Time trends of the prevalences of hepatitis B e antigen positives among hepatitis B virus carriers in Japan

In order to examine time trends of the prevalences of HBeAg positives among HBV carriers in Japan, we analysed data on HBeAg of HBsAg positive voluntary blood donors (23,560 males, and 8659 females) at the Osaka Red Cross Blood Centre between January 1977 and March 1984. Age-specific prevalences of HBeAg positives decreased year by year for both sexes, especially for those in their teens and twenties. The prevalences of HBeAg positives decreased with age, but at any given age it was lower for the later than for the earlier birth cohorts. Although reasons for the secular declines are unknown, the findings suggest that the prevalence of HBeAg positives among HBV carriers will continue to decrease in Japan. This, together with the immunization programme implemented this year, may lead to a future reduction in the risk of HBV related liver diseases in Japan.     

Hepatitis B vaccine response among infants born to hepatitis B surface antigen-positive women

Purpose

Annually, an estimated 25,000 infants are born to hepatitis B surface antigen (HBsAg)-positive women in the United States. Hepatitis B (HepB) vaccine and hepatitis B immune globulin (HBIG) are recommended at birth, followed by completion of vaccine series and post-vaccination serologic testing (PVST). In a large cohort of infants born to HBsAg-positive women, factors influencing vaccine response were evaluated.

Methods

Data were from HBsAg-negative infants born to HBsAg-positive women in the Enhanced Perinatal Hepatitis B Prevention Program (EPHBPP) from 2008 to 2013. Vaccine non-responders were defined as infants with antibody to hepatitis B surface antigen (anti-HBs) <10 mIU/mL at PVST after receiving ≥3 vaccine doses. Multivariable analyses modeled statistically significant predictor variables associated with non-response.

Results

A total of 17,951 maternal-infant pairs were enrolled; 8654 HBsAg-negative infants born to HBsAg-positive mothers received ≥3 doses of vaccine with anti-HBs results. 8199 (94.7%) infants responded to a primary HepB series; 199 (94.8%) to a second series. Factors associated with anti-HBs <10 mIU/mL included gestational age <37 weeks, vaccine birth dose >12 h after birth, timing of final vaccine dose <6 months after birth, receipt of 3 vs. 4 vaccine doses, and PVST interval >6 months from final vaccine dose in bivariate analysis. PVST interval >6 months from final vaccine dose (OR = 2.7, CI = 2.0, 3.6) was significantly associated with anti-HBs <10 mIU/mL; the proportion increased from 2% at 1–2 months to 21.6% at 15–16 months after the final dose. Receipt of a 4th dose improved the response rate (OR = 0.5, CI = 0.3, 0.8).

Conclusions

Ninety-five percent of a large cohort of uninfected infants born to HBsAg-positive mothers in the United States responded to primary HepB vaccine series. The proportion of infants with anti-HBs <10 mIU/mL increased with longer interval between the final vaccine dose and PVST. Optimal timing of PVST is within 1–2 months of final vaccine dose to avoid unnecessary revaccination.     

Hepatitis B immunisation of infants at risk

A retrospective cohort review survey assessed hepatitis B immunisation uptake in at-risk infants over 4 years and a GP questionnaire identified the problems of poor communication and uncertainty of responsibility for immunisation as barriers to successful implementation of the immunisation programme. Incorporating appointments for hepatitis B immunisation within the national child immunisation recall system would help improve uptake but, in the meantime, a manual appointment system could be incorporated within existing child immunisation systems.     

住院患者携带乙型肝炎表面抗原调查分析

目的总结和分析医院住院患者乙型肝炎表面抗原携带情况,为乙型肝炎的预防提供科学的指导。方法采用酶联反应吸附试验(ELISA)对1 220例住院患者进行血清乙型肝炎表面抗原(HBsAg)检测,利用SPSS13.0统计软件进行描述性分析,并进行不同年份和性别间率的比较。结果 1 220例住院患者携带HBsAg 56例,携带率为4.59%,其中男性660例携带34例,携带率为5.12%,女性560例携带22例,携带率为3.93%;HBsAg携带在科室分布中,最高为传染病科占16.1%,其次为心胸外科占14.3%。结论对住院患者或健康体检者进行感染性标志物检测很有必要的,可为疾病预防提供依据,阻止传染病的传播。     

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.     

