Hepatitis B immunisation rates among infants in ethnic groups with high prevalences of hepatitis B surface antigen carriers

Abstract: To determine hepatitis B immunisation rates in infants from ethnic groups with hepatitis B surface antigen chronic carrier prevalence over 5 per cent, a questionnaire was sent to all Maternal and Child Health Centres in Victoria, requesting information on the hepatitis B and diphtheria–tetanus–pertussis (DTP) or combined diphtheria–tetanus (CDT) immunisation status for all infants born between 1 July 1992 and 30 June 1993 and at risk of hepatitis B infection because of maternal ethnicity. We received data on 3611 of 5744 infants (62.9 per cent) in targeted ethnic groups. Of these, 12.8 per cent had not received hepatitis B vaccine, and 81.6 per cent, 76.8 per cent and 64.0 per cent had received at least one, two and three doses respectively, while 84 per cent had received at least three doses of DTP vaccine and/or CDT vaccine. Coverage with DTP or CDT was higher than for hepatitis B vaccine ( P < 0.001), and coverage was better in areas with a higher percentage of infants in high–prevalence ethnic groups ( P < 0.001). Changes in the program in Victoria in terms of timing of the first dose of vaccine plus greater attention to follow–up may lead to improved hepatitis B immunisation rates among infants in targeted ethnic groups. Adoption of universal infant hepatitis B immunisation, by increasing familiarity with hepatitis B vaccine, is likely to be the best way to increase immunisation coverage for these infants.     

Subtypes of hepatitis B antigen among patients and symptomless carriers.

A study of the distribution of subtypes ad and ay among sera from hepatitis B antigen-positive subjects in North West England and North Wales revealed a marked contrast between symptomless carriers among whom ad predominated and patients with acute hepatitis the majority of whom were ay. Those with hepatitis associated with drug addiction or other forms of "needle transmission" were almost all of subtype ay. On the other hand in cases of "sporadic" hepatitis without evidence of parenteral exposure subtypes ad and ay are about equally distributed. These findings are similar to those reported from other countries in Northern Europe and North America. Although geographical and social factors clearly affect the distribution of the two subtypes it is suggested that the virus of subtype ay may be more readily transmitted than subtype ad by parenteral routes involving small amounts of blood.     

Detection of hepatitis B virus DNA in asymptomatic hepatitis B surface antigen carriers: relation to sexual transmission

The authors tested, by molecular hybridization, for hepatitis B virus DNA in serum specimens of 182 asymptomatic hepatitis B surface antigen (HBsAg) Greek carriers who were heterosexual partners of patients with acute hepatitis B (group A: 96 cases) or healthy subjects who were susceptible to hepatitis B (group B: 86 cases). The mean age (34.1 +/- 10.4 vs. 33.9 +/- 8.4 years) and the mean duration of sexual contact (6.9 +/- 8.9 vs. 7.2 +/- 6.3 years) were similar in the two groups of carriers. Hepatitis B virus DNA was detected significantly more frequently in group A than in group B (59.4% vs. 11.6%, p less than 0.001). In particular, in group A, hepatitis B virus DNA was detected in 96.9% of hepatitis B e antigen (HBeAg)-positive and 41% of antibody to HBeAg (anti-HBe)-positive carriers. In contrast, in group B, hepatitis B virus DNA was identified in only 10.8% of anti-HBe-positive carriers (p less than 0.001). These differences were especially significant in the young and middle-aged carriers (16-49 years old) and during the first four years of sexual contact. These data suggest that 1) there is a positive correlation between the presence of hepatitis B virus DNA in serum and the epidemiologic evidence of sexual transmission of hepatitis B virus, 2) hepatitis B virus DNA is a better indicator of infectivity than HBeAg/anti-HBe, and 3) the detection of hepatitis B virus DNA in serum probably identified carriers with high infectivity and potentially higher risk of transmitting hepatitis B virus to their sexual partners.     

