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Bailey JT, Moshkani S, Rexhouse C, Cimino JL, Robek MD. CD4 + T cells reverse surface antigen persistence in a mouse model of HBV replication. Microbiol Spectr 2023; 11:e0344723. [PMID: 37948314 PMCID: PMC10715182 DOI: 10.1128/spectrum.03447-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
IMPORTANCE Hepatitis B virus (HBV) is a leading causative agent of viral hepatitis. A preventative vaccine has existed for decades, but only limited treatment options are available for people living with chronic HBV. Animal models for studying HBV are constrained due to narrow viral tropism, impeding understanding of the natural immune response to the virus. Here, using a vector to overcome the narrow host range and establish HBV replication in mice, we identified the role of helper T cells in controlling HBV. We show that helper T cells promote the B cell's ability to generate antibodies that remove HBV and its associated surface antigen from the blood and that transfer of purified helper T cells from HBV-immunized mice can reverse the accumulation of virus and antigen, furthering our understanding of the immune response to HBV.
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Affiliation(s)
- Jacob T. Bailey
- Department of Immunology & Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Safiehkhatoon Moshkani
- Department of Immunology & Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Catherine Rexhouse
- Department of Immunology & Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Jesse L. Cimino
- Department of Immunology & Microbial Disease, Albany Medical College, Albany, New York, USA
| | - Michael D. Robek
- Department of Immunology & Microbial Disease, Albany Medical College, Albany, New York, USA
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2
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Park T, Hwang H, Moon S, Kang SG, Song S, Kim YH, Kim H, Ko EJ, Yoon SD, Kang SM, Hwang HS. Vaccines against SARS-CoV-2 variants and future pandemics. Expert Rev Vaccines 2022; 21:1363-1376. [PMID: 35924678 PMCID: PMC9979704 DOI: 10.1080/14760584.2022.2110075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Vaccination continues to be the most effective method for controlling COVID-19 infectious diseases. Nonetheless, SARS-CoV-2 variants continue to evolve and emerge, resulting in significant public concerns worldwide, even after more than 2 years since the COVID-19 pandemic. It is important to better understand how different COVID-19 vaccine platforms work, why SARS-CoV-2 variants continue to emerge, and what options for improving COVID-19 vaccines can be considered to fight against SARS-CoV-2 variants and future pandemics. AREA COVERED Here, we reviewed the innate immune sensors in the recognition of SARS-CoV-2 virus, innate and adaptive immunity including neutralizing antibodies by different COVID-19 vaccines. Efficacy comparison of the several COVID-19 vaccine platforms approved for use in humans, concerns about SARS-CoV-2 variants and breakthrough infections, and the options for developing future COIVD-19 vaccines were also covered. EXPERT OPINION Owing to the continuous emergence of novel pathogens and the reemergence of variants, safer and more effective new vaccines are needed. This review also aims to provide the knowledge basis for the development of next-generation COVID-19 and pan-coronavirus vaccines to provide cross-protection against new SARS-CoV-2 variants and future coronavirus pandemics.
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Affiliation(s)
- Taeyoung Park
- Department of Biology, College of Life Science and Industry, Sunchon National University (SCNU), Suncheon, South Korea
| | - Hyogyeong Hwang
- Department of Biology, College of Life Science and Industry, Sunchon National University (SCNU), Suncheon, South Korea
| | - Suhyeong Moon
- Department of Biology, College of Life Science and Industry, Sunchon National University (SCNU), Suncheon, South Korea
| | - Sang Gu Kang
- Department of Biology, College of Life Science and Industry, Sunchon National University (SCNU), Suncheon, South Korea
| | - Seunghyup Song
- Department of Biology, College of Life Science and Industry, Sunchon National University (SCNU), Suncheon, South Korea
| | - Young Hun Kim
- Department of Biology, College of Life Science and Industry, Sunchon National University (SCNU), Suncheon, South Korea
| | - Hanbi Kim
- Department of Biology, College of Life Science and Industry, Sunchon National University (SCNU), Suncheon, South Korea
| | - Eun-Ju Ko
- College of Veterinary Medicine and Interdisciplinary Graduate Program in Advanced Convergence Technology and Science, Jeju National University, Jeju, South Korea
| | - Soon-Do Yoon
- Department of Chemical and Biomolecular Engineering, Chonnam National University, Yeosu, South Korea
| | - Sang-Moo Kang
- Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA, USA
| | - Hye Suk Hwang
- Department of Biology, College of Life Science and Industry, Sunchon National University (SCNU), Suncheon, South Korea