高中新生乙肝表面抗原及抗体检测分析

目的了解通海县高中入学新生乙型肝炎表面抗原(HBsAg)携带及乙肝表面抗体(抗-HBs)产生情况,探讨预防乙肝的对策与措施。方法对2008—2012年新入学5550名高中学生进行乙肝表面抗原及乙肝表面抗体血清学检测分析。结果乙肝表面抗原阳性率3.39%、乙肝表面抗体阳性率72.81%。结论乙肝表面抗原阳性率呈逐年下降趋势,乙肝表面抗体呈逐年上升趋势,差异有统计学意义。说明乙肝疫苗纳入计划免疫接种以来,有效地控制了乙肝病毒的传播。     

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.     

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.     

宁波市乙型肝炎表面抗原阳性母亲新生儿乙肝免疫球蛋白接种率调查及影响因素分析

目的了解宁波市乙型肝炎表面抗原（HBsAg）阳性母亲所生新生儿乙肝免疫球蛋白接种率及影响接种率的相关因素。方法采用多重抽样的方法随机选取宁波市医院机构分娩的产妇和新生儿为调查对象,查阅出生记录,利用自制的调查表摘录乙肝免疫球蛋白接种的相关信息并计算接种率。使用SAS统计软件建立logistic回归模型,筛选影响接种率的相关因素。结果共查阅产妇及新生儿病历3613份,产妇HBsAg筛查率为100％,其中HBsAg阳性产妇287人,产妇HBsAg携带率7．94％（287／3613）。实际调查病历276份,HBsAg阳性产妇所生新生儿乙肝免疫球蛋白接种率为92．75％,其中12h内接种率为58．70％,24h内接种率为84．06％。多因素分析显示,产妇户籍、医院类别、医院级别是影响乙肝免疫球蛋白及时接种的因素,OR（95％CI）分别为0．438（0．205～0．933）、0．322（0．153～0．681）、0．485（O．237t0．993）,而产妇户籍是影响乙肝免疫球蛋白是否接种的因素。结论宁波市乙肝免疫球蛋白接种情况较好,但12h及时接种率有待提高。     

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     

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.     

Modelling death rates for carriers of hepatitis B

Hepatitis B carriers who acquired the infection perinatally die from hepatocellular carcinoma (HCC) and cirrhosis at high rates. Published cohort studies are largely limited to males and are too small to estimate the age-specific risk of death. We therefore used routinely collected Hong Kong data to estimate the risks. Deaths were partitioned between carriers and non-carriers, then current life table calculations determined life expectancy and probability of dying from HCC or cirrhosis. HCC is the dominant cause of death for male carriers in middle adulthood with a lifetime risk of 27% for HCC compared to 4% for females. Predicted life expectancy is 72 years for male carriers, compared to 79 years for non-carriers. Female carriers have a life expectancy of 81 years and non-carriers 83 years. This model probably applies to all southern Chinese populations and emigrants with similar life history, and other populations that acquired infection early in life.     

Hepatitis B surface antigen seroprevalence among children in the Philippines, 2018

