Response to HBV vaccine in relation to anti-HCV and anti-HBc positivity: a study in intravenous drug addicts

Drug addicts represent the group of young adults with the lowest response to hepatitis B virus (HBV) vaccine. A study was carried out on 110 current intravenous heroin users attending the service providing assistance to intravenous drug users (IVDUs) (SERT) in Padua: 66.4% of them were found anti-hepatitis C virus (HCV)-positive and 33.6% were anti-HBc positive; 29.9% were positive for both. The subjects were vaccinated with 10 microg of yeast-derived vaccine at months 0, 1 and 2 (fast schedule). The overall response rate was 66.4%. Response seems to be affected by positivity to anti-HBc, but not to HCV infection.     

Hepatitis B in Poland in 1999

A total of 3,508 of hepatitis B cases (including 152 cases of mixed HBV and HCV infections) were reported in Poland in 1999. For the first time since 1979, when registration has began, the incidence decreased below 10.0 and was 9.1 per 100,000. The program of eradication of hepatitis B in Poland has been introduced in 1993 and since then the fourfold decrease in number of hepatitis B cases has been noticed. During the past 7 years there has been a steady decline in hepatitis B incidence. In 1997 the incidence decreased 23% as compared to 1996, followed by 16.8% decrease in 1998 and 13.9% in 1999; the marked differences in incidence in particular voivodeships have been observed. The overall rate of hospitalized hepatitis B cases in Poland reached 98.1%. A total of 25 cases of hepatitis B (rate 1.2 per 100,000) occurred among children under 4 years of age, who should be vaccinated. Among children aged 5-9 years, of which many could not be vaccinated, the incidence rate was 6 times higher, ranging from 4.9 per 100,000 in girls to 9.8 per 100,000 in boys. The increase of incidence from 5.3 to 9.2 was observed in young people (14-24 years old). Data from the study of serological markers of hepatitis B, conducted among 4,500 health care workers during 1998-2000, have indicated that about 22% of health care workers have been infected with HBV (in 21% of persons anti-HBc and in 1% anti-HBc together with HBsAg were detected).     

Prevalence of hepatitis B markers in patients with hepatitis C infection in north-eastern Poland: Risk factors and vaccine use

We evaluated the prevalence of hepatitis B virus (HBV) markers and established HBV vaccination status among 111 patients with hepatitis C virus (HCV) infection. A history of HBV immunisation was recorded in 30 patients (27.0%) and only 17/30 (66.7%) had anti-HBs level 10 mIU/ml. All patients were HBsAg-negative and 22.2% of nonvaccinated subjects had evidence of HBV infection as determined by anti-HBc presence. Among patients with anti-HBc in 7/18 cases (38.9%) anti-HBc was the only marker of HBV infection (without anti-HBs). The prevalence of anti-HBc was significantly higher among patients who reported a history of acute hepatitis. In conclusion the prevalence of HBV markers in patients with HCV infection in north-eastern Poland is similar to the prevalence in general population, which suggests no increased risk for nosocomial HBV infection among those individuals. HCV infection seems to favour unusual serological pattern of HBV infection with anti-HBc as the only marker. HBV vaccine use is low among patients with HCV infection in north-eastern Poland.     

Hepatitis B and Delta virus infection among heterosexuals,homosexuals and bisexual men

The hepatitis B virus (HBV) and hepatitis Delta virus (HDV) infection rates were estimated in patients attending a venereal disease outpatient clinic: 759 heterosexuals and 154 homosexual-bisexual men. The anti-HBC prevalence was higher in homo-bisexual men (68.8 per 100) than in heterosexuals (41.8 per 100), whereas HBsAg was roughly the same in the two groups (about 6 per 100). The anti-HBc prevalence rate among heterosexuals was higher than that estimated in hospital personnel from the same geographical area. A positive association between anti-HBc prevalence and present or past sexually transmitted diseases (STD) was found among homo-bisexual men. Anti-HBc was also positively associated with herpes simplex type 2 antibodies in both heterosexuals and homo-bisexual men. These data are consistent with the hypothesis that sexual behavior also plays a role in the spread of infection among heterosexuals. Ten of the 46 HBsAg-positive subjects were anti-HDV positive: 6 of the 36 heterosexuals and 4 of the 10 homosexuals. All HDV-positive subjects had present or past STDs. These findings suggest sexual transmission of HDV infection.     