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3
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Talla C, Itanyi IU, Tsuyuki K, Stadnick N, Ogidi AG, Olakunde BO, Patel D, Oko JO, Aarons G, Onoka CA, Ezeanolue EE. Hepatitis B infection and risk factors among pregnant women and their male partners in the Baby Shower Programme in Nigeria: a cross-sectional study. Trop Med Int Health 2020; 26:316-326. [PMID: 33247862 DOI: 10.1111/tmi.13531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the population prevalence and determinants of hepatitis B (Hep B) status, and status discordance, among pregnant women and their male partners in Nigeria. METHODS Cross-sectional study assessing the seroprevalence of Hep B virus in a cohort of 16 920 pregnant women and their male partners in northcentral Nigeria. Rapid HBsAg antibody test was used for Hep B diagnosis. Demographic, socio-economic and behavioural information was collected through interviewer-administered questionnaires and evaluated as determinants of Hep B status and couple status discordance using logistic regression. RESULTS Of 16 920 participants who had a Hep B test result, 6750 couples and 1316 discordant couples were identified. The prevalence of Hep B among all participants was 10.9%, with lower prevalence among pregnant women (10.2%) than their male partners (11.9%), P < 0.001. The prevalence of Hep B sero-discordance among couples was 19.5% (1316/6750). Younger age, prior Hep B testing and a prior positive Hep B test increased the odds of Hep B infection while being a woman decreased the odds of Hep B among all participants, and among couples. Furthermore, polygamy (adjusted odds ratio [AOR]: 1.49, 95% confidence interval [CI]: 1.19-1.87), prior Hep B testing (AOR: 2.38, 95% CI: 1.14-4.97) and a prior positive Hep B test result were significant determinants of status discordance among the participating couples. CONCLUSION The prevalence of Hep B among pregnant women and their male partners in northcentral Nigeria is high. A large-scale intervention is required to reduce Hep B prevalence in this setting.
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Affiliation(s)
- Carol Talla
- Caritas Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - Kiyomi Tsuyuki
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Nicole Stadnick
- Department of Psychiatry, University of California, San Diego, CA, USA.,UC San Diego Dissemination and Implementation Science Center, San Diego, CA, USA
| | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Babayemi Oluwaseun Olakunde
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria.,National Agency for the Control of AIDS, Abuja, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | | | - Gregory Aarons
- Department of Psychiatry, University of California, San Diego, CA, USA.,UC San Diego Dissemination and Implementation Science Center, San Diego, CA, USA
| | - Chima Ariel Onoka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria.,Healthy Sunrise Foundation, Las Vegas, NV, USA
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4
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Qian C, Liu X, Xu Q, Wang Z, Chen J, Li T, Zheng Q, Yu H, Gu Y, Li S, Xia N. Recent Progress on the Versatility of Virus-Like Particles. Vaccines (Basel) 2020; 8:vaccines8010139. [PMID: 32244935 PMCID: PMC7157238 DOI: 10.3390/vaccines8010139] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/15/2020] [Accepted: 03/15/2020] [Indexed: 12/11/2022] Open
Abstract
Virus-like particles (VLPs) are multimeric nanostructures composed of one or more structural proteins of a virus in the absence of genetic material. Having similar morphology to natural viruses but lacking any pathogenicity or infectivity, VLPs have gradually become a safe substitute for inactivated or attenuated vaccines. VLPs can achieve tissue-specific targeting and complete and effective cell penetration. With highly ordered epitope repeats, VLPs have excellent immunogenicity and can induce strong cellular and humoral immune responses. In addition, as a type of nanocarrier, VLPs can be used to display antigenic epitopes or deliver small molecules. VLPs have thus become powerful tools for vaccinology and biomedical research. This review highlights the versatility of VLPs in antigen presentation, drug delivery, and vaccine technology.
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Affiliation(s)
- Ciying Qian
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Sciences, Xiamen University, Xiamen 361102, China; (C.Q.); (X.L.); (Q.X.); (Z.W.); (J.C.); (T.L.); (N.X.)
| | - Xinlin Liu
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Sciences, Xiamen University, Xiamen 361102, China; (C.Q.); (X.L.); (Q.X.); (Z.W.); (J.C.); (T.L.); (N.X.)
| | - Qin Xu
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Sciences, Xiamen University, Xiamen 361102, China; (C.Q.); (X.L.); (Q.X.); (Z.W.); (J.C.); (T.L.); (N.X.)
| | - Zhiping Wang
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Sciences, Xiamen University, Xiamen 361102, China; (C.Q.); (X.L.); (Q.X.); (Z.W.); (J.C.); (T.L.); (N.X.)
