used data from the 2009 European Health Survey (EHS), which included a population of 22,188 individuals (≥16 years of age), of whom 1,669 [7.5 %; 95 % confidence interval (CI), 7.13–7.98] had asthma. The dependent variable was the answer (yes/no) to a question asking whether or not the interviewed person had been vaccinated against seasonal (not pandemic) influenza in the previous season. As independent variables, we analysed socio-demographic characteristics, health-related variables and the use of health care services.

Results

Vaccination coverage was 35.2 % (95 % CI, 32.5–37.9) among asthmatics and 22.1 % (95 % CI, 21.4–22.7) among non-asthmatics (p < 0.001). The probability of being vaccinated is almost twice as high for asthmatics as it is for non-asthmatics [odds ratio (OR), 1.92; 95 % CI, 1.69–2.17]. Among asthmatics, vaccination coverage increased with age, worse self-rated health status and not smoking. No significant change in coverage was observed between the study periods.

Conclusions

Seasonal influenza vaccination coverage among Spanish asthmatics is lower than desired and has not improved in recent years. Urgent strategies are necessary in order to increase vaccination coverage among asthmatics.     

Exploring the effect of previous inactivated influenza vaccination on seasonal influenza vaccine effectiveness against medically attended influenza: Results of the European I‐MOVE multicentre test‐negative case‐control study, 2011/2012‐2016/2017

Background

Results of previous influenza vaccination effects on current season influenza vaccine effectiveness (VE) are inconsistent.

Objectives

To explore previous influenza vaccination effects on current season VE among population targeted for vaccination.

Methods

We used 2011/2012 to 2016/2017 I‐MOVE primary care multicentre test‐negative data. For each season, we compared current season adjusted VE (aVE) between individuals vaccinated and unvaccinated in previous season. Using unvaccinated in both seasons as a reference, we then compared aVE between vaccinated in both seasons, current only, and previous only.

Results

We included 941, 2645 and 959 influenza‐like illness patients positive for influenza A(H1N1)pdm09, A(H3N2) and B, respectively, and 5532 controls. In 2011/2012, 2014/2015 and 2016/2017, A(H3N2) aVE point estimates among those vaccinated in previous season were ?68%, ?21% and ?19%, respectively; among unvaccinated in previous season, these were 33%, 48% and 46%, respectively (aVE not computable for influenza A(H1N1)pdm09 and B). Compared to current season vaccination only, VE for both seasons' vaccination was (i) similar in two of four seasons for A(H3N2) (absolute difference [ad] 6% and 8%); (ii) lower in three of four seasons for influenza A(H1N1)pdm09 (ad 18%, 26% and 29%), in two seasons for influenza A(H3N2) (ad 27% and 39%) and in two of three seasons for influenza B (ad 26% and 37%); (iii) higher in one season for influenza A(H1N1)pdm09 (ad 20%) and influenza B (ad 24%).

Conclusions

We did not identify any pattern of previous influenza vaccination effect. Prospective cohort studies documenting influenza infections, vaccinations and vaccine types are needed to understand previous influenza vaccinations' effects.

     

Efficacy of Hepatitis B vaccine in those who lost Hepatitis B surface antigen during follow-up: Efficacy of HBV vaccine in those who lost HBsAg

Background

The level of HBsAg in some chronic hepatitis B virus (HBV)-infected individuals may decline over time so that it is not detectable in serum.

Objective

To assess the efficacy of HBV vaccine in those who lost their HBsAg without seroconverssion to anti-HBs antibody.

Patients and Methods

From April 1993 to December 2008, of 1603 chronic HBV-infected individuals, 34 (22 men and 12 women) became HBsAg-negative in follow-up visits, with no detectable anti-HBs antibody and HBV DNA in their sera. They received HBV vaccination at 0, 1 and 6 months (case group). Fifty-two subjects (30 men and 22 women) who were negative for HBsAg, anti-HBs and anti-HBc antibody, received HBV vaccination according to the said schedule (control group). Anti-HBs antibody was assessed one month after the last dose of vaccination in the both groups.