Prevalence of infection with hepatitis delta virus (HDV) among carriers of hepatitis B surface antigen in Amazonas State, Brazil

Serum samples were non-randomly obtained from apparently healthy inhabitants of 5 villages in the Amazonas State, Brazil. Sera were tested by enzyme immunoassay for the presence of hepatitis B surface antigen (HBsAg) and, if this was found, for antibody to hepatitis delta virus (HDV). Of 574 people tested, 96 (16.7%) were reactive for HBsAg and 33 of these (34.4%) for anti-HDV. The results were analysed according to sex, age and history of jaundice and showed a high prevalence of hepatitis B virus (HBV) and HDV infections in these asymptomatic persons, mainly in young people. The rates of prevalence observed in Amazonas for both HBV and HDV are perhaps among the highest in the world, demonstrating that these viruses are endemic in this region of Brazil.     

乙型肝炎表面抗原和e抗原阳性产妇所生新生儿乙型肝炎母婴传播阻断效果的影响因素

目的探讨乙型肝炎(乙肝)表面抗原(HBsAg)和e抗原(HBeAg)阳性产妇所生新生儿在出生后乙肝疫苗(HepB)和乙肝免疫球蛋白(HBIG)联合免疫以及完成HepB全程免疫后乙肝病毒(HBV)突破性感染的影响因素。方法2016年6月-2017年5月在南昌市2个县(区)选择HBsAg和HBeAg阳性产妇所生新生儿,在联合免疫和HepB全程免疫完成后1-2个月检测血清HBsAg和乙肝表面抗体(HBsAb),分析儿童母婴传播阻断失败率(HBsAg阳性率)。结果本研究共纳入278名婴儿,母婴传播阻断失败率为2.52%(7/278),HBsAb阳性率为96.8%(269/278)。产妇HBsAg阳性时间在2年以上是阻断失败的危险因素,而分娩方式、喂养方式、母亲和婴儿HBIG的使用情况和婴儿性别等与HBV阻断失败率无相关性。结论HepB和HBIG联合免疫对HBsAg和HBeAg阳性产妇所生新生儿具有较好的乙肝母婴传播阻断效果,建议加强育龄妇女HBsAg和HBeAg筛查。     

乙型肝炎病毒携带者的健康教育

目的 了解慢性无症状HBV携带者(AsC)对肝病知识的需求并针对性地进行健康宣教.方法 采用自行设计问卷表,对80例AsC进行问卷调查.结果 87.5%的AsC迫切需要了解乙型肝炎临床治愈后的复发及如何传播方面问题.结论 AsC对肝炎知识的了解较少,大多数对自我护理和预防保健没有充分认识.通过健康宣教可使患者掌握一般的肝病保健知识,增强自我保护的意识和能力,减少复发,延缓或制止肝脏慢性炎症病变.     

乙型肝炎病毒携带者的健康教育

目的 了解慢性无症状HBV携带者(AsC)对肝病知识的需求并针对性地进行健康宣教.方法 采用自行设计问卷表,对80例AsC进行问卷调查.结果 87.5%的AsC迫切需要了解乙型肝炎临床治愈后的复发及如何传播方面问题.结论 AsC对肝炎知识的了解较少,大多数对自我护理和预防保健没有充分认识.通过健康宣教可使患者掌握一般的肝病保健知识,增强自我保护的意识和能力,减少复发,延缓或制止肝脏慢性炎症病变.     

Province of origin of hepatitis B surface antigen carriers among blood donors in Port Moresby

A paper published in the Medical Journal of Australia in 1972 gave a breakdown of Port Moresby blood donors by HBS Ag carrier status and area of origin. It has lately become possible to test whether such geographical subsamples provide reliable evidence of the carrier status in the home areas, and it appears that, except for the Islands provinces, they do not. Traditional lifestyles conduce to the maintenance and spread of the virus, which is much more prevalent in the provinces than in the capital.     

工矿企业成人HBsAg慢性携带者生活质量评价

目的了解HBsAg慢性携带者生活质量的现状。方法以某集团公司现有在岗5 a以上的职工中的HBsAg慢性携带者104人为研究组,并随机抽取与其具有可比性的正常人群105人为对照组,采用《生活质量综合评定问卷(GQOL-74)》和《健康状况调查问卷(SF-36中文版)》等进行生活质量的调查,分析慢性HBsAg携带者生活质量的现状。结果HBsAg慢性携带者GQOL-74总分为59.88±9.82,低于正常人得分66.73±7.86;SF-36总分为73.95±10.46,亦低于正常人得分81.88±8.22。结论慢性HBsAg携带者的生活质量因HBsAg的感染而受到了影响。     

乙肝病毒携带者母婴传播阻断效果的观察

目的为观察基因工程乙肝疫苗对乙型肝炎病毒母婴传播阻断效果,我们将乙肝表面抗原(HBsAg)、乙肝e抗原(HBeAg)和乙肝核心抗体(抗-HBc)三项均阳性的118名孕妇的婴儿随机分组,一组是单纯疫苗组,按0、1、6个月注射三针乙肝疫苗(5μg);另一组是孕妇临产前3个月,每月注射一次乙型肝炎免疫球蛋白(HBIG),每次100IU,婴儿出生后使用乙肝疫苗的同时,加注100IUHBIG。全程免疫后7个月采血,采用酶联免疫吸附试验(ELISA)检测乙肝表面抗体(抗-HBs)、HBsAg和抗-HBc。3次随访结果显示,单独及时全程接种乙肝疫苗组,婴儿抗-HBs阳性率为75.39%,无应答率为6.15%,HBsAg阳性率18.46%,保护率为76.92%;联合免疫组,抗-HBs阳性率为90.57%,无应答率为3.77%,HBsAg阳性率5.66%,保护率为92.92%。提示,基因工程乙肝疫苗具有良好安全性和免疫原性,可有效阻断乙肝病毒的母婴传播,HBIG联合乙肝疫苗可明显提高阻断效果。     

Marked decrease of hepatitis B virus infection among children in Okinawa, Japan

During the period 1980-1989 in Okinawa, Japan, serologic markers of hepatitis B infection (hepatitis B surface antigen; HBsAg, antibody to hepatitis B core antigen; anti-HBc) were investigated in nursery school children (1-4 years of age). Prevalences of HBsAg were 1.1-1.5% in the period from 1980-1984, but decreased to under 1.0% in the period from 1985. In 1989 there were two carriers in nursery schools, both born in 1985 or fathers who were HBsAg carriers. Prevalences of anti-HBc were 3.3-7.1% in the period from 1980-1983 with a decrease to 0.5% by 1988. Since hepatitis B vaccine was available for neonates whose mothers were HBsAg carriers with hepatitis Be antigen (HBeAg) and for nursery school children in 1983, hepatitis B virus infection among nursery school children and HBsAg carriers due to transmission from mother-to-child were markedly reduced. This strategy for immunization is useful in endemic areas. Immunization for children whose fathers are HBsAg carriers may also be necessary.     

乙型肝炎病毒e抗原结构、功能及变异的临床意义

HBeAg并非HBV装配、复制或感染所必需,但却具有免疫调节和影响病毒复制的重要功能,而HBeAg变异后出现的HBeAg阴性慢性乙型肝炎更有特殊的临床特征。此文就近年有关HBeAg结构及功能的研究进展及其变异临床意义进行综述。     

慢性乙型肝炎病毒携带者的肝组织病理分析

目的对178例年龄在12～40岁之间的慢性HBV携带者与非活动性HBsAg携带者肝组织病理结果进行分析。方法178例分为<20岁、<30岁、<40岁三个年龄组,分别观察三个年龄组间肝组织炎症活动度及纤维增生的分布情况及差异性。结果>G2/S2的分布为<20岁年龄组(14%),<30岁年龄组(41%),<40岁年龄组(80%)。随年龄增长,肝组织损伤的程度呈加重趋势,差异有显著性(P<0.05)。不同年龄与病毒基因水平,肝组织病变程度与病毒基因水平之间差异无显著性(P>0.05)。慢性HBV携带者与非活动性HBsAg携带者之间肝组织病变差异有显著性(P<0.05)。结论对上述两种携带者,有条件时最好行肝活检,以早期发现适宜治疗者而避免延误病情。对两者间的治疗应有所侧重。     

原发性肝癌患者HBV前C/BCP区变异与HBeAg的相关性研究

目的 分析原发性肝癌(HCC)患者乙型肝炎病毒(HBV)前C区和C基因基本核心启动子(BCP)变异情况及与HBeAg的关系,为HCC的发病机制及预后提供理论依据.方法 收集39例原发性肝癌患者血清,采用巢式PCR法扩增前C/BCP区基因片段,PCR产物直接测序以检测前C/BCP区基因变异情况.结果 BCP区T1762/A1764双变异28例,前C区A1896变异19例,T1762、A1764、A1896聚集变异16例,在HBeAg阴性者中分别出现17、10、10例,HBeAg阳性者则分别为11、9、6例,上述3种变异HBeAg阴性组与HBeAg阳性组比较,差异无统计学意义;其他变异位点有C1753、T1846、A1899和T1846变异,其中T1846变异7例HBeAg阴性者中出现6例,HBeAg阳性者中出现1例,比较差异有统计学意义(P＜0.05).结论 原发性肝癌HBV前C/BCP区A1896、T1762、A1764双变异及T1762、A1764、A1896聚集变异在HBeAg阴性者中较常见,但对HBeAg表达影响不明显.     

Acquisition rate of antibody to hepatitis B surface antigen among medical and dental students in Japan after three-dose hepatitis B vaccination

Background

Health care workers (HCWs) are at high risk of contracting blood-borne infections including hepatitis B virus (HBV) infection. In Japan, all HCWs are required to receive HB vaccination before beginning work. This study aimed to investigate the dynamics of the HB surface antibody (anti-HBs) titer after a three-dose HB vaccination in HCWs and to determine effective scheduling of HB vaccination for non-responders.

Seroepidemiological study of hepatitis B virus markers in Japan

BackgroundIn Japan, since 1986, selective vaccination has been implemented as a hepatitis B prevention strategy. The target of vaccination is the infant born to a hepatitis B surface antigen (HBsAg)-positive mother. The current Japanese hepatitis B prevention strategy focuses on reducing the number of HBV carriers but overlooks the risk to susceptible populations. We conducted a nationwide HBV seroepidemiological study to explore the next hepatitis B control strategy.MethodsWe used sera derived from healthy individuals collected nationwide from 2005 through 2011 to investigate the HBsAg seroprevalence among children aged 4–9 years and 10–15 years (3000 samples) and hepatitis B core antibody (HBcAb) seroprevalence among people 10–39 years of age (600 samples).FindingsAmong sera from 3000 children, 5 (0.17%) specimens were HBsAg-positive. There was no significant difference in HBsAg prevalence between age groups. Among 600 samples, 15 (2.5%) were HBcAb-positive. Out of 15 samples, 4 were from teenagers. Both HBsAg- and HBcAb-positive sera were found mainly in the Southern area of Japan.ConclusionThe prevalence of HBsAg among children was 0.17% in the present study. This is higher than the prevalence reported in previous studies performed in the local area or in blood donors. The prevalence of HBcAb is also higher than we estimated. One of the reasons for this discrepancy from previous studies may be due to the small sample size and the impact of HBV high-endemic areas included in the present nationwide study. Nevertheless, our findings revealed that the opportunities for acquiring HBV infection in the susceptible population were more frequent than we thought, especially in some localities. Hepatitis B vaccination should be introduced into the routine child immunization program for susceptible populations, and the selective vaccination program should be continued for high-risk children.     

大学新生乙肝病毒表面抗原阳性的危险因素分析

目的探讨某高校入学新生乙肝病毒表面抗原（hepatitis Bvirus surface antigen,HBsAg）阳性的危险因素并分析因素间的交互作用。方法采用分层整群抽样方法抽取该校919名新生进行问卷调查并采集血样,使用酶联免疫吸附法（enzyme—linked immunosorbent assay,ELISA）定性检测HBsAg。采用检验和非条件Logistic回归模型分析HBsAg阳性的危险因素,应用相加效应模型分析各危险因素间的交互作用。结果所调查的919名新生HBsAg阳性率为10．12％（93／919）。多因素分析结果表明HBsAg阳性的危险因素包括：男性、来自农村、未接种乙肝疫苗、有乙型肝炎病毒（hepatitis Bvirus,HBV）家族感染史和穿耳洞,其0R值分别为2．838、1．669、2．824、8．555、2．965。其中HBV家族感染史与性别、乙肝疫苗接种史之间存在交互作用,超额相对危险度（relative exeess risk of interaction,RERI）分别为17．828和55．675。结论男性、来自农村、未接种乙肝疫苗、有HBV家族感染史和穿耳洞是HBsAg阳性的危险因素,其中HBV家族感染史与性别、疫苗接种史之间存在相加交互作用。     

Transmission of hepatitis B virus among siblings

The authors investigated families with at least one hepatitis B surface antigen (HBsAg) carried in Okinawa, Japan, to determine possible routes of hepatitis B virus transmission within family units. A total of 175 members of 37 families on the western part of Iriomote Island, Okinawa, were followed up for 2-13 years; 68 were HBsAg-positive at least once. Sera were collected once a year. All serum samples were assayed by radioimmunoassay to determine presence of HBsAg, antibody to HBsAg (anti-HBs), hepatitis B e antigen (HBeAg), antibody to hepatitis B e antigen (anti-HBe) and antibody to hepatitis B core antigen (anti-HBc). In five of the 15 families with a positive mother and negative father, one or more HBsAg-positive children were found. In contrast, an HBsAg-positive child was found in only one of the eight families with a negative mother and positive father. In nine of the 14 families with both parents negative, two or more children were positive. Apparent sibling-to-sibling hepatitis B transmission occurred during the period of observation in four of the families with both parents negative. Eight children less than four years old were HBsAg-positive when first surveyed or became HBsAg carriers when four years of age or younger. No one over four years of age changed from HBsAg-negative to positive. This study found 1) in the family setting, there were cases of apparent maternal transmission but there were more cases of apparent sibling-sibling transmission, and 2) children under four years of age seemed to become carriers more easily than older children.     

Serum alpha fetoprotein in 714 mentally retarded carriers of hepatitis B surface antigen

Sera from 714 mentally retarded carriers of hepatitis B surface antigen were screened for alpha fetoprotein (AFP) by monoclonal radioimmunoassay. Serum AFP levels were less than 20 mcg/L in 708 (99.2%) carriers. One 29-year-old carrier with normal liver function had serum AFP level of 1500 mcg/L, which increased to 12,500 mcg/L after 72 days. She died of multifocal hepatocellular carcinoma (HCC) with cirrhosis. Five other carriers with serum AFP levels between 20 and 165 mcg/L are alive without clinical HCC. No correlation was found between serum AFP level and race, age, sex, Down's syndrome, serum alanine aminotransferase level, and hepatitis B e antigen positivity. Single cross-sectional serum AFP screening by itself is not sufficient for early diagnosis of HCC.Corresponding author.Department of Pathology, University of California, Irvine, CA 92717