| | - Jie Chen
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Sciences, Xiamen University, Xiamen 361102, China; (C.Q.); (X.L.); (Q.X.); (Z.W.); (J.C.); (T.L.); (N.X.)
| | - Tingting Li
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Sciences, Xiamen University, Xiamen 361102, China; (C.Q.); (X.L.); (Q.X.); (Z.W.); (J.C.); (T.L.); (N.X.)
| | - Qingbing Zheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China; (Q.Z.); (H.Y.)
| | - Hai Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China; (Q.Z.); (H.Y.)
| | - Ying Gu
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Sciences, Xiamen University, Xiamen 361102, China; (C.Q.); (X.L.); (Q.X.); (Z.W.); (J.C.); (T.L.); (N.X.)
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China; (Q.Z.); (H.Y.)
- Correspondence: (Y.G.); (S.L.)
| | - Shaowei Li
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Sciences, Xiamen University, Xiamen 361102, China; (C.Q.); (X.L.); (Q.X.); (Z.W.); (J.C.); (T.L.); (N.X.)
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China; (Q.Z.); (H.Y.)
- Correspondence: (Y.G.); (S.L.)
| | - Ningshao Xia
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Sciences, Xiamen University, Xiamen 361102, China; (C.Q.); (X.L.); (Q.X.); (Z.W.); (J.C.); (T.L.); (N.X.)
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China; (Q.Z.); (H.Y.)
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Abstract
Vaccination against hepatitis B is the most effective strategy to control HBV infection. The first licensed hepatitis B vaccine was developed by the purification of hepatitis B surface antigen (HBsAg) from plasma of asymptomatic HBsAg carriers. Then, the recombinant DNA technology enabled the development of recombinant hepatitis B vaccine. A series of three doses vaccine can elicit long-term protection more than 30 y. Concurrent use of hepatitis B immunoglobulin and hepatitis B vaccine has substantially reduced the mother-to-child transmission of HBV, nearly zero infection in children of carrier mother with negative hepatitis B e antigen (HBeAg) and 5-10% infection in children of HBeAg-positive mothers. By the end of 2018, 189 countries adopted universal hepatitis B vaccination program, which has dramatically reduced the global prevalence of HBsAg in children <5 y of age, from 4.7% in the prevaccine era to 1.3% in 2015. However, the implementation of universal hepatitis B vaccination in some regions is suboptimal and timely birth dose vaccine is not routinely administered in more than half of newborn infants. Optimal worldwide universal hepatitis B vaccination requires more efforts to overcome the social and economic challenges.
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Affiliation(s)
- Hong Zhao
- Department of Infectious Diseases, The Second Hospital of Nanjing, School of Medicine, Southeast University , Nanjing, China
| | - Xiaoying Zhou
- Department of Internal Medicine, Zhongda Hospital, School of Medicine, Southeast University , Nanjing, China
| | - Yi-Hua Zhou
- Departments of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School , Nanjing, China
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6
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Boppana SB, Britt WJ, Fowler K, Hutto SC, James SH, Kimberlin DW, Poole C, Ross SA, Whitley RJ. Pathogenesis of Non-Zika Congenital Viral Infections. J Infect Dis 2019; 216:S912-S918. [PMID: 29267912 DOI: 10.1093/infdis/jix431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A widespread epidemic of Zika virus (ZIKV) infection was reported in 2015 from South and Central America and the Caribbean. Although the full spectrum of ZIKV infection of the newborn has yet to be determined, other maternal viral infections resulting in transmission to the fetus provide instructive lessons that can be applied to the prospective evaluation of individuals with ZIKV infection. This review focuses on those other congenital infections, including rubella, congenital cytomegalovirus, human immunodeficiency virus, hepatitis B virus, and neonatal herpes simplex virus, from which lessons for the evaluation of ZIKV in the newborn can be applied.
