Hepatitis B infection in Eastern Indian families: need for screening of adult siblings and mothers of adult index cases

OBJECTIVES: India, with its 43 million hepatitis B virus (HBV) carriers and absence of any national immunization programme, adds a substantial number of HBV infections to the HBV carrier pool yearly. The aim of this study was to assess the spread of HBV infection in families with an infected member and to identify the family members with the highest risk of infection in our community. METHODS: A total of 937 serum samples from 215 HBV-infected cases and 722 members of their households were screened prospectively for markers of HBV by commercial enzyme-linked immunosorbent assay. RESULTS: Among family members, 140 (19.4%) were HBsAg positive and 272 (37.6%) were negative for HBsAg but positive for either anti HBc or anti HBs. There were 145 HBsAg-positive adults among the index cases whose 133 adult siblings, 59 spouses and 59 mothers participated in the study. Interestingly, 28.81% mothers and 28.57% adult siblings of these adult index cases were positive for HBsAg compared with only 8.75% of their spouses (P < 0.001). Only 15.2% of the HBsAg-positive women in the childbearing age group were found to be HBeAg positive. CONCLUSIONS: Our results suggest that intrafamilial childhood horizontal transmission is important for HBV transmission in our community, and highlight the need for screening of adult siblings and mothers of adult HBsAg carriers in addition to their spouses and children.     

HBV infection among pre-school children in naples (Italy) and the role of intrafamily contact

In the Neapolitan area the prevalence of adult HBsAg carriers ranges from 4-7%. Moreover, hepatitis B virus (HBV) is responsible for most of the chronic hepatitis cases in childhood. Since the chronic carrier state in our area is acquired by early horizontal contact, we investigated the prevalence of HBV infection among 207 pre-school children and of HBsAg carriers among their family members. None of the children was found to be HBsAg positive and 3.9% of them had anti-HBs. HBsAg was positive in 29 out of 892 (3.3%) of the family members. There was a clear age-related distribution of the carriers, their prevalence reaching 6.7% among the elderly members. On the whole, 19 out of the 207 index cases had at least one HBsAg carrier in their family. The results suggest that in our area a decline of HBV endemia may be under way and that early intrafamily contact is no more a common pathway in acquiring an HBsAg carrier state.     

学龄前儿童HBV感染率及危险因素研究

对520名2~6岁托幼机构儿童进行了乙型肝炎病毒(HBV)标记的检测和感染危险因素的调所获资料用Mantd-Haenzel卡方及Mantel扩展卡方分析.其结果为:在学龄前儿童中,HBsAg携带率为8.08%,HBV感染率为21.73%,两者与性别无关,但都随年龄而增高.母亲HBsAg尤其HBeAg阳性是学龄前儿童HBV感染的笊要危险因索。家庭成员有肝炎史者,HBV感染危险性增高。由家长将食物咀嚼后喂养者,HBV感染率显著商于不具有此项暴露因素者,且在各年龄组都存在这一趋势,因此,经成人咀嚼后喂养,可能是造成家庭内HBV传播的一个危险因素。     

儿童HBsAg阳性与父母HBV血清学标志调查

厦门市防疫站1987年反馈性的对HBsAg阳性儿童调查其父母的HBV血清学标志情况。检测结果儿童父母只HBV总感染率70.65%,父母间无显著差异。HBsAg、HBeAg阳性率母亲明显高于父亲。父母成对检测分析:父母间只有一方受HBV感染的比较、父母双方都受HBV感染与双方都未受HBV感染的比较,差异均不显著。调査结果表明:母亲血清有HBsAg与HBeAg是孩子的主要传染源,但又不可忽视父亲对孩子的传播作用与日常生活中的传播机会。     

Hepatitis B surface antigen seroprevalence among pre- and post-vaccine cohorts in Cambodia, 2017

Background: Hepatitis B virus (HBV) infection is highly endemic in most low income countries including Cambodia. This nationwide serosurvey was conducted to assess the impact of hepatitis B vaccination and to determine whether Cambodia met the WHO regional 2017 target of hepatitis B surface antigen (HBsAg) seroprevalence less than 1% in five-year-old children.Methods: A cross-sectional multi-stage cluster survey was conducted among children born during 2010–2012 and their mothers in Cambodia. HBsAg prevalence was estimated by rapid point-of-care testing, and demographic data, including vaccination history, was collected. Vaccine coverage in children and the prevalence of HBsAg among children and mothers was calculated taking into account the complex survey design. Factors associated with children’s failure to receive timely (within 24 h) vaccination were analysed by multivariate logistic analysis.Findings: A total of 2,520 children 5–7 years old and 2,028 mothers were recruited. In total, 78.4% of children received hepatitis B vaccination birth-dose (HepB-BD); of these, 58.7% were administered ≤ 24 h. Birth at home or “other” location were independent risk factors for children’s failure to receive timely HepB-BD. Overall HBsAg seroprevalence was 4.39% (95%CI: 3.53%–5.45%) among mothers and 0.56% (95%CI: 0.32%–0.98%) among children. The prevalence among children without hepatitis B vaccination was 4.62% (95%CI: 1.31%–14.97%). Among children with a HBsAg-positive mother, prevalence was 10.11% (95%CI: 5.41%–18.11%).Interpretation: Having achieved the 2017 target of less than 1% HBsAg prevalence among 5 years old children, Cambodia can now focus on eliminating mother-to-child transmission of HBV. Moreover, the high HBsAg prevalence among mothers suggests that routine screening with proper linkage to care and treatment is needed. Strengthening measures to improve vaccination coverage further and eliminate mother-to-child transmission by coordinated programming with other services offering additional HBV interventions will help move towards the global goal of hepatitis B elimination by 2030.Funding: As per sources of funding.     

Assessing the impact of the routine childhood hepatitis B immunization program and the need for hepatitis B vaccine birth dose in Sierra Leone, 2018

Sierra Leone is highly endemic for hepatitis B virus (HBV) infection and thus recommends three doses of hepatitis B vaccine (HepB3) from 6 weeks of age but does not recommend a birth dose (HepB-BD) to prevent mother-to-child transmission (MTCT). We evaluated impact of the existing HepB3 schedule and risk for MTCT of HBV. We conducted a community-based serosurvey among 4–30-month-olds, their mothers, and 5–9-year-olds in three districts in Sierra Leone. Participants had an HBV surface antigen (HBsAg) rapid test; all HBsAg-positive and one HBsAg-negative mother per cluster were tested for HBV markers. We collected children’s HepB3 vaccination history. Among 1889 children aged 4–30 months, HepB3 coverage was 85% and 20 (1·3% [95% CI 0·8–2·0]) were HBsAg-positive, of whom 70% had received HepB3. Among 2025 children aged 5–9 years, HepB3 coverage was 77% and 32 (1·6% [1·1–2·3]) were HBsAg-positive, of whom 56% had received HepB3. Of 1776 mothers, 169 (9·8% [8·1–11·7]) were HBsAg-positive. HBsAg prevalence was 5·9% among children of HBsAg-positive mothers compared to 0·7% among children of HBsAg-negative mothers (adjusted OR = 10·6 [2·8–40·8]). HBsAg positivity in children was associated with maternal HBsAg (p = 0·026), HBV e antigen (p < 0·001), and HBV DNA levels ≥ 200 000 IU/mL (p < 0·001). HBsAg prevalence was lower among children than mothers, for whom HepB was not available, suggesting routine infant HepB vaccination has lowered HBV burden. Since HBsAg positivity in children was strongly associated with maternal HBV infection and most of the HBsAg-positive children in the survey received HepB3, HepB-BD may prevent MTCT and chronic HBV infection.     

乙型肝炎母婴传播阻断成功儿童乙型肝炎病毒突破性感染的特征

目的了解乙型肝炎(乙肝)母婴传播阻断成功儿童乙肝病毒(HBV)突破性感染及其影响因素。方法选取江苏省淮安市淮安区2009年9月-2011年1月乙肝表面抗原(HBsAg)阳性母亲所生儿童,且乙肝母婴传播阻断成功。阻断成功定义为儿童按国家免疫程序在完成出生时乙肝疫苗(HepB)和乙肝免疫球蛋白以及1、6月龄HepB接种后7-12月龄HBsAg阴性,HBV突破性感染定义为阻断成功儿童在12月龄后HBsAg阳性或24月龄后乙肝核心抗体(HBcAb)阳性。至2019年9月进行5次随访并检测HBV血清标志物,分析HBV突破性感染及其影响因素。结果本研究共纳入儿童390名,其中12名29-117月龄儿童发生HBV突破性感染,发生率为3.08%(12/390),均为乙肝核心抗体(HBcAb)阳性和HBsAg阴性。乙肝疫苗(HepB)初次免疫无、低、正常、高应答儿童HBV突破性感染率分别为25.00%、6.67%、2.61%、0.95%;母亲HBeAg阳性、阴性的儿童分别为9.76%、0.00%;母亲高、低HBV病毒载量的儿童分别为11.96%、0.34%。儿童HBV突破性感染发生密度为0.36/100人年;多因素Cox回归分析显示,HepB初次免疫低或无应答、母亲高病毒载量是儿童HBV突破性感染的危险因素(HR=5.91,95%CI:1.87-18.71;HR=45.81,95%CI:5.88-356.96)。结论乙肝母婴传播阻断成功儿童的HBV突破性感染发生率较低;母亲HBeAg阳性、母亲高HBV病毒载量、HepB初次免疫低或无应答的儿童更易发生突破性感染。     

The prevalence and transmission of hepatitis B virus infection in urban, rural and institutionalized black children of Natal/KwaZulu, South Africa

The sera of statistically selected urban (805), rural (238) and institutionalized (127) black children were tested for markers of hepatitis B virus (HBV) infection. The age-standardized (6-14 years) prevalence rates of HBs antigenaemia for comparison between urban, rural and institutionalized children were 10%, 18.5% and 25.1% and the HBV exposure rates were 31.4%, 62.1% and 72.0% respectively. In the newborn to six years age group the prevalence rates of HBsAg and HBV exposure were 2.5% and 7.1% for urban children and 53.1% and 70.3% for institutionalized children. Peak prevalences of HBsAg occurred in the 6-8 year age group and were 14.4% and 22.6% in urban and rural children respectively. Hepatitis Be Antigen (HBeAg) was detected in 46.5% and antibodies to hepatitis Be antigen (HBeAb) in 10.0% of all HBsAg positive children. Multiple mechanisms involving horizontal rather than vertical transmission appeared to be important in urban children, with HBV exposure in females being significantly associated with ear-piercing (p less than 0.001) and scarification (p less than 0.05). In addition, HBsAg was detected in 25 of 29 pools of bloodfed mosquitoes caught at the children's institution and was negative in all four pools of unfed mosquitoes, suggesting that these arthropods may also be one factor in the horizontal spread of HBV infection. Familial clustering of HBV infection was suggested by a significantly higher (p less than 0.01) prevalence of HBsAg amongst family contacts of HBsAg positive urban children (17.7%) than in the control groups of family contacts of HBsAb positive children (8%) and children who were negative for all HBV markers (2.4%). The significance and implications of these findings are discussed.     

Familial pattern of infection with hepatitis B virus among immigrating Ethiopian Jews in Israel

Seventy-eight families (506 members) of recently immigrating Ethiopian Jews to Israel, were tested for the presence of HBV serological markers to evaluate the intrafamilial horizontal transmission of the virus. Eighty-four members (16.6%) were carriers and 20.2% were HBeAg positive, the overall infection rate was 67.8%. In 40 families (51.3%) at least one family member was HBsAG positive, and in 19 families (24.4%) two or more family members were HBsAg positive. Thirty-six carriers (42.8%) were children under the age of 10, by one year of age 30% have contracted the virus, and by the age of 5 and 10 years 43.5% and 57.1% have had serological markers for past HBV infection, respectively. Our data correlate with other studies regarding the importance of horizontal spread of HBV among Sub-Saharan Africans.     

肝癌家庭成员HBV、HCV感染的调查分析

目的：通过调查HCC家庭成员HBV、HCV感染状况,探讨HCC的发生与HBV、HCV感染的关系。方法：应用ELISA法和PCR法,分别检测了HCC病例与对照家庭成员血清中HBsAg,抗－HBs,HBeAg,抗－HBe,抗－HBc,抗－HCV 及HBV DNA。结果：病例组子女的HBsAg,抗－HBe,抗－HBc和HBV总感染率均高于对照组,具有统计学意义（P＜0．05或P＜0．01）;且病例组子女HBV DNA检测高于对照组（P＜0．05）,HBeAg和HBV DNA密切相关,HBeAg阳性血清HBV DNA检测均为阳性,抗－HCV在病例与对照组间均无显著性差异（P＞0．05）。进入条件Logistic回归方程中的因素为HBsA抗－HBc,其OR值分别为27．96和4．77。结论：HCC家内有HBV感染的聚集性倾向,HBsAg和抗－HBc两项标记,在HCC家庭成员乙肝感染中更具代表性,密切生活接触也是HBV感染传播途径之一,丙肝感染不占主要地位。     

不同喂养方式对乙型肝炎病毒母婴传播的影响

目的研究乙型肝炎病毒（HBV）表面抗原（HBsAg）阳性产妇所生婴儿母乳喂养和人工喂养对HBV母婴传播的影响。方法选择2001～2010年孕期或住院分娩时检测乙肝病毒表面抗原（HBsAg）阳性的母亲及其儿童206对,进行问卷调查和采集血清标本,用固相放射免疫法（SPRIA）检测HBV血清学标志物,比较母乳喂养和人工喂养对儿童HBV感染的影响。结果 206名儿童中母乳喂养100人,阳性3人,阳性率3.00%;人工喂养106人,阳性2人,阳性率1.89%。母亲在双阳性（HBsAg、乙肝病毒e抗原（HBeAg）均阳性）或单阳性（HBsAg阳性、HBeAg阴性）情况下,母乳喂养和人工喂养儿童HBsAg阳性率的差异均无统计学意义。结论母乳喂养未增加儿童感染乙肝的风险。     

HBV基因分型方法在家系传播研究中的应用

本文报告了河北省一个自然村乙型肝炎的血清流行病学研究结果。HBsAg阳性率为3.75%,HBV总感染率为27.65%,属于低发区;其成因可能与人群特征(献血员占多数)和HCV感染率高(10.31%)有关。经二项分布拟合分析,抗-HBc和HBV总感染率有家庭聚集性,并且主要是父母对其子女的传播和子女之间的水平传播所致。HBV DNA阳性率为24.77%(27/109),大多数(72.22%)家庭成员感染者之间为同一HBV基因型。在HBV亚型基因分类的基础上,将HBV的家庭传播划分为家系世代、水平、隐性、内外混合传播型和家系不传播型及未定型等六种。     

乙型肝炎病毒携带儿童血清病毒含量与母婴传播

目的 探讨乙型肝炎病毒(HBV)携带儿童较高的血清病毒含量与母婴传播的关系。方法 调查214例人群抽查发现并经随访确证的HBsAg慢性携带儿童,并对所有研究对象及其母亲采血,ELISA试剂盒检测HBV感染的血清学标志物及表面抗原滴度。结果 母亲HBsAg阳性的HBV慢性携带儿童具有相对较高的HBsAg滴度及HBeAg阳性率;其年阴转率为0.4％,明显低于母亲HBsAg阴性的HBV慢性携带儿童年阴转率1.7％;发生母婴传播的孕妇HBsAg年阴转率为0.3％,显著低于同龄携带者人群HBsAg的自然阴转率。结论 HBV慢性携带儿童较高血清病毒含量可能与母婴传播有关,代代相传可能是我国母婴传播发生率较高进而形成我国巨大HBsAg携带者库的重要原因。     

乙型肝炎表面抗原携带者父子间传播的研究

目的：研究乙型肝炎表面抗原携带者及其子女间的遗传传递。方法：对乙型肝炎表面抗原携带者117个家庭234个个体进行了HBV五项血清标志物（HBsAg、抗－HBs、HBeAg、抗－HBe和抗HBc）及游离型HBV DNA检测。结果：HBsAg阳性父亲出生的子女与HBsAg阴性的父亲所生的子女相比,差异非常显著。在HBsAg父、子女同阳的63个家系中,HBV血清学标志组合父、子女同时阳性率为52．4％,其HBV DNA主要分布在父、子女同阳组合中,与其他标志组合相比,有非常显著性差异。HBV DNA与HBeAg标志呈一致性增高,HBeAg阳性父亲所生子女HBeAg和HBV DNA也都阳性。HBsAg高滴度的父亲HBV DNA与出生后的子女呈一致性增高。结论：HBsAg阳性者,通过父亲遗传传递给子代是有可能的。     

Effectiveness of a Chinese hamster ovary cell derived hepatitis B vaccine in Chinese rural communities

Objective

To evaluate the effectiveness of a Chinese hamster ovary cell derived hepatitis B vaccine in a country community in Hebei Province, PR China.

Method

A cross-sectional investigation was carried out in 4 of 7 randomly selected country communities in Zhengding County in 2005. All of the children who were born between 1997 and 1999 were selected as study objects. Their serum samples were taken to test for HBV markers, and HBsAg prevalence was compared to that of the same age group before hepatitis B vaccination in 1983. In addition, for HBsAg positive children, their mothers were visited and tested for serum HBV markers, in order to distinguish maternal HBV transmissions.

Results

Among the 2205 children of the selected birth cohort, 1696 (76.9%) were visited. The prevalence of HBsAg was 0.53%, and by comparing to that of before hepatitis B vaccination, the effectiveness was 95.3%, similar to that of yeast derived hepatitis B vaccines. Among 7 mothers of HBsAg positive children, 5 were HBsAg positive, indicating maternal HBV transmissions; and although one mother was HBsAg negative, her kid was not vaccinated, which indicates a horizontal transmission. As for the other kid, he was adopted and the HBV infection status of his birth mother was unknown.

Conclusion

The effectiveness of the CHO derived hepatitis B vaccine is comparable to yeast derived ones, and after the hepatitis B vaccination maternal transmission is the most important route of spreading HBV.     

Prevalence of hepatitis B markers in the population of catalonia (Spain). Rationale for universal vaccination of adolescents

The prevalence of hepatitis B markers was determined in a representative sample of the general population of Catalonia (Spain). HBsAg was found in 0.5% of children (less than 15 years of age) and in 1.7% of adults (more than 15 years of age), and anti HBs in 1.6% and 18%, respecitvely. Age-specific prevalence for both markers showed a low risk for hepatitis B before puberty, and a progressive rise since adolescence, suggesting that perinatal transmission and horizontal transmission in children are relatively uncommon in Spain. Prevalence of hepatitis B markers was significantly higher among subjects with low education level, residing in an urban area and born outside Catalonia, but in the stratified analysis, a statistical significant difference was only maintained in the prevalence of HBV markers between those who live in urban and rural areas, and between those who were born outside Catalonia and in Catalonia. These data may be used as a basis for a strategy of hepatitis B prevention in Spain which include universal vaccination of adolescents, passive-active immunization of newborns to HBsAg positive mothers and vaccination of susceptible adults subjects from high-risk groups.Preventive Medicine Unit.Liver Unit.Corresponding author.     

Searching for chronic hepatitis B patients in a low prevalence area – role of racial origin

Background

Clinical studies for testing new drugs against hepatitis B ought to be carried out in low prevalence areas despite difficulties on patient recruitment. In such areas, relatives of chronic hepatitis B patients are considered to be at risk of acquiring the hepatitis B virus (HBV). The aim of this study was to evaluate the prevalence of HBV markers (anti-HBc, HBsAg and anti-HBs) in familial members of chronic hepatitis B (CHB) patients according to their origin (Asian or Western) in a low prevalence area, the city of São Paulo, Brazil.

Methods

Twenty three Asian CHB probands and their 313 relatives plus 31 CHB probands of Western origin and their 211 relatives were screened for HBV serological markers; the study was carried out in the outpatient clinic of the University of São Paulo School of Medicine.

Results

Mother to child transmission was greater in the Asian group whereas sexual transmission was more frequent in the Western group (p < 0.0001). Anti-HBc was positive in 90% and 57% of the Asian and Western parents (p = 0.0432) and in 97% and 33% of the Asian and Western brothers (p = 0.0001), respectively. HBsAg was more frequent among the Asian (66%) than the Western (15%) mothers (p = 0.0260) as well as among the Asian (81%) than the Western (19%) brothers (p = 0.0001). We could detect 110 new HBsAg-positive subjects related to the 54 index patients, being the majority (81%) of Asian origin.

Conclusion

In low prevalence area of hepatitis B, family members and household contacts of chronic HBV carriers are at high risk for acquiring hepatitis B.

     

HBV Pre-S1蛋白与胎儿宫内感染

目的:探讨HBV前S1蛋白与胎儿感染的相关性,为筛查HBsAg阳性孕产妇中可能感染胎儿的高危人群提供参考依据。方法:采用酶联免疫吸附试验(ELISA)双抗体夹心方法、分级定量PCR检测、酶联免疫吸附试验,检测256例HBV携带孕妇及其分娩的256例新生儿静脉血前S1蛋白、HBV DNA及HBV标志物。结果:①256例新生儿中发生HBV感染81例,感染率为31.6%。②前S1蛋白阳性孕产妇所分娩的85例新生儿中,感染率为88.2%(75/85),显著高于前S1蛋白阴性者的3.5%(6/171)(P<0.01)。③在感染的81例新生儿中,有79例其母前S1蛋白阳性(97.5%)(79/81),81例其母HBVDNA阳性,两者差异无统计学意义(P>0.01)。结论:①孕妇单纯HBsAg阳性,其婴儿感染率相对较低,如合并有前S1蛋白阳性或HBV DNA阳性,则胎盘传播率显著上升;②前S1蛋白检测可以代替血HBV DNA检测作为判断胎儿宫内感染的重要依据,可作为筛查HBsAg阳性孕产妇中易发生垂直传播人群的方法。     

乙肝父婴垂直传播的临床观察

目的:探讨父亲单方为乙肝病毒(HBV)感染者对子代的影响。方法:对父亲HBsAg阳性,母亲血清HBVM及HBVDNA均为阴性的306个家庭进行父亲血清HBeAg阳性状态、父亲血清HBV-DNA病毒载量、父亲精液HBV-DNA载量及新生儿脐带血HBV-DNA进行临床观察。结果:父亲肝功能异常发生率为7.5%;新生儿HBV感染率为21.6%(66/306);病例组中父亲为HBeAg阳性者达81.8%、血液HBV DNA阳性者达100%、精液HBV DNA阳性者达54.2%,分别是阴性者中发生HBV父婴垂直传播的8.7倍、2.1倍和34.3倍。结论:临床观察结果表明,孕前保健中务必将准父亲的血清HBeAg、HBVDNA、精液HBV DNA列入男性HBsAg阳性者的检测常规,对阳性者进行必要的系统有效的抗病毒治疗将对防范乙肝父婴垂直传播起积极和有效的作用。     

北京某郊区乙型肝炎的流行病学研究

从1982年6月到1983年6月我们研究了北京近郊-个农业生产大队HBV感染的自然史。1982年对全体人员的84%(491人)用固相放射免疫分析法(SPRIA)检测了HBV标记,HBsAg阳性率为7.3%,抗-HBs是36.7%,抗-HBc是45.6%,HBV总感染率52.3%。男性HBsAg阳性率是女性的1.5倍(8.9%对5.9%,P>0.05)。HBsAg阳性者中56%是15岁以下的儿童。抗-HBs、抗-HBc和总HBV感染率男女性都无显著差异。1983年复查了398人(81%)。191名在1982年HBV标记阴性者中有6人获得了HBV标记,HBV新感染率3.1%,6人都是亚临床感染。1982年HBsAg阳性的31人有28人在1983年变成了HBsAg慢性携带者,HBsAg慢性携带率占HBV感染者的13.6%。抗-HBs阳性者占HBV感染者的70%。