The World Health Organization Western Pacific Region (WPR) set a hepatitis B virus (HBV) control target to achieve HBV surface antigen (HBsAg) prevalence of <1% among children aged 5 years by 2017. The estimated HBsAg prevalence in the Philippines among adults was 16.7% during the pre-vaccine era. We estimated the HBsAg seroprevalence among children aged 5–7 years to measure the impact of vaccination.We conducted a household serosurvey, using a three-stage cluster survey methodology (provinces, clusters, and households). We estimated HBsAg prevalence using a rapid, point-of-care HBsAg test and calculated vaccination coverage by reviewing vaccination records or by caregiver recall. A questionnaire was administered to assess demographic variables for the child and family. We assessed the association between chronic HBV infection, vaccination coverage, and demographic variables, accounting for the complex survey design.Of the 2178 children tested, HBsAg was detected in 15 children [0.8%, 95% confidence interval (CI): 0.4, 1.7]. Only two of the HBsAg-positive children had been fully vaccinated against HBV. Based on documented vaccination or caregiver recall for the survey population, hepatitis B vaccine birth dose (HepB-BD) coverage was 53%, and the third dose hepatitis B vaccination (HepB3) coverage was 73 percent. Among the 1362 children with documented HepB-BD, timely HepB-BD coverage (given within 24 h of birth) was 43%; children born outside a health facility were less likely to receive a timely HepB-BD than those born in a health facility (adjusted odds ratio 0.10, 95% CI: 0.04, 0.23).HBsAg prevalence among children in the Philippines has decreased compared to the prevalence among adults in the pre-vaccination era. Strategies to further reduce HBsAg prevalence include ensuring that all children, whether born in health facilities or at home, receive a timely HepB-BD, and increasing HepB-BD and HepB3 coverage to reach the WPR goals of ≥95% coverage.     

Hepatitis B surface antigen in Cimex lectularius

Bedbug (Cimex lectularius) samples adult and nymphs either engorged or starved from Central Security Forces sleeping wards, laboratory animal house and control samples from laboratory reared colonies were ground and subjected to ELISA test of hepatitis B surface antigen together with 276 serum samples from the recruits slept in those wards. In the camp 7 out of 30 samples of engorged adult bedbugs were positive to HBSAg and 5 out of 30 samples of starved bedbugs were positive. Regarding nymphs 4 out of 30 engorged samples showed positive results. One of five samples of engorged adult bedbugs from the laboratory animal farm was positive. The control samples were negative. Serum samples of 276 recruits showed 3.6% positive results of HBSAg.     

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。     

云南HBsAg阳性孕产妇生产婴儿免疫应答及感染状况分析

目的 了解云南省乙肝表面抗原（HBsAg）阳性孕产妇所生婴儿在实施母婴阻断后的免疫应答及乙肝感染状况。方法 筛查出全云南省2011年1-6月入院分娩的HBsAg阳性孕产妇,实施母婴阻断后以其所生婴儿为调查对象,于7-12月龄采集静脉血2 mL,分离出血清标本先统一采用ELISA法做乙肝血清学5项指标检测,筛选出HBsAg阳性的标本采用荧光定量PCR法进行乙肝病毒载量（HBV DNA）检测,筛选出HBsAg阴性且乙肝表面抗体（anti-HBs,抗-HBs）阳性的标本采用化学发光法做抗-HBs定量检测。结果 共收集到调查对象3 026人,母婴阻断实施后免疫应答率为92.43%,有效免疫应答率为80.04%;低、无免疫应答者占16.09%;母婴阻断失败率为3.87%。本次调查共检出10种乙肝血清标志物组合模式,检出率最高为模式6,占74.62%：其次为模式5,占14.44%：再次为模式7,占3.70%：模式4占3.37%。母婴阻断失败组中,HBV DAN含量>5×10⁷ IU/mL占45.30%;500~5×10⁷ IU/mL占39.32%;<500 IU/mL占15.38%;HBeAg阳性率为79.49%。产生免疫应答组检出3种血清组合模式,乙肝病毒e抗体（anti-HBe,抗-HBe）阳性率为3.79%,乙肝病毒核心抗体（anti-HBc,抗-HBc）阳性率为23.20%。定量检测抗-HBs,抗体水平>1 000 mIU/mL的高免疫应答者占66.93%,抗体水平在100~1 000 mIU/mL的中免疫应答者占19.66%,抗体水平在10~100 mIU/mL的低免疫应答者占13.41%。经统计分析,产生免疫应答抗-HBs的抗体水平高低与婴儿体内是否携带抗-HBe、抗-HBc及性别无关。结论 对HBsAg阳性孕产妇所生婴儿实施母婴阻断,并建立健全产后对婴儿追踪机制,对预防和控制婴儿感染乙肝起关键作用。