Prevalence of hepatitis B, D and C virus infections among children and pregnant women in Moldova: additional evidence supporting the need for routine hepatitis B vaccination of infants

Rates of acute hepatitis B are high in Moldova, but the prevalence of chronic infection is unknown. In 1994, we surveyed children and pregnant women, collected demographic information, and drew blood for laboratory testing. Among the 439 children (mean age, 5 years), the prevalence of antibody to hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were 17.1 and 6.8%, respectively. Among the 1098 pregnant women (mean age, 26 years), 52.4% were anti-HBc-positive and 9.7% were HBsAg-positive. Of the HBsAg-positive pregnant women, 35.6% were hepatitis B e antigen (HBeAg) positive and 18.3% had antibodies to hepatitis D virus. The prevalence of antibody to hepatitis C virus was 1.4% in children and 2.3% in pregnant women. The high HBeAg prevalence among HBsAg-positive pregnant women and the high anti-HBc prevalence among children indicate that both perinatal and early childhood transmission contribute to the high hepatitis B virus endemicity in Moldova.     

Rationale for the infant and adolescent vaccination programmes in Italy

In Italy in the 1980s, the incidence of acute hepatitis B was about 13 per 100,000, corresponding on average to 7500 new symptomatic cases per year was about 3%, making Italy an area of intermediate endemicity. HBV infection was also associated with 12 per 100,000 deaths from cirrhosis and with 5.1 per 100,000 deaths from hepatocellular carcinoma. In view of the large numbers of pregnant women who were hepatitis B surface antigen (HBsAg)-positive, selective hepatitis B vaccination of all newborns to these mothers and of other high-risk groups was introduced in 1983. Compliance was high among the newborns but low in other high-risk groups. Hepatitis vaccination was adopted in Italy in 1991, including each year all newborns, all adolescents aged 12 years and other high-risk groups. Compliance has been nearly 95% for newborns and 80% for adolescents. Since the introduction of vaccination, both the incidence of acute hepatitis B and the prevalence of HBV carriage have fallen, the latter from 3.4% in 1985 to 0.9% in 1996. There is good evidence that these decreases are mainly the result of the vaccination programmes. Although the full economic impact cannot yet be assessed, about 18,000 cases of acute HBV infection have been prevented over the 6 years since starting the mass vaccination programme, with cost savings of about US$ 244,308,000.     

Continuing outbreak of hepatitis A linked with intravenous drug abuse in Multnomah County

A communitywide outbreak of hepatitis A occurred in Portland, OR, from 1983 through 1986. At the peak of the outbreak, the age- and sex-specific annual incidence rate approached 400 cases per 100,000 population among men ages 25 to 34, the highest risk group. The community incidence rate was nearly 10 times the relevant national incidence rate. A review of the records concerning cases of hepatitis A reported in the last 6 months of 1985 revealed that about half the number of young adults whose cases were investigated during that time reported a history of intravenous (IV) drug use--a proportion about 50 times greater than expected among persons in that age range. A simultaneous epidemic of overdose deaths from heroin and a concomitant increase in hepatitis B incidence rates led to the suspicion that this was a drug-abuse-associated epidemic of hepatitis among new IV drug users. Control of this outbreak was difficult because the population most at risk was distrustful of public health officials. Increased surveillance in food service establishments and schools might have prevented outbreaks from a common source in the general population; however, an increase of sporadic cases in the nondrug-using population clearly occurred.     