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Affiliation(s)
- Suresh B Boppana
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - William J Britt
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Karen Fowler
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - S Cecelia Hutto
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Scott H James
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - David W Kimberlin
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Claudette Poole
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Shannon A Ross
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Richard J Whitley
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
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7
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Devine A, Harvey R, Min AM, Gilder MET, Paw MK, Kang J, Watts I, Hanboonkunupakarn B, Nosten F, McGready R. Strategies for the prevention of perinatal hepatitis B transmission in a marginalized population on the Thailand-Myanmar border: a cost-effectiveness analysis. BMC Infect Dis 2017; 17:552. [PMID: 28793866 PMCID: PMC5550954 DOI: 10.1186/s12879-017-2660-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 08/01/2017] [Indexed: 12/27/2022] Open
Abstract
Background Data on the cost effectiveness of hepatitis B virus (HBV) screening and vaccination strategies for prevention of vertical transmission of HBV in resource limited settings is sparse. Methods A decision tree model of HBV prevention strategies utilised data from a cohort of 7071 pregnant women on the Thailand-Myanmar border using a provider perspective. All options included universal HBV vaccination for newborns in three strategies: (1) universal vaccination alone; (2) universal vaccination with screening of women during antenatal visits with rapid diagnostic test (RDT) plus HBV immune globulin (HBIG) administration to newborns of HBV surface antigen positive women; and (3) universal vaccination with screening of women during antenatal visits plus HBIG administration to newborns of women testing HBV e antigen positive by confirmatory test. At the time of the study, the HBIG after confirmatory test strategy was used. The costs in United States Dollars (US$), infections averted and incremental cost effectiveness ratios (ICERs) were calculated and sensitivity analyses were conducted. A willingness to pay threshold of US$1200 was used. Results The universal HBV vaccination was the least costly option at US$4.33 per woman attending the clinic. The HBIG after (RDT) strategy had an ICER of US$716.78 per infection averted. The HBIG after confirmatory test strategy was not cost-effective due to extended dominance. The one-way sensitivity analysis showed that while the transmission parameters and cost of HBIG had the biggest impact on outcomes, the HBIG after confirmatory test only became a cost-effective option when a low test cost was used or a high HBIG cost was used. The probabilistic sensitivity analysis showed that HBIG after RDT had an 87% likelihood of being cost-effective as compared to vaccination only at a willingness to pay threshold of US$1200. Conclusions HBIG following confirmatory test is not a cost-effective strategy for preventing vertical transmission of HBV in the Thailand-Myanmar border population. By switching to HBIG following rapid diagnostic test, perinatal infections will be reduced by nearly one third. This strategy may be applicable to similar settings for marginalized populations where the confirmatory test is not logistically possible. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2660-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Angela Devine
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. .,Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
| | - Rebecca Harvey
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Mary Ellen T Gilder
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Moo Koh Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Joy Kang
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Isabella Watts
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Rose McGready
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
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Aba HO, Aminu M. Seroprevalence of hepatitis B virus serological markers among pregnant Nigerian women. Ann Afr Med 2016; 15:20-7. [PMID: 26857933 PMCID: PMC5452689 DOI: 10.4103/1596-3519.172555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Chronic hepatitis B infection is a global problem; however, Asia and sub-Saharan Africa are most affected by it. Hepatitis B status of pregnant women is essential for the effective management of the disease and prevention of mother to child transmission. Materials and Methods: The study was conducted at the antenatal care unit of four hospitals within Kaduna Metropolis, Nigeria, between August and December 2011. After obtaining ethical clearance, blood samples were collected from 800 consenting pregnant women, the plasma were screened for hepatitis B surface antigen (HBsAg) using first response HBsAg card and the reactive sera were confirmed with enzyme-linked immunosorbent assay. Other serological markers of hepatitis B virus (HBV) were detected using the one-step HBV multi-5 test kit. Results: Of the 800 pregnant women screened, 31 (3.9%) tested positive for HBsAg. Only one of the 31 HBsAg positive women had developed the hepatitis B surface antibody, 16 (51.6%) had the envelop antibody, 18 (58.1%) had the hepatitis B core antibody (anti-HBc), and two (6.5%) had hepatitis B envelop antigen (HBeAg). The highest prevalence of HBsAg was recorded among women in age group 21–25 years old (P = 0.968). Similarly, married women (P = 0.772), women in their second trimester of pregnancy (P = 0.938), women with tertiary education (P = 0.972), women from the South-East geopolitical zone (P = 0.250) and those whose husbands were in polygamous relationships (P = 0.944) had the highest seroprevalence of HBsAg. Conclusion: HBV was detected with a prevalence of 3.9% among pregnant women in Kaduna Metropolis, Nigeria. About 96.8% (29) of the reactive women had HBeAg negative chronic hepatitis while 6.5% (2) had HBeAg positive chronic hepatitis B infection. About 58.1% of the women had anti-HBc, hence, did not have immunity and probably had chronic infection with reduced risk of vertical transmission. Pregnant women should be screened for HBsAg at the first antenatal clinic visit for appropriate clinical management and effective prevention of vertical transmission.
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Affiliation(s)
| | - Maryam Aminu
- Department of Microbiology, Faculty of Sciences, Ahmadu Bello University, Zaria, