Nigerian medical students are at risk for hepatitis B infection

Medical students are exposed to blood and body fluids. This study was conducted to estimate the prevalence of hepatitis B virus (HBV) infection amongst medical students of the Lagos State University College of Medicine, Ikeja, Nigeria. Data were collected through a self-administered questionnaire and through blood analysis for hepatitis B surface antigen (HBsAg), hepatitis B 'e' antigen (HBeAg) as well as antibodies to the core (anti-HBc), surface (anti-HBs) and 'e' (anti-HBe) antigens. Three hundred and thirteen of 325 students (96%) participated. The mean age was 24.3+/-3.98 years; 231 (74%) were pre-clinical students and 82 (26%) were in the clinical years of study. Only 8 (2.6%) had received three doses of vaccination against HBV. Eighty-one (26%) tested positive for anti-HBc, 10 (3.2%) were positive for HBsAg and 56 (17.9%) had anti-HBs antibodies. A significant relationship was found between students who had a positive history of hepatitis B in the family and anti-HBc (P=0.03). Age was also significantly associated with HBsAg (P=0.012). Two hundred and twenty-five (72%) students were susceptible to the infection and required vaccination. Most students at this medical school are susceptible to HBV infection and should be vaccinated.     

深圳市居民乙型肝炎病毒感染危险因素分析

目的 了解广东省深圳市居民乙肝病毒(HBV)感染现状,分析HBV感染的相关危险因素.方法 于2010年在深圳市采用多阶段系统随机抽样方法抽取10个社区、1000户家庭,进行入户个案调查乙肝感染相关危险因素,并采集血样.用酶联免疫吸附试验(ELISA)检测乙肝血清标志物:乙肝表面抗原(HBsAg)、乙肝表面抗体(抗-HBs)和乙肝核心抗体(抗-HBc).结果 HBsAg、抗-HBs、抗-HBc阳性率和HBV感染率分别为6.68％ (252/3771)、71.92％(2 712/3771)、37.39％(1564/3771)和45.98％(1734/3771);≤15岁人群乙肝疫苗接种率为93.62％(1 752/1 872),＞15岁人群接种率为79.48％(1 509/1899),差异有统计学意义(x2=160.89,P ＜0.01);接种乙肝疫苗者与未接种者的HBV感染率分别为32.45％(1508/3261)和87.24％ (445/510),差异有统计学意义(x2 =552.72,P＜0.01);HBsAg阳性率与HBV感染率均随年龄上升有增加的趋势;多因素Logistic回归分析结果显示,家中有乙肝患者、内窥镜史、手术史及有偿献血史是深圳市居民乙肝感染的危险因素.结论 深圳市乙肝感染情况低于全国平均水平;乙肝感染具有家庭聚集性;医疗卫生因素对乙肝感染的影响较大.     

Occupational risk of blood-borne viruses in healthcare workers: a 5-year surveillance program.

OBJECTIVE: This study presents the results of a 5-year surveillance program involving the prospective follow-up of healthcare workers (HCWs) in the Veneto region of Italy exposed to blood-borne viruses. DESIGN: All HCWs who reported an occupational exposure to blood-borne infection joined the surveillance program. Both HCWs and patients were tested for viral markers (hepatitis B surface antigen [HBsAg], antibody to hepatitis B surface antigen [anti-HBs], antibody to hepatitis B core antigen [anti-HBc], antibody to hepatitis C virus [anti-HCV], HCV RNA, and antibody to human immunodeficiency virus [HIV]) and had these markers plus transaminases assayed at 3, 6, and 12 months and then yearly thereafter. Moreover, a program of hepatitis B virus (HBV) prophylaxis was offered to those whose anti-HBs levels were less than 10 IU/mL. PARTICIPANTS: Two hundred forty-five HCWs (156 women and 89 men) with a mean age of 37 (+/- 10) years who reported occupational exposure during the 5-year period. RESULTS: At the time of exposure, 1 HCW was positive for HBsAg (0.4%) and 2 were positive for HCV RNA (0.8%). Among the patients involved, 28 (11.4%) were positive for HBsAg, 68 (27.8%) were positive for HCV RNA, 6 (2.4%) were positive for HIV, and 147 (60.0%) were negative for all viral markers (4 patients were positive for both HCV and HIV). During the follow-up period after exposure (mean, 2.7 [+/- 1.6] years), there was no increase in transaminases or seroconversions to any of the viral markers. CONCLUSION: Our accurate postexposure follow-up revealed a lack of transmission of HBV, HCV, and HIV.     