Results

The mean±SD age of the case and control groups was 38±12.7 and 33.4 ± 8.6 years, respectively (p = 0.07). The sex distribution between these two groups were similar (p = 0.652). The mean ± SD years of follow-up for the case group was 7.6 ± 4.5 years. Anti-HBs antibody level ≥ 10 IU/L was found in 8 (24%) subjects in the case group and in 45 (87%) in the control group (p < 0.001). The mean±SD anti-HBs antibody level in the case group was 68 ± 32.66 and in the control group 344.6 ± 38.9 IU/L (p < 0.001).

Conclusions

We found that nearly 24% of chronic HBsAg-positive subjects who lost their HBsAg responded to HBV and the remaining cases need to be followed for occult HBV infection.     

Hepatitis delta: on soft paws across Germany

Introduction

Globally, more than 350 million people are considered to be chronic carriers of the hepatitis B virus (HBV) infection; thereof, 15?C20 million of these individuals are thought to be coinfected with hepatitis delta virus (HDV). The clinical course depends on the mode of transmission; whereas coinfection commonly resolves, superinfection aggravates the disease and progresses to chronicity in over 90?% of the cases, which, again, results in cirrhosis.

Objective

Although many tests are performed in HBV carriers, data on the prevalence of anti-HDV-IgG in Germany are only rarely available and outdated. Therefore, we retrospectively evaluated the seroprevalence of anti-HDV-IgG from the results of our routine service.

Materials and methods

Between January 2000 and October 2011, serum samples from 2,844 patients (carrying hepatitis B surface antigen) admitted to University Hospital Frankfurt am Main, Frankfurt, Germany, were tested for anti-HDV-IgG by enzyme-linked immunosorbent assay (ELISA).

Results

The overall seroprevalence of anti-HDV-IgG in the collective of Frankfurt (n?=?2,844) is 7.4?% [95?% confidence interval (CI): 6.4?C8.4]. The amount of seropositive men (8.3?%, 95?% CI: 6.9?C10) significantly exceeds the female proportion (5.7?%, 95?% CI: 4.3?C7.5). The rate of seropositivity to anti-HDV-IgG in this collective of Frankfurt reached a maximum in the year 2003 (10.1?%, 95?% CI: 8.9?C11.1). The lowest rate was observable in 2004, where 5.4?% were positive to anti-HDV-IgG.

Conclusion

Of the HBV carriers in Germany, 5?C8?% reveal serologic evidence of coinfection with HDV. The vaccination against HBV is the key to prevent HDV infection; therefore, vaccination must strongly be propagated further on.     

Prevalence of markers of hepatitis B virus infection or vaccination in HBsAg-negative subjects

Background.

The implementation of mass vaccinations against hepatitis B virus (HBV) has significantly reduced the prevalence of HBsAg-positive subjects. At the same time, the prevalence of the other markers of infection has decreased, but there has been an increase in the percentage of subjects with markers of a successful vaccination. It has been suggested that increasing immigration from countries in which this virus is highly endemic is changing the epidemiology of HBV infection. The aim of this study was to assess the prevalence of the serological markers of HBV in Italian and non-Italian HBsAg-negative subjects.

Materials and methods.

In the years 2007–2008, 8,018 samples from HBsAg-negative subjects (7,521 Italians and 497 non-Italians) were received for detection of anti-HBs and/or anti-HBc. The findings in the 1,358 samples from candidate blood donors were compared with those obtained in 1991 and 1999.

Results.

The rate of anti-HBc positivity was 18.3% in the Italian samples and 32.8% in the non-Italian samples; the corresponding percentages of anti-HBs/anti-HBc positive samples (indicating past infection), anti-HBs positive only samples (vaccination) and anti-HBc positive only were, 11.3% vs. 22.5%, 25.8% vs. 17.2%, and 6.9% vs. 9.9% in Italians and non-Italians, respectively. The differences were more marked when stratified by age. In relation to candidate blood donors, simultaneous positivity for anti-HBs and anti-HBc decreased from 11.0% in 1991 to 8.1% in 1999 and 3.9% in 2007–2008, whereas isolated anti-HBs positivity increased from 2.2% in 1991 to 21.4% in 1999 and 42.9% in 2007–2008.

Conclusions.

The frequency of markers of past infection among Italians has decreased over time as a result of mass vaccination and is significantly lower than that observed in non-Italians. The increasing number of immigrants from countries in which HBV is highly endemic is changing the epidemiology of HBV infection in Italy.