Hepatitis B in children in Italy: Incidence and risk factors

The objectives of the present report were to give a baseline picture of hepatitis B notification incidence rates in children before the campaign of mass vaccination for newborns and adolescents (12–13 years old), and to study the role of different risk factors. Data from a specific national surveillance system of acute viral hepatitis (SEIEVA, Sistema Epidemiologico Integrato dell'Epatite Virale Acuta) were used and acute hepatitis B cases were compared to acute hepatitis A patients with the case-control study method to estimate the associations with the considered risk factors. Since the system began, one hundred and sixty-three local health departments have joined SEIEVA covering 30% of the Italian population. The incidence of acute hepatitis B notifications among 0–14 aged children was 9 per 100,000 in 1985 and 1 per 100,000 in 1990. Such decline in incidence was observed in both the North and the South of Italy. Surgical interventions, dental therapy and household contacts with a HBsAg chronic carrier were found to be associated with acute hepatitis B. The point estimate of the odds ratio was 10 for the latter risk factor. Other preventive measures in addition to vaccination are needed to control the risk of hepatitis B infection and other parenteral diseases due to surgical intervention and dental therapy.     

Control of occupational hepatitis B among healthcare workers in the Czech Republic, 1982 to 1995.

Occupational hepatitis B remains a threat to healthcare workers (HCWs) worldwide, even with availability of an effective vaccine. Despite limited resources for public health, the Czech Republic instituted a mandatory vaccination program for HCWs in 1983. Annual incidence rates of acute hepatitis B were followed prospectively through 1995. Despite giving vaccine intradermally from 1983 to 1989 and intramuscularly as half dose from 1990 to 1995, rates of occupational hepatitis B decreased dramatically, from 177 cases per 100,000 workers in 1982 (before program initiated) to 17 cases per 100,000 in 1995. Among high-risk workers, the effect was even more dramatic (from 587 to 23 per 100,000). We conclude that strong public-health leadership led to control of occupational hepatitis B among HCWs in the Czech Republic, despite limited resources that precluded administering full-dose intramuscular vaccine for much of the program. Application of a similar program should be considered for other countries in regions that currently do not have a hepatitis B vaccination program.     

Immunization programme against hepatitis B virus infection in Italy: cost-effectiveness

In Italy in the 1980s the extent of viral hepatitis B infection was on average about 11,000 symptomatic cases of acute viral hepatitis (AVH) per year (19/100,000 inhabitants). The prevalence of HBsAg carriers in the general population was about 3% and in pregnant women 2.4%. 64,000 people were affected by chronic viral hepatitis (CVH) or cirrhosis (prevalence rate 112/100,000) and 3400 by hepatocellular carcinoma (HCC) (prevalence rate 5.9/100,000). To reduce these HBV related pathologies in the Italian population, universal vaccination of newborn babies, 12-year old adolescents and high risk groups was implemented in 1991. The annual cost of this immunization is about 57 million 544 thousand USD: direct costs: 41 million 34 thousand USD; indirect costs: 16 million 510 thousand USD. Concerning the vaccination impact on HBV endemicity in Italy, we found a significant reduction of acute viral hepatitis incidence (4.2/100,000 in 1996 versus 19/100,000 in the '80s) and HBsAg carrier prevalence (0.9% in 1997 versus 3% in the '80s). As for the assistance and social cost of acute viral hepatitis occurring from 1991 to 1996 (17,608 cases) it was 238 million 908 thousand USD, while the cost for the same pathology in the years from 1985 to 1990 (35,614 cases) was 483 million 216 thousand USD. Thus, the saving during the years of the vaccination was evaluated in 244 million 308 thousand USD. At the moment, we have no information about the reduction in chronic sequelae of HBV pathology as an effect of the vaccination, because the incidence of this pathology generally starts to appear after 15 years (in our case in 2006).     

