Discordance of hepatitis B vaccination policies for healthcare workers between the USA,the UK,and Germany

The hepatitis B (HB) vaccine is effective for the prevention of HB virus infection. It has been widely accepted that an anti‐HB surface antibody (HBs) level ≥10 mIU/mL is protective against HB virus infection. Although transient infection can occur in individuals who attain a peak level of anti‐HBs ≥10 mIU/mL after primary vaccination, long‐term follow‐up studies show that successful primary vaccination can prevent individuals from acute clinical hepatitis and chronic infection. Healthcare workers (HCWs) are at‐risk individuals. Based on the accumulated data, the USA considers an anti‐HBs level ≥10 mIU/mL to constitute successful vaccination for HCWs. In contrast, because some anti‐HBs assays cannot accurately measure in the low anti‐HBs range, including 10 mIU/mL, the UK and Germany consider an anti‐HBs level ≥100 mIU/mL to constitute successful vaccination for HCWs. In the USA and UK, a booster dose is unnecessary for HCWs after successful vaccination. In Germany, anti‐HBs testing is recommended for HCWs who are at particularly high individual exposure risk 10 years after successful primary immunization, and a booster dose is offered if the anti‐HBs level has declined to ?100 mIU/mL. The differences in the goal of HB vaccination, reliability of anti‐HBs assays, and use of booster vaccination cause discordance in HB vaccination policies for HCWs.     

Overt and occult hepatitis B virus infection among community children in Northwest China

Although a universal newborn hepatitis B (HB) immunization programme has been implemented in China, hepatitis B virus (HBV) breakthrough infection, including HB surface antigen (HBsAg)‐positive infection and occult HBV infection (OBI), still occurs during infancy or childhood. Obtaining the actual prevalence of HBV infection in general children is important for preventing and controlling the spread of HB. Accordingly, we investigated the prevalence of overt infection and OBI in community children and compared the serological and virological characteristics of OBI and HBsAg carrier children to clarify the mechanisms related to OBI. In total, 6 706 community children <12 years of age were included from a population‐based HBV seroepidemiological investigation in Northwest China. The HBsAg carrier rate in community children was 1.60% (107/6706), and the anti‐HBs positive rate was 57.35% (3846/6706). Additionally, 1192 HBsAg‐negative children were examined for OBI using nested PCR. The prevalence of OBI in local children was 1.26% (15/1192), and the predominant OBI genotypes were C and D. The 15 OBI children and 29 HBsAg‐positive children from the same population did not have a statistical significant difference in age, gender, alanine aminotransferase (ALT), proportion of anti‐HBs or anti‐HBc, viral genotypes or mutations. Children with chronic overt infection had higher viral loads than OBI children (P=.004). These results suggested that HBV overt and occult infection of children was more serious in underdeveloped north‐west regions. HBV neonatal immunization and catch‐up programmes should be strengthened and supplemented. None of specific viral mutations or genotypes related to OBI were found. OBI may be a specific stage of HBV infection.     

Incidence of hepatitis B virus infection in young Chinese blood donors born after mandatory implementation of neonatal hepatitis B vaccination nationwide

This study was carried out to determine the incidence of hepatitis B virus (HBV) infection in the young generation born after mandatory implementation of hepatitis B vaccination since 1992. Repeat blood donors born between 1992 and 1997 were enrolled, who gave blood at least twice during the past 3 years. Donors were tested for HBV infection markers of HBsAg, anti‐HBc, anti‐HBs and viral DNA by immunoassays (EIAs) and nucleic acid tests (NAT). A total of 14 937 pre‐donation screening qualified young repeat donors aged 18‐23 years were tested with 9 (0.06%) being HBsAg by EIA and 10 (1:1494) HBV DNA positive by Ultrio NAT (10.4 IU/mL), respectively. HBV DNA was further detected in 1:192 (9/1732) anti‐HBc+ repeat donors with Ultrio Plus NAT (3.4 IU/mL). Most cases were identified as occult HBV infection (OBI). Of 14 937 repeat donors, 20.9% were anti‐HBc+ positive, while approximately 50% of 12 024 repeat donors were anti‐HBs negative or had levels <100 IU/L. HBsAg+ or OBI strains were classified as wild type of genotype B or genotype C. Incident HBV infection in repeat donors was approximately 1:18.5 person‐years (1.1%/year) but significantly less frequent in donors with confirmed HBV vaccination (2.4%‐3.3%) than those unsure of vaccination status (10.5%; P = .0023). Hepatitis B virus vaccination appears largely protective of HBV infection, but incidence of infections increases in young adults with mostly undetectable or low anti‐HBs or occasionally high anti‐HBs. A boost of hepatitis B vaccine for adolescents prior to age 18 years may reduce HBV infection, and implementation of more sensitive NAT in blood donation screening may improve HBV safety in blood transfusion.     