Hepatitis B prevalence in local authority employees

Prevalence of hepatitis B infection was determined in 420 employeesfrom three local authorities by testing for hepatitis B coreantibody (anti-HBc). Five (1.2 per cent) were positive: thisincluded a hepatitis BsAg carrier, three with antibody to hepatitisBsAg (anti-HBs) and one who had only anti-HBc. The prevalenceof hepatitis B was not significantly different (P>0.05) froma control group of blood donors. However, four out of five anti-HBcpositive individuals worked with mentally or physically handicappedindividuals or those discharged into the community after long-terminstitutionalized care.     

Prevalence of serologic markers of hepatitis B virus in hospital personnel]

OBJECTIVE: To verify the prevalence of the anti-HBc, anti-HBs and HBsAg markers of hepatitis B virus, and to identify the risk factors determining occupational infection with this virus among hospital personnel. METHODS: Samples of serum from 210 persons both male and female who work in different occupations at a hospital university, were analysed. The technique employed was the immunoenzymatic assay using commercial kits. RESULTS: As a control group, samples of serum from 45 volunteer blood donors were utilized. It was verified that 20.5% of the hospital personnel presented a positive reaction to at least one of the markers songht, as against 6.6% of the control group. The prevalence of each marker separately was: anti-HBc 8.1%, anti-HBs 5.2%, and HBsAg 2.9% in the hospital personnel; and 4.4%, 2.2% and 0.0% in the control group. The simultaneous presence of the anti-HBc and anti-HBs markers was detected in 4.3% of the workers. In the control group, the presence of the anti-HBc and anti-HBs markers was detected, isolately, with respective prevalences of 4.4% and 2.2%. Those who presented the highest rates of positivite reaction were: laboratory technicians 24.0%, nurses 23.6%, physicians 20.8%, and cleaning personnel 18.2%. CONCLUSIONS: The findings suggest that direct contact with patients and handling of blood and other body fluids are risk factors related to occupational infection with HBV. Therefore, it is recommended that hospital personnel be vaccinated against hepatitis B.     

深圳市儿童乙型肝炎血清流行病学调查分析

目的探讨深圳市儿童乙型病毒性肝炎(简称乙肝)流行现状及乙肝疫苗应用效果。方法采用多阶段整群系统随机抽样方法抽取调查户,对深圳市1～14岁常住人口进行问卷调查并采血检测HBsAg、抗-HBs及抗-HBc。采用Epidata 3.2软件建立调查数据库,利用SPSS 16.0软件进行数据处理分析,两组之间率比较采用χ2检验,P<0.05为差异有统计学意义。结果调查1～14岁儿童1 653人,HBsAg阳性率2.06%,抗-HBs阳性率74.53%,抗-HBc阳性率5.32%,HBV感染率9.62%。有乙肝疫苗免疫史儿童1 349人,HBsAg阳性率1.85%、抗-HBs阳性率75.02%、抗-HBc阳性率4.60%及HBV感染率5.41%;无乙肝疫苗免疫史儿童92人,HBsAg阳性率4.35%、抗-HBs阳性率68.48%、抗-HBc阳性率10.87%及HBV感染率73.91%;有无乙肝疫苗免疫史儿童HBsAg阳性率、抗-HBs阳性率差异无统计学意义,抗-HBc阳性率、HBV感染率差异有统计学意义,(χ2=7.14、457.83,P均<0.01)。乙肝疫苗免疫3年以内儿童601人,其中HBsAg阳性率为0、抗-HBs阳性率73.71%、抗-HBc阳性率2.0%、HBV感染率2.0%;免疫7～9年183人,其中HBsAg阳性率5.46%、抗-HBs阳性率79.23%、抗-HBc阳性率8.74%、HBV感染率11.48%。乙肝疫苗不同免疫年限儿童抗-HBs阳性率差异无统计学意义,HBsAg阳性率、抗-HBc阳性率、HBV感染率差异有统计学意义(χ2=29.53、36.88、43.75,P均<0.01)。结论持续保持较高的乙肝疫苗接种率,可以有效降低乙肝流行率。研究和推行乙肝疫苗加强免疫策略也是乙肝防治工作重点之一。     

Significance and anamnestic response in isolated hepatitis B core antibody-positive individuals 18 years after neonatal hepatitis B virus vaccination in Taiwan

Aim

To investigate the significance of isolated hepatitis B core antibody (anti-HBc) and to analyze the response to hepatitis B virus (HBV) booster vaccination in young adults with isolated anti-HBc who had been fully vaccinated with HBV vaccine as infants.

Materials and methods

We screened 1734 new university entrants who had been fully vaccinated against HBV in infancy for the presence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and anti-HBc upon university entry. Results positive for isolated anti-HBc were reconfirmed by testing for the presence of HBsAg and anti-HBc once more, and further evaluated for anti-HCV, anti-HIV, and HBV DNA status 6 months later. Students were also offered HBV booster vaccinations at that time. Geometric mean titers (GMT) of anti-HBs after one booster dose of HBV were compared between students with isolated anti-HBc and students with HBV naïve status.

Results

The overall prevalence of isolated anti-HBc in our student cohort was 1.2% (21 of 1734). No evidence of occult HBV infection was observed. A “booster” anamnestic response (anti-HBs titer ≥10 mIU/mL) was noted in 95% (20 of 21) of subjects with isolated anti-HBc. After re-measurement of anti-HBc, 13 (62%) of the 21 subjects with isolated anti-HBc were reclassified as having resolved HBV infection with a loss of anti-HBs. In the remaining 8 subjects (38%), isolated anti-HBc was determined to be false positive. The HBV status of these 8 subjects was HBV naïve due to the waning-off effect of anti-HBs of the neonatal HBV vaccination. There was no significant difference in anamnestic response to a single HBV booster dose of vaccine between students with isolated anti-HBc (n = 13) and those with HBV naïve (n = 323) status (GMT 50.6 vs 47.7 mIU/mL, P = 0.90).

Conclusion

The presence of isolated anti-HBc 18 years after HBV vaccination can be attributed to post-HBV infection with a loss of anti-HBs and to a decline in anti-HBs elicited by vaccine. A single HBV booster dose of vaccine is recommended for subjects with isolated anti-HBc who were fully vaccinated with HBV vaccine as infants. This finding needs to be replicated in further studies with larger cohorts.     

蓬莱市农村人群乙肝疫苗接种和乙肝病毒感染相关性

目的分析评价乙肝疫苗免疫接种对蓬莱市农村居民乙肝病毒(HBV)感染变化的影响。方法采用多阶段整群抽样方法,对蓬莱市农村1～59岁常住人口共629人进行乙肝血清流行病学调查和乙肝疫苗接种率调查,采用ELISA法检测HB-sAg、抗-HBs、抗-HBc等乙肝标志物。结果 629名调查对象HBV感染率为22.26%,HBsAg、抗-HBs、抗-HBc阳性率分别为2.70%、62.32%、18.44%。乙肝疫苗接种率由1992年以前出生人群的18.89%提高到2002-2006年出生人群的100.00%,HBV感染率由42.11%降为1.31%;有乙肝免疫史的人群HBV感染率和HBsAg、抗-HBc阳性率均低于无乙肝疫苗免疫史人群,抗-HBs阳性率明显高于无乙肝疫苗免疫史人群,乙肝疫苗保护率为85.63%。结论从1992年使用乙肝疫苗以来,不仅有效的减少了乙肝病毒携带状态,且乙肝疫苗保护率达到较好的效果,进一步说明接种乙肝疫苗可有效防止乙肝病毒的感染。     

乙型肝炎X抗原和抗-HBx的血清流行病学调查

对437例乙型肝炎和肝癌病人进行了HBxAg和抗-HBx的血清流行病学调查。结果表明HBxAg阳性率为3.66%(16/437),抗-HBx阳性率为2.97%(13/437);HBxAg主要出现在HBsAg、HBeAg和抗-HBc阳性,而抗-HBe为阴性的血清中,它与抗-HBs的关系不密切;抗-HBx主要出现在HBeAg和抗-HBc阳性,而HBsAg和抗-HBe为阴性的血清中,它与抗-HBs的关系亦不密切。上述结果说明HBxAg/抗-HBx系统的出现与体内乙型肝炎的病毒复制有关,同时也说明抗-HBx不是保护性抗体。     

Seroepidemiology of hepatitis A and hepatitis B virus in Luxembourg

A prospective seroepidemiological survey was carried out in Luxembourg in 2000-2001 to determine the antibody status of the Luxembourg population against hepatitis A virus (HAV) and hepatitis B virus (HBV). One of the objectives of this survey was to assess the impact of the hepatitis B vaccination programme, which started in May 1996 and included a catch-up campaign for all adolescents aged 12-15 years. Venous blood from 2679 individuals was screened for the presence of antibodies to HAV antigen and antibodies to hepatitis B surface antigen (anti-HBs) using an enzyme immunoassay. Samples positive for anti-HBs were tested for antibody to hepatitis B core antigen (anti-HBc) using a chemiluminiscent microparticle immunoassay to distinguish between individuals with past exposure to vaccine or natural infection. The estimated age-standardized anti-HAV seroprevalence was 42.0% [95% confidence interval (CI) 39.8-44.1] in the population >4 years of age. Seroprevalence was age-dependent and highest in adult immigrants from Portugal and the former Yugoslavia. The age-standardized prevalence of anti-HBs and anti-HBc was estimated at 19.7% (95% CI 18.1-21.3) and 3.16% (95% CI 2.2-4.1) respectively. Anti-HBs seroprevalence exceeding 50% was found in the cohorts targeted by the routine hepatitis B vaccination programme, which started in 1996. Our study illustrates that most young people in Luxembourg are susceptible to HAV infection and that the hepatitis B vaccination programme is having a substantial impact on population immunity in children and teenagers.     

Hepatitis B serology in Greek prostitutes: significance of the different serum markers.

One hundred and ninety-eight prostitutes (mean age 41.8 years) and 117 control women of low socio-economic class (mean age 43.8 years) were tested by solid-phase radioimmunoassay for hepatitis B surface antigen (HBsAg), its antibody (anti-HBs) and antibody to hepatitis B core antigen (anti-HBc). The prevalence of HBsAg was higher among prostitutes (11% v. 4%, P approximately 0.06). This difference was accounted for by the higher infection rate of prostitutes to hepatitis B virus (HBV) 97% v. 45%, P less than 10(-6)), since the proportion of HBsAg carriers among those infected was practically the same between the two groups (11% v. 9%). Among the previously infected prostitutes who did not become carriers the majority (75%) were positive for both anti-HBc and anti-HBs, whereas among control women about half (52%) were positive only for anti-HBc.     

Hepatitis B markers in West Yorkshire firemen

Firemen have been considered at occupational risk of hepatitis (HBV) infection, but proof is lacking. The aim of this study was to assess the degree of risk by determining the prevalence of serological markers of past infection with HBV in members of the West Yorkshire Fire Service. Sera from 173 firemen, 9.3% of the brigade, were tested for antibodies to HBV surface antigen and to core antigen. Those containing anti-HBs greater than or equal to 10 IU/L or anti-core antibody, were also tested for antibody to HBe antigen. The presence of more than one marker was used to define past infection. One sample satisfied this criterion, giving a prevalence rate of 0.6%. This compares with a rate of 1% in London blood donors. We conclude that the group shows no evidence of having been at increased risk of HBV infection. A comprehensive vaccination policy for firemen might be questionable.     

抗HBc阳性,HBsAg阴性献血者乙型肝炎病毒感染性研究

目的为预防输血后乙型肝炎，是否有必要在献血者中加做抗－ＨＢｃ筛查以及采取何种取舍标准？为此，对常规筛查合格的献血者血液进行了抗－ＨＢｃ滴度与ＨＢＶＤＮＡ相关性的研究。方法用免疫－套式ＰＣＲ法检测了２９７份不同滴度组抗－ＨＢｃ阳性血液的ＨＢＶＤＮＡ。结果在４份抗－ＨＢｃ滴度≥１１２８的血液中检出１例ＨＢＶＤＮＡ，而在另７５份抗－ＨＢｃ滴度＜１１２８的血液中未检出，ＨＢＶＤＮＡ与抗－ＨＢｃ滴度之间有显著相关性。在２１８份抗－ＨＢｃ／抗－ＨＢｓ双阳血液及５０份抗－ＨＢｃ阴性血液中未检出ＨＢＶＤＮＡ。结论仅含高滴度单项抗－ＨＢｃ的血液可能具有传染性；ＨＢＶＤＮＡ在抗－ＨＢｃ阳性血液中的总检出率低，仅为０．３４％（１／２９７）。建议将有限的资金首先用于进一步提高现有献血者ＨＢｓＡｇ检测试剂的灵敏度（目前为１ｎｇ／ｍｌ），或许更为有效。     

Incidence of hepatitis B virus infection among an Italian military population: Evidence of low infection spread

In 1990, a prospective serological survey to estimate the rate of clinical and inapparent infection with hepatitis B virus was performed in a cohort of 1324 soldiers, 18–24 years old, during an eight month period in Italy. At the time of enrollment the prevalence of hepatitis B markers was 4.6% (0.7% subjects positive for hepatitis B surface antigen [HBsAg], 3.0% positive for antibody to hepatitis B surface antigen [anti-HBs], and 0.9% positive for antibody to hepatitis B core antigen [anti-HBc] alone. Among the 1263 susceptible subjects who were followed-up, only 2 (0.24/100 person-years of exposure) had seroconversion for HBV markers, none of which was associated with clinical illness. Among the 9 subjects HBsAg-positive at the time of enrollment, 1 (11.2%) had lost HBsAg at the end of follow-up. These data show a low spread of HBV infection among Italian young generations.     

乙肝患者血清HBsAg与HBsAb双阳性的特殊模式

目的通过分析乙肝患者乙型肝炎病毒(HBV)血清标志物乙型肝炎表面抗原(HBsAg)与乙型肝炎表面抗体(HBsAb)同时阳性罕见模式的病例,探讨其存在原因及临床价值。方法应用ELISA法对乙肝感染者HBV标志物进行初筛,再采用微粒子酶免疫化学发光分析法(MEIA)检测其浓度;对HBsAg与HBsAb同时阳性者应用PCR方法定量检测HBV-DNA,并结合患者的临床特点进行综合分析。结果 HBsAg与HBsAb同时阳性的检出率为4.46%,检出率最高为重型肝炎(18.18%),其次为慢性肝炎(9.09%)和肝硬化(8.96%)。重型肝炎、慢性肝炎和肝硬化HBsAg与HBsAb同时阳性率明显高于无症状携带者和急性肝炎(P0.01)。HBsAg高滴度组HBV-DNA病毒载量及阳性率明显高于低滴度组(P0.01)。HBs-Ab值与HBV-DNA病毒载量间无明显相关性(P0.05)。结论 HBsAg与HBsAb同时阳性的模式,是由多种原因引起,HBV亚型双重感染可能是主要原因。     

2006年枣庄市薛城区农村人群乙型肝炎病毒感染血清学调查

[目的]了解农村人群乙肝病毒（HBV）感染状况。[方法]2006年10月,枣庄市薛城区疾病预防控制中心对辖区3个乡镇的610名农村居民进行血清学调查。[结果]检测610人,HBsAg阳性者28人,阳性率为4．59％;抗-HBs阳性的362人,阳性率为59．34％,其中单项抗-HBs阳性、有乙肝疫苗接种史的246人（占检测总人数的40．33％）;抗-HBc阳性的156人,占25．57％。HBV感染率为26．56％（162／610）,〈10岁儿童最低（5．53％）,50～54岁最高（60．00％）,随着年龄的增大呈递增趋势（P〈0．01）;农民为45．90％,其他人群为13．66％（P〈0．01）。[结论]薛城区农村人群HBV感染率较高。     

Hepatitis B virus infection in Danish dentists. A case-control and follow-up study

The authors determined the seroprevalence of hepatitis B virus markers among Danish dentists in 1985 in an effort to assess occupational risk factors. A case-control study approach was applied using pedodontists as zero-exposure controls. The study further allowed serologic and epidemiologic follow-up of dentists who participated in a similar study in 1976. The authors sought to determine whether exposure to hepatitis B virus in this population sometimes leads to immunization without infection (antibody to hepatitis B surface antigen (anti-HBs) positivity only). A total of 922 dentists (22% of all Danish dentists) gave blood; of these, 254 (28%) participated in the 1976 study. Serum samples were tested using commercial solid phase radioimmunoassays. The prevalences of anti-HBs and antibody to hepatitis B core antigen (anti-HBc) were 7.2% (95% confidence interval (CI) = 5.7-9.0) and 5.2% (95% CI = 3.8-6.6), respectively. Twenty-one dentists (31%) only had anti-HBs (without prior vaccination). Age-standardization of the two data sets (1976 and 1985) indicated no substantial change in seroprevalence. Private practitioners, especially those working in Copenhagen, had an increased odds ratio (OR) of being seropositive compared with that of pedodontists (OR = 3.0 (95% CI = 1.3-6.8) adjusted for age and sex and OR = 2.4 (95% CI = 1.1-5.2) adjusted for age and site of practice). The proportion attributable to occupational exposure was approximately 50%. In a logistic regression model, site of practice and type of specialty were associated with hepatitis B virus seropositivity (p = 0.01 and 0.05, respectively), whereas age, sex, hours of oral surgery per week, and use of gloves were not. Four persons had become seropositive in the follow-up study, for a seroconversion rate of 0.2% per year. Seven out of 18 dentists who were anti-HBs positive in 1976 were found to be anti-HBs negative in 1985. Most of these dentists had values below 10.0 units by S/N ratio (ratio of counts per minute of sample compared with the mean number of counts per minute of negative controls). The findings do not justify institution of a large-scale vaccination program for dentists, but there are certain subgroups of dentists which constitute candidates for vaccination.     

珠海市健康体检人群乙型肝炎病毒感染分析

目的了解珠海市健康人群乙型肝炎病毒（HBV）感染情况。方法用酶联免疫吸附实验（ELISA）检测体检者乙型肝炎病毒标志物（乙肝两对半）。结果6351例体检者中，乙型肝炎病毒两对半全部阴性的有2553例（40．19％）；单项抗-HBs阳性有2933例（46．18％）；抗-HBs和抗-HBc阳性有197例（3．10％）；抗-HBs、抗-HBe和抗-HBc阳性有136例（2．14％）；HBsAg、抗-HBe、抗-HBc阳性有323例（5．09％）；HBsAg、HBcAg、抗-HBc阳性有79例（1．24％）；其他130例（2．05％）。结论40．19％的受检人群未受HBV感染，且无保护性抗体；另有8．37％的受检人群呈阳性模式，需采取相应措施控制乙肝病情的发展。     

某监狱乙型肝炎病毒感染的前瞻性血清流行病学调查

男性青壮年犯人2443人,随访观察12~36(23.7±11.4)个月,每年检测血清乙型肝炎病毒标志物。初次检测只85人8检出率25.1%(614/2443),其中一过性携带14.7%,慢性携带85.3%,后者HBsAg年阴转率为1.4%.该人群中抗-HBs检出率46.3%(1 130/2 443),年消失率6.0%,提示经常暴露于HBV而抗体应答持续存在。HBeAg年阴转率22.3%,HBeAg阳转率7.9%,提示感染状态的持续性和波动性。人群感染率(HBsAg、抗-HBs、抗-HBc-项或一项以上阳性)为81.1%(1 981/2 443),而初检血清标志物阴性的易感者,年感染率22.3%。     

Hepatitis B core antigen synthesised in Escherichia coli: its use for antibody screening in patients attending a clinic for sexually transmitted diseases.

Hepatitis B core antigen (HBcAg) synthesised in Escherichia coli by recombinant DNA techniques was compared with HBcAg prepared from infected liver tissue. The two antigens were used in radioimmunoassays (RIA) to detect antibody to HBcAg (anti-HBc) in sera from patients attending a clinic for sexually transmitted diseases. Out of 2151 sera tested, 260 were anti-HBc positive with both HBcAg preparations but seven were positive with the liver-derived antigen alone. Reasons for these discrepant results are discussed. The slight loss of sensitivity of the anti-HBc RIA using E. coli HBcAg was not considered significant when compared with the potential advantages of a synthetic antigen. The presence of other hepatitis B markers in the 267 anti-HBc positive sera was determined: 25 contained HBsAg, 220 anti-HBs and, of the 22 that were HBsAg/anti-HBs negative, 12 contained anti-HBe. In the 10 remaining sera, anti-HBc was the only hepatitis B marker that could be found.