Hepatitis B vaccination coverage among adults--United States, 2004

Hepatitis B virus (HBV) infection is a major cause of cirrhosis and liver cancer in the United States. The Advisory Committee on Immunization Practices (ACIP) has recommended a comprehensive strategy to eliminate HBV transmission, including prevention of perinatal HBV transmission; universal vaccination of infants; catch-up vaccination of unvaccinated children and adolescents; and vaccination of unvaccinated adults at increased risk for infection. The incidence of acute hepatitis B has declined 75%, from 8.5 per 100,000 population in 1990 to 2.1 per 100,000 population in 2004, with the greatest declines (94%) among children and adolescents. Incidence remains highest among adults, who accounted for approximately 95% of the estimated 60,000 new infections in 2004. To measure hepatitis B vaccination coverage among adults, data were analyzed from the 2004 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that, during 2004, 34.6% of adults aged 18-49 years reported receiving hepatitis B vaccine, including 45.4% of adults at high risk for HBV infection. To accelerate elimination of HBV transmission in the United States, public health programs and clinical care providers should implement strategies to ensure that adults at high risk are offered hepatitis B vaccine.     

1997至2006年卢湾区乙型肝炎流行病学分析

目的分析卢湾区近10年急性乙型肝炎流行特征。方法由本区各社区卫生服务中心防保人员对在1997年至2006年间接报的常住户籍人口急性乙肝病例开展流行因素调查。结果近10年间累计报告急性乙肝病例442例，年均报告发病率12．76／10万，占急肝发病总数的23．62％。1997至2001年间20～29岁年龄组的急性乙肝发病率最高，为30．44／10万，后5年发病高峰退至30～39岁年龄组，平均发病率较前5年下降50．89％。其中，工人乙肝发病数占乙肝发病总数的26．70％。男女发病比为2．65：1。结论在重点人群中开展预防乙肝、提高自身防护意识的健康教育，对重点人群实施免疫接种、提高肝炎病毒分型能力是预防控制乙肝的重要措施。     

The epidemic dynamics of HIV-1 in Italy: modelling the interaction between intravenous drug users and heterosexual population.

Data gathered through the Latium HIV Surveillance System were used in conjunction with a compartmental mathematical model to describe the transmission dynamics of HIV-1 in Italy. In the Latium region, as in the rest of Italy, fewer than 1 in 5 cumulative cases of AIDS are attributable to male homosexual transmission, while 55-60 per cent of the cases have been observed among intravenous drug users (IVDUs). Moreover, the number of non-drug-using heterosexual cases is increasing (14 per cent of cumulative cases). Anonymous notification of positive HIV-1 tests, mandatory in Latium since 1985, were used to produce a time series of new HIV-1 diagnoses; just over 400 new cases of infection per quarter were diagnosed from mid 1989 to mid 1990, with no evidence of increasing incidence. A minimum of 6009 and a maximum of 10,000 individuals with HIV-1 as of the end of 1989 were estimated, 80 per cent of adult cases occurring among IVDUs. The model included two main subgroups: IVDUs and non-drug-using heterosexuals, both with behavioural heterogeneities. Sharing of needles among IVDUs and heterosexual contact were considered as possible ways of transmitting HIV-1. A mathematical framework was developed to reproduce different mixing patterns within and between subgroups. A scenario analysis of the model showed incident cases of HIV-1 among IVDUs peaking early, then declining dramatically and stabilising at low values, with a stable-state prevalence higher than 0.75. Heterosexual interaction with IVDUs resulted in a significant, but non-self-sustaining, virus spread in the general population, affecting females more than males. The extent of this spread is associated with the assortativeness of the sexual mixing pattern adopted. The qualitative features of the Italian epidemic are well represented by the model, which highlights the role of IVDUs as an infection reservoir. However, the need emerges for more accurate information on the key parameters influencing the transmission dynamics of HIV-1.     

Hepatitis C virus infection in Iceland: a recently introduced blood-borne disease.

This study demonstrates a very high prevalence of antibodies to hepatitis C virus among Icelandic intravenous (i.v.) drug users. Of 152 identified i.v. drug users 95 (63%) were shown to have antibodies to the hepatitis C virus. In contrast the seroprevalence in the general Icelandic population is low, (0.2%). Almost all cases of hepatitis C virus infection in Iceland are due to i.v. drug use or to use of infected blood or blood products. Sporadic cases with unexplained modes of transmission, a significant portion of hepatitis C infections elsewhere, are virtually non-existent in Iceland. The results of this study are consistent with the hypothesis that the sporadic community-acquired cases could be caused by blood transfer due to bites from insect vectors such as mosquitoes which are not found in Iceland.     

Epidemiology of hepatitis B infection in Finland: Implications for immunisation policy

ObjectivesWe describe the current epidemiology of acute and chronic hepatitis B infections in Finland. We estimate the total incidence of chronic hepatitis B following from the current incidence of acute infections and the influx of chronic carriers of hepatitis B associated with net immigration. We evaluate the incidence of hepatitis B infections preventable by a universal vaccination programme among infants.MethodsWe analysed hepatitis B cases reported to the National Infectious Disease Register during 2004–2012 and used pre-developed methods to adjust for acute asymptomatic infections. We estimated the projected incidence of chronic infection by applying age-specific risks of chronic infection to the estimated incidence of acute infection. We estimated the influx of chronic carriers associated with immigration by utilising data on immigration during 2004–2012 and the WHO regional estimates of carriage prevalence.ResultsThe estimated incidence of acute hepatitis B infection in Finland, adjusted for asymptomatic infections, was 1.67 per 100,000 per year (95% Crl 1.43–1.94) which is 4.2-fold to the register-based incidence. The estimated lifetime risks of acute and chronic hepatitis B infections were 0.13% and 0.01%, respectively. We estimated that annually seven new chronic infections would result from infections acquired in Finland. These new chronic infections accounted for 1.2% of the total incidence of chronic infections. We estimated that eventually three chronic infections per year would be potentially preventable by a universal infant vaccination programme.ConclusionsPartly due to the fact that hepatitis B infections in neonates and in children are rare, a very limited number of chronic hepatitis B infections resulted from infection acquired within the country. A vast majority of chronic hepatitis B infections occurred among foreign-born persons and were therefore not preventable by a universal infant immunisation programme in Finland. Even with a targeted immunisation programme, the incidence of hepatitis B infection has remained low.     

Acute hepatitis B among children and adolescents--United States, 1990-2002

Since the 1991 adoption of a comprehensive strategy to eliminate hepatitis B virus (HBV) transmission in the United States, the incidence of acute hepatitis B cases has declined steadily. Declines have been greatest among children born after the 1991 recommendations for universal infant hepatitis B vaccination were implemented. In 1995, the elimination strategy was expanded to include routine vaccination of all adolescents aged 11-12 years and, in 1999, to include children aged < or =18 years who had not been vaccinated previously. To describe the epidemiology of acute hepatitis B in children and adolescents in the United States, CDC analyzed notifiable disease surveillance data collected during 1990-2002 and data collected during 2001-2002 through enhanced surveillance of reported cases of acute hepatitis B in children born after 1990. This report summarizes the results of that analysis, which indicated that the rate of acute hepatitis B in children and adolescents decreased 89% during 1990-2002 and that racial disparities in hepatitis B incidence have narrowed. Many confirmed cases in persons born after 1990 occurred among international adoptees and other children born outside the United States. Continued implementation of the hepatitis B elimination strategy and accurate surveillance data to monitor the impact of vaccination are necessary to sustain the decline of acute hepatitis B among children.     

Hepatitis C in Poland in 2001

Hepatitis C is a notifiable disease in Poland since 1997. The increasing trend in incidence over the last four years may be explained by continuous improvement of diagnosis and notification. In the year 2001, for the first time since 1997, a number of cases and an incidence of hepatitis C was lower than in preceding years. The total number of 1953 acute and chronic hepatitis C cases has been reported in 2001. Incidence per 100,000 inhabitants was 5.05. The differences in hepatitis C incidence in regard to gender, region and age have been observed. The incidence in urban regions was higher than in rural; 6.49/100,000 and 2.74/100,000, respectively. The incidence among men was higher than in women; 5.87/100,000 and 4.28/100,000, respectively. Coinfection with hepatitis B has been observed in 5.84% of hepatitis C cases.     

Six years of sentinel surveillance of hepatitis B in general practice in France

Despite the availability of a safe and efficacious vaccine, new cases of infection by hepatitis B virus (HBV) still occur at a substantial rate. This increases the current prevalence of chronic HBV carriers (10% of newly infected subjects) and in the long run, will raise the incidence of chronic liver disease. The surveillance of viral hepatitis commenced in December 1990 by the French sentinel network for electronic surveillance of communicable diseases. Between 1991 and 1996, a decrease in the annual incidence was observed although it was not significant (p=0.06). The mean number of cases for this period was 12 per 100,000 inhabitants. The sex ratio (M/F) was 1.6 (p<0.01) and the median age, 32 years. Heterosexual transmission was suspected in 25% of cases, homo- bisexual transmission in 10%, use of injected drugs in 19%, percutaneous exposure in 9%, and blood transfusion or hemodialysis in 6%. Although the incidence of HBV infection is decreasing, the prevalence of chronic infection will continue to rise. However, the universal hepatitis B immunisation strategy proposed by WHO will dramatically limit the expansion of the population of chronically infected subjects if high coverage is achieved rapidly.     

台山市2010年乙型病毒性肝炎病例报告及发病率评估分析

目的了解疾病监测信息报告管理系统中乙肝病例的报告准确性，评估台山市乙肝的实际发病水平。方法收集2010年台山市的报告发病率资料，对台山市报告的本辖区乙肝病例进行流行病学调查，采集血清后采用化学发光微粒子免疫分析法，使用雅培试剂进行HBsAg、抗-HBeIgM和抗-HAVIgM检测，根据流行病学调查结果和实验室检测结果按照卫生部发布的《乙肝诊断标准》进行诊断和复核分类，根据复核分类结果对台山市实际发病率进行估算。结果2010年台山市通过疾病监测信息报告管理系统报告乙肝病例659例，其中急性、慢性和未分类病例分别为7、327、325例，报告年发病率为31．21／10万。共报告474例本辖区病例，其中急性、慢性和未分类分别为5、193、276例，其中已检测HBsAg、抗-HBeIgM、抗-HAVIgM、HBV—DNA的病例分别占97．89％（464／474）、26．37％（125／474）、17．93％（85／474）、4．64％（22／474）。69．201（328／474）的病例有肝炎症状或体征，69．83％（331／474）的病例肝功能异常，2种合并的病例有235例（49．58％）。403例病例采血经实验室检测复核分类，急性乙肝、慢性乙肝、乙肝病毒携带者和其他病例分别为26、341、28和8例，分别占6．46％、84．62％、6．95％和1．99％，急性病例和慢性病例报告诊断和复核诊断一致的分别为2例（40．00％）和142例（89．31％）。根据复核分类结果估算2010年台山市实际发病率为3．95／10万。结论2010年台山市报告乙肝发病率可能高于实际发病水平，报告病例中实验室特异性诊断的比例较低。提示应在各级医院推广开展抗-HBeIgM等实验室特异性诊断项目，统一和修订乙肝报告标准，以保证病例报告的质量和准确性。     

Hepatitis B and workers in institutions for the mentally retarded: risk of infection for staff in patient care

In the fall of 1982, we conducted a serosurvey of 920 of 933 employees in a large residential institution for the mentally retarded in Salem, Oregon. This survey demonstrated an overall prevalence of 10% for antibody to hepatitis B core antigen (anti-HBc), a marker of present or previous hepatitis B virus infection. Antibody positivity was significantly associated with a history of ever having worked in a position involving direct patient care (adjusted odds ratio = 3.1, 95% confidence interval 2.6-4.2). The length of time employed at the institution was significantly associated with an increasing prevalence of anti-HBc positivity among those persons who had ever worked in direct patient care (chi 2 for linear trend = 19.3, P less than .00001, one tail), but not among those employees who had never worked in patient contact. This evidence supports the Immunization Practices Advisory Committee (ACIP) recommendation of hepatitis B virus screening and, where appropriate, vaccinations for those workers in institutions for the mentally retarded who work closely with patients.