A seroepidemiological survey of the effect of hepatitis B vaccine and hepatitis B and C virus infections among elementary school students in Siem Reap province,Cambodia

Aim

This study aimed to survey the prevalence and incidence of hepatitis B (HBV) and hepatitis C virus (HCV) infection among elementary school students in Siem Reap province, Cambodia and to evaluate the effects of a national infant HBV vaccination program introduced in 2001.

Methods

Students in 3rd grade during the 2011, 2012, and 2013 academic years were enrolled in this study; at the time of the second examination, in the 2014–2015 academic year, the students were in 5th or 6th grade. The incidence and prevalence rates of HBV and HCV infection were estimated and full HBV sequences were analyzed.

Results

Among 248 students (107 male and 141 female) born between 1999 and 2005, five students were HBV surface antigen (HBs‐Ag) positive (2.02%), and all of them were infected with genotype C. Among them, subgenotype C1 was found in four students and, unexpectedly, complete genetic sequence identity of subgenotype C1 was found in two students from different families. The anti‐HBV core (HBc) and anti‐HBs prevalence rates were 10.89% and 16.13%, respectively. Twenty‐five students were positive for anti‐HBs and negative for both HBsAg and anti‐HBc (10.08%; estimated serological vaccination rate); this rate increased significantly with the birth year (P = 0.0229). Prevalence of anti‐HCV was 2.82%, and HCV RNA was not detected. The estimated incidence of HBV and HCV infection were both 0/1000 person‐years (PY) (95% confidence interval, 0–20.61/1000 PY and 0–14.50/1000 PY, respectively).

Conclusion

Hepatitis B virus full‐genome sequencing and serological analysis revealed the possibility of horizontal transmission of HBV among Cambodian schoolchildren. However, the anti‐HBc positivity rate decreased along with increasing age and estimated serological vaccination rates.     

Persistent and transient hepatitis B virus (HBV) infections in children born to HBV‐infected mothers despite active and passive vaccination

Summary. Combined passive and active immunization for newborns very effectively prevents perinatal hepatitis B virus (HBV) infections. In the Netherlands, babies born to hepatitis B surface antigen (HBsAg)‐positive women receive passive immunization with hepatitis B and at least three active HBsAg vaccinations. Serological testing for the presence of HBV markers was offered for all infants born to HBsAg‐positive mothers between January 2003 and July 2007, after completion of their vaccination schedule. About 75% of the infants (n = 1743) completed their HB‐vaccination schedule and participated in the serologic evaluation. Twelve of them (0.7%) were found to be HBV infected. Furthermore, we identified three older children with high levels of anti‐HBc, anti‐HBs and anti‐HBe, while they were HBsAg and HBV DNA negative. This serologic profile is evidence for a resolved HBV infection. In the group of older children (1.5–5 years of age, n = 728), about half of the HBV‐infected children (3 of 7) had already cleared their infection at the time of sampling. For a proper evaluation of the efficacy of a new intervention programme to prevent vertical HBV transmission, it is also important to analyse the HBV markers in serum collected when the children are older than 1.5 years. In a programmatic setting, all children born to HBV‐infected mothers should be tested not only for the level of anti‐HBs but also for the absence of HBsAg, because 2 of the 12 HBV‐infected children (17%) had a high level of anti‐HBs.     

Evidence of protection against clinical and chronic hepatitis B infection 20 years after infant vaccination in a high endemicity region

Summary. Vaccination against hepatitis B virus (HBV) immediately after birth prevents neonatal infection by vertical transmission from HBV carrier mothers. There is an ongoing debate whether infant vaccination is sufficient to protect against infection when exposed to HBV later in life. We studied 222 Thai infants born to HBsAg ?/+ and HBeAg ?/+ mothers who were vaccinated with recombinant hepatitis B vaccine at 0‐1‐2‐12 months of age. A subset of 100 subjects received a booster dose at age 5 years. Blood samples collected yearly for 20 years were examined for anti‐HBs antibodies and serological markers of hepatitis B infection (anti‐HBc, HBsAg, and in selected cases HBeAg, anti‐HBe, HBV DNA). During the 20‐year follow‐up, no subject acquired new chronic HBV infection or clinical hepatitis B disease. During the first decade, possible subclinical breakthrough HBV infection (anti‐HBc seroconversion) was only observed in subjects born to HBsAg +/HBeAg + mothers (6/49 [12.2%]). During the second decade, breakthrough HBV infections were detected in all groups (18/140 [12.8%]). Increases in anti‐HBs concentrations that were unrelated to additional HBV vaccination or infection were detected in approximately 10% of subjects in each decade. Primary infant vaccination with a recombinant hepatitis B vaccine confers long‐term protection against clinical disease and new chronic hepatitis B infection despite confirmed hepatitis B exposure. ( http://www.clinicaltrials.gov NCT00240500 and NCT00456625)     

Five years of vaccination campaign against hepatitis B in Italy in infants of hepatitis B surface antigen carrier mothers

The programme of the current vaccination campaign against hepatitis B in Italy considers the newborn of hepatitis B surface antigen (HBsAg) positive mothers to be high priority. Pregnant women are screened for HBsAg during the third trimester of pregnancy. All newborn of HBsAg positive women, regardless of the mother's status of hepatitis Be antigen (HBeAg), are given a single dose of hepatitis B immune globulin within 24h after birth and the first dose of hepatitis B vaccine within 7 days after birth. During the period 1984-1988 the percentage of pregnant women screened for HBsAg increased from 32% in 1984 to 71% in 1988 (P less than 0.001). The prevalence of HBsAg positive mothers was stable, ranging from 2.2% to 2.5%, but with wide regional differences (range 0.3%-6.4%). The screening compliance of pregnant women has been significantly better (P less than 0.01) in regions at a lower (less than 5%) HBsAg carrier rate. The percentage of children born to carrier mothers, who received active plus passive immunization, ranged from 75% to 85%. The number of infants immunized as percentage of those expected to be immunized (applying the observed prevalence of carrier mothers to the total number of deliveries by year) increased from 29% in 1984 to 62% in 1988 (P less than 0.01). No serious side effects were reported.     

Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India

Background and Aim: The risk of acquiring hepatitis B virus (HBV) infection through exposure to blood or its products is highest amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. India is second to China in the numbers of people with chronic HBV. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs in India. Methods: A total of 2162 HCWs were screened for the presence of serological markers of HBV and hepatitis C virus (HCV). Occult HBV infection was tested by detection of HBV‐DNA for surface and core regions by nested polymerase chain reaction in HBsAg‐negative and IgG anti‐hepatitis core antigen–positive subjects. Results: Only 1198 (55.4%) of the 2162 HCWs screened had been vaccinated; and 964 (44.6%) were not vaccination‐status conscious; of these HCWs, 600 (27.7%) had never been vaccinated and 364 (16.4%) were unaware of their vaccination status. Protective (> 10 IU/mL) anti‐hepatitis B surface (anti‐HBs) antigen titers were seen in only 61.7%. The anti‐HBs titers were found to be lower with the passage of time; the median anti‐HBs titers in subjects who were vaccinated > 10 years ago were significantly lower than those who had been vaccinated < 5 years ago (P < 0.001). One percent of HCWs were HBsAg‐positive, and 24.7% of 700 HCWs screened had past exposure (IgG‐anti‐HBc‐positive). Occult HBV was detected in 5% of 120 positive subjects with past exposure; all had anti‐HBs titers > 10 IU/mL. Conclusions: Even today, 28% HCWs in India are unvaccinated and 17% are unaware of their vaccination status. This data suggests that use of hepatitis B immune globulin be mandatory in needle‐pricked HCWs in India, and that implementation of awareness strategies is urgent. Since the anti‐HBs titers decline in a fair proportion, there is justification for giving a booster dose of vaccine 10 years after primary vaccination to HCWs in India.     

Reduced prevalence of hepatitis B surface antigen positivity among pregnant women born after the national implementation of immunoprophylaxis for babies born to hepatitis B virus‐carrier mothers in Japan

Aim

We aimed to estimate hepatitis B surface antigen (HBsAg) positivity among birth year‐stratified pregnant women in Hiroshima, Japan, and compare prevalence rates between women born before and after implementation of a national immunoprophylactic vaccination program for babies born to hepatitis B virus (HBV) carrier mothers in Japan.

Methods

Pregnant women who gave birth at all delivery hospitals/clinics in Hiroshima prefecture between 1 April 2010 and 31 March 2011 were eligible. Lists collected from each institution included survey items such as age (pregnant woman's birth year) and HBsAg and hepatitis C virus (HCV) antibody (anti‐HCV) test results, which were posted anonymously and non‐consolidated from medical records. We calculated the HBsAg and anti‐HCV prevalence in our cohort according to the mothers' birth year.

Results

In 41 of 58 hospitals/clinics, 15 233 and 15 035 pregnant women underwent HBsAg and anti‐HCV testing, corresponding to 59.6% and 58.9% of 25 546 births in the 2010 fiscal year, respectively. The overall HBsAg positive rate was 0.51% (95% confidence interval [CI], 0.40–0.63%), and an extremely low prevalence (0.10%; 95% CI, 0.00–0.25%) was observed among pregnant women born after 1986. However, the prevalence in this study was slightly higher than the nationwide value (0.31%) and the Chugoku region‐specific value (0.46%) among first‐time blood donors at Japanese Red Cross blood centers between 2001 and 2006. No significant difference in anti‐HCV positivity was observed.

Conclusion

Only two pregnant women born after the preventive program implementation were HBsAg‐positive. Perinatal HBV transmission is estimated to be almost completely inhibited in the next generation.

     

Maternal immunization promotes the immune response of neonates towards hepatitis B vaccine

Infants infected with hepatitis B virus (HBV) face the risk of developing severe complications. Unfortunately, in spite of universal vaccination programmes, 5% or more of vaccinated newborns still do not achieve protective levels of anti‐hepatitis B virus surface antigen titres (anti‐HBs). The aim of this study was to use animal experiments and population‐based research to determine whether maternal vaccination against HBV affects the outcome of neonatal vaccination. Six sows and 53 newborn piglets were used for this study and randomly assigned to the vaccination group (three 20 μg doses of recombinant HBV vaccine). All the piglets were followed up to 10 weeks of age, and peripheral blood was withdrawn for measurement of anti‐HBs. A cross‐sectional study was also conducted on 449 mothers with infants. A structured questionnaire was used to collect demographic, medical and maternal data, and their peripheral blood was collected for measurement of anti‐HBs. The results of animal experiments demonstrated that nonvaccinated piglets born to vaccinated sows and nonvaccinated piglets born to nonvaccinated sows were negative for anti‐HBs. Repeated measures analysis of variance showed that the titres of anti‐HBs in vaccinated piglets born to vaccinated sows were significantly higher than in vaccinated piglets born to nonvaccinated sows (P < 0.05). In a population‐based study, a cumulative logistic regression analysis showed that the strongest influences on neonatal anti‐HBs titres were delay of the first vaccination dose [OR = 3.02(95% CI: 1.72–5.30)] and maternal anti‐HBs titres [OR = 2.48(95% CI: 2.03–3.04)]. In conclusion, high maternal anti‐HBs titres can enhance the response to HBV vaccination in infants.     

Prevalence and virological features of occult hepatitis B virus infection in female sex workers who work uncontrolled in Turkey

Background: There is little information about the prevalence of occult hepatitis B virus infection (OHBVI). We have investigated the prevalence and virological features of OHBVI among female sex workers (FSWs) in Istanbul. Methods: Hepatitis B surface antigen (HBsAg) was tested in FSWs who work uncontrolled and were admitted to Venereal Diseases Hospital. HBV DNA and anti‐HBs were investigated in all the HBsAg‐negative cases. Hepatitis B envelope (HBe) antigen, anti‐HBe, anti‐hepatitis B core (HBc) antigen, HBV genotype, S gene and precore (PC)/basic core promoter (BCP) mutations were determined in HBV DNA‐positive sera. Results: Two hundred and eighty‐six volunteers were enrolled and 32.5% (n=93) of them had anti‐HBs positivity. HBV DNA (range 30–209 copy/ml) was positive in 11 anti‐HBs‐negative and two anti‐HBs‐positive cases. The prevalence of OHBVI was 4.5% (13/286). Anti‐HBc was positive in 77% (10/13) of those with OHBVI and anti‐HBe positivity was 53.8% (7/13). Only genotype D was present in all occult HBV‐infected cases. One PC (G1896A) and one BCP (T1762/A1764) mutation was found, but S gene mutation was not detected in any of the samples. Conclusion: In this population, OHBVI may have a negligible role in the horizontal transmission because of a very low viral load, and PC and core promoter mutations are very rare.     

Hepatitis B seroprevalence in Thailand: 12 years after hepatitis B vaccine integration into the national expanded programme on immunization

OBJECTIVES: To evaluate the impact of the universal hepatitis B (HB) vaccination programme on the prevalence of hepatitis B surface antigen (HBsAg) carriers and immunity to HB virus infection among children <18 years and to determine the HB seroprevalence in the Thai population. METHODS: We enrolled people in four provinces, including Chiangrai, Udon Thani, Chonburi and Nakhon Si Thammarat to geographically represent populations in the North, Northeast, Center and South of the country respectively. Serology for HBsAg, anti-hepatitis B surface (anti-HBs), and anti-hepatitis B core (anti-HBc) was tested using ELISA commercial kits. In total, 6213 subjects aged 6 months to 60 years from the four provincial hospitals and two to three district hospitals of each participating province participated. RESULTS: Overall HBsAg, anti-HBs, and anti-HBc seropositive rates amounted to 4%, 41.6% and 26.5% respectively. Of 2887 participants aged 6 months to 18 years, 2303 were born after (group I) and 584 prior to (group II) HB vaccine integration into the expanded programme on immunization of each participating province. The HBsAg seropositive rate was 0.7% among group I children and 4.3% among group II children. The prevalence rate of anti-HBc was 2.9% in group I and 15.8% in group II. In children under 18 years, the HBsAg carrier rate was 0.98% among complete vaccinees and 1.36% among participants without vaccination. CONCLUSIONS: This finding supports the efficacy of universal HB immunization in reducing the prevalence of HB infection in Thailand which is a highly endemic country.     

Factors associated with isolated anti‐hepatitis B core antibody in HIV‐positive patients: impact of compromised immunity

Summary. In regions that are hyperendemic for chronic hepatitis B virus (HBV) infection, prevalence of and risk factors associated with isolated anti‐hepatitis B core antibody (anti‐HBc) in HIV‐positive patients are less well described. HIV‐positive patients who were tested for hepatitis B surface antigen (HBsAg), anti‐hepatitis B surface antibody (anti‐HBs) and anti‐HBc at designated hospitals for HIV care in Taiwan were included for analysis. HBV DNA was detected by real‐time polymerase chain reaction in patients with and without isolated anti‐HBc. Of 2351 HIV‐positive patients, 450 (19.1%) were HBsAg positive, 411 (17.5%) were anti‐HBc positive alone and 963 (41.0%) for both anti‐HBs and anti‐HBc. Compared with patients who were positive for both anti‐HBs and anti‐HBc, patients with isolated anti‐HBc were older, less likely to have anti‐hepatitis C virus antibody (anti‐HCV), had lower CD4 lymphocyte counts and higher plasma HIV RNA loads. Older age (adjusted odds ratio, 1.029; 95% confidence interval, 1.015–1.043) and CD4 <100 cells/μL (adjusted odds ratio, 1.524; 95% confidence interval, 1.025–2.265) were independently associated with isolated anti‐HBc by logistic regression, while presence of anti‐HCV and injecting drug use were not. HBV DNA was detectable in 8.3% of 277 patients with isolated anti‐HBc and 14.3% of 56 patients with both anti‐HBs and anti‐HBc (P = 0.160). In a country hyperendemic for HBV infection, HIV‐positive patients at older age and with CD4 <100 cells/μL were more likely to have isolated anti‐HBc, suggesting that compromised immunity plays a role in the presence of this marker.     

Clearance of hepatitis B surface antigen in chronic carriers of hepatitis delta antibodies

Abstract: Background/Aims: We evaluated the rate of seroclearance of the hepatitis B surface antigen (HBsAg) and its clinical significance in patients with chronic hepatitis delta virus (HDV). Methods: Antibody to HDV was tested in HBsAg‐positive subjects admitted to our Hospital from 1991 to 1995. In 1997, a biochemical and virologic study was performed in the surviving anti‐HD‐positive patients who had not undergone transplantation. As a control, a cohort of 106 HBsAg‐positive, anti‐HD‐negative patients was studied. Results: One hundred and forty‐one subjects were originally positive for anti‐HD. After 4 years of follow‐up, six of the 60 patients who underwent re‐evaluation (10%) had cleared the HBsAg: three of the six patients had minimal changes at the initial liver histology and normal ALT, whereas in the remaining three patients with chronic active hepatitis ALT normalized during the observation. Anti‐HD persisted in five of the six patients. Only one patient had raised anti‐HBs. In contrast, three of 106 HBsAg carriers without HDV infection (2.8%) cleared the HBsAg within the same time and seroconverted to anti‐HBs (p=0.002). Conclusion: HBsAg clearance is increased over the years in HDV patients compared to ordinary HBsAg carriers, and is often associated with improvement of HDV disease without seroconversion to anti‐HBs.     

Prevalence and clinical features of patients with concurrent HBsAg and anti‐HBs: Evaluation of the hepatitis B research network cohort

The prevalence of concurrent HBsAg and anti‐HBs in plasma of persons with chronic hepatitis B virus (HBV) infection is variable and its clinical significance enigmatic. We examined the prevalence and clinical and virological features of concurrent HBsAg and anti‐HBs in children and adults with chronic HBV infection living in North America. A total of 1462 HBsAg positive participants in the Hepatitis B Research Network paediatric and adult cohorts were included (median age 41 (range 4‐80) years, 48% female, 11% white, 13% black, 73% Asians). Only 18 (1.2%) were found to be anti‐HBs positive (≥10 mIU/mL) at initial study evaluation. Distributions of sex, race, HBV genotype and ALT were similar between participants with and without concurrent anti‐HBs. Those who were anti‐HBs positive appeared to be older (median age 50 vs 41 years, P = .06), have lower platelet counts (median 197 vs 222 × 103/mm³, P = .07) and have higher prevalence of HBeAg (44% vs 26%, P = .10). They also had lower HBsAg levels (median 2.0 vs 3.5 log₁₀ IU/mL, P = .02). Testing of follow‐up samples after a median of 4 years (range 1‐6) in 12 of the 18 participants with initial concurrent anti‐HBs showed anti‐HBs became undetectable in 6, decreased to <10 mIU/mL in 1 and remained positive in 5 participants. Two patients lost HBsAg during follow‐up. In conclusion, prevalence of concurrent HBsAg and anti‐HBs was low at 1.2%, with anti‐HBs disappearing in some during follow‐up, in this large cohort of racially diverse children and adults with chronic HBV infection living in North America. Presence of concurrent HBsAg and anti‐HBs did not identify a specific phenotype of chronic hepatitis B, nor did it appear to affect clinical outcomes.     

Prevalence of Hepatitis B Virus Seromarkers in Young Adults Vaccinated at Birth; Impact on the Epidemiology of Hepatitis B Infection in Iran

Background:

The epidemiological impact and the duration of protection provided by infant hepatitis B (HB) vaccination are unknown.

Objectives:

This study was designed to determine the hepatitis B virus (HBV) infection seromarkers in young adults who have been vaccinated against HBV as the first group of Iranian neonates during 1993 and 1994.

Patients and Methods:

We recruited 510 young adults with a history of complete HB vaccination at birth. HBV seromarkers (HB surface antigen (HBs Ag), antibody against HBs Ag (Anti-HBs), and antibody against HB core antigen (Anti-HBc) were measured using ELISA method. Anti-HBs titers ≥ 10 IU/L were considered protective and titers more than 300 IU/L were indicative of a natural boosting. Positive results for Anti-HBc and HBs Ag were considered as breakthrough infection and possible vaccine failure, respectively. The history of acute symptomatic clinical hepatitis was also investigated.

Results:

Anti-HBs seropositivity rate was detected in 224 of 510 [95% CI: 39-47] young adults. Breakthrough infection (positive sera for Anti-HBc without chronic infection) was observed in 18 [95% CI: 2.5-3.5] subjects. There were neither HBs Ag positive results nor symptomatic hepatitis cases.

Conclusions:

The study results indicated that the neonatal HBV immunization induced a long-term protection against HBV and was very efficacious in reducing chronic HBV infection rate in vaccinated young adults in Iran.     

Serodiagnosis of hepatitis B virus infection by antibody to core antigen

In a military population antibody to hepatitis B core antigen (anti-HBc) was found in 39% of acute hepatitis cases negative for hepatitis B surface antigen (HBS Ag) and in 96% of HBs Ag-positive cases. Persistence of antibody to HBs Ag (anti-HBs) in convalescent-phase sera was significantly greater (P less than 0.001) in individuals with acute HBs Ag-positive hepatitis B than in patients with clinical HBs Ag-negative hepatitis B. The prevalence of anti-HBc in the absence of HBs Ag, anti-HBs, and clinical disease was 3.2% in this military population. In longitudinal studies of hepatitis B infection, the presence of anti-HBc preceded anti-HBs and improved the ability to determine the onset of sublicnical infection. Anti-HBc is a useful serologic marker for the study of the epidemiology of hepatitis B and improves the efficiency of detection of hepatitis B virus infection.     

Protective hepatitis B surface antibodies in blood and ascites fluid in the early stage after liver transplantation for hepatitis B diseases

Aim: The aim of this study is to identify the titres of protective hepatitis B surface antibodies (anti‐HBs) in the blood and their effective factors in the early stage after liver transplantation (LT) for hepatitis B virus (HBV) related diseases. The condition of anti‐HBs lost in ascites fluid was also investigated. Methods: Twenty‐six patients who received LT were administered prophylaxis of lamivudine combining intravenous hepatitis B immunoglobulin (HBIG) post‐LT. The titres of anti‐HBs were recorded and analyzed daily in blood and ascites fluid within the first week post‐LT. Results: In the first 5 days post‐LT, the titres of anti‐HBs in HBV DNA positive groups, high hepatitis B surface antigen (HBsAg) groups, hepatitis B e antigen (HBeAg) positive groups were lower than that in the parallel HBV DNA negative groups, low HBsAg groups and HBeAg negative groups. The mean titre level of anti‐HBs in ascites fluid is 224.89 IU/L and fluctuated from 0.00 IU/L to 968.50 IU/L, which is also correlated with anti‐HBs titres in blood drawn at the same time (r = 0.927, P = 0.000). The level of anit‐HBs in ascites fluid was very high; however, it fluctuated in a wide range (from 0.00 IU to 908.55 IU). Conclusions: Patients in high risk groups should receive a higher level of HBIG to maintain sufficient amounts of anti‐HBs in the early stage post‐LT, while the patients in low risk groups need a lower level of HBIG administration. Furthermore, the lost amount of anti‐HBs in ascitic fluid post‐LT has minimum impact on the anti‐HBs titres in blood.     

Changing aetiology of liver dysfunction in the new generation of a hepatitis B and C‐endemic area: cross‐sectional studies on adolescents born in the first 10 years after universal hepatitis B vaccination

Background/Aim: Geographical variation in viral hepatitis infection complicates various levels of liver diseases. This study elucidates the changing aetiology of alanine transaminase elevation (ALT levels >40 IU/L) in a previously hepatitis‐endemic township. Design/Methods: Five cross‐sectional screenings were performed on teenagers born from 1984 to 1993. We examined hepatitis B surface antigen (HBsAg), anti‐hepatitis C virus (anti‐HCV), ALT and body mass index, and additionally checked hepatitis B envelope antigen (HBeAg) for positive HBsAg and HCV RNA for positive anti‐HCV. Teenagers with ALT elevation underwent an ultrasonography examination. Results: This study enrolled 1788 (93.7%) of 1909 students, discovering individual prevalence of HBsAg (6.3%), anti‐hepatitis B core (anti‐HBc) (15.5%), anti‐HCV (2.2%), overweight (22.4%), obesity (12.8%) and ALT >40 IU/L (3.7%). HBsAg and anti‐HBc prevalence declined with trends, while obesity increased with trends (P<0.001). Among 66 ALT‐elevated teenagers, prevalence percentages of risk factors were HBsAg (22.7%), anti‐HCV (1.5%), obesity (45.5%), HBsAg with obesity (7.6%) and anti‐HCV with obesity (3.0%). Additionally, obesity showed predominance (85.7%) among aetiologies of teenagers with fatty livers (60.9%). The independently associated factors of ALT elevation included being male (odds ratio, 2.18; 95% confidence interval, 1.21–3.93), HBsAg (4.25; 1.06–17.13), HBeAg (7.24; 1.64–31.9), HCV RNA (29.03; 5.8–145.29) and obesity (16.5; 8.79–30.98). Conclusion: In place of viral hepatitis, obesity is becoming the major aetiology of abnormal liver function among the young generation in a previously hepatitis‐endemic area.     

Implications of the relationship between maternal age and parity with hepatitis B carrier status in a high endemicity area

Summary. This study aimed to examine the prevalence of maternal hepatitis B virus (HBV) infection in the past 10 years and the age‐ and parity‐specific incidences for evidence of control of HBV infection in the female reproductive population. We conducted a retrospective cohort study on 58 736 consecutive pregnant women delivered from July 1998 to June 2008. Maternal HBV status and demographic data were retrieved from a computerized database for analysis by year, age, year of birth and parity. A total of 5788 (10.1%) women had HBV infection, and the annual prevalence was around 10% throughout. When categorized by maternal age into six 5‐year cohorts, the incidence increased from 6.8% in the <20 years cohort to 10.8% in the 20–24 and 25–29 year cohorts, then declined to 9.3% in the ≥40 years cohort (P < 0.001). When categorized by year of birth into 5‐year cohorts, the incidence varied from 9.2% for the 1965–1969 cohort to 11.3% in the 1980–1984 cohort, which then declined to 7.3% in the ≥1985 cohort (P < 0.001). Multiparas had higher incidence when compared with nulliparas overall (10.5%vs 9.6%, P = 0.001), and significantly higher incidences for the 25–29 year (P = 0.009), 30–34 year (P < 0.001) and 35–39 year (P = 0.032) cohorts when analysed by age. In conclusion, the prevalence of maternal HBV infection remained constant at 10% for the past decade. The changes in relation to age and parity suggested that horizontal transmission, probably by sexual contact, had played an important role in maintaining the same prevalence as reported from Hong Kong 20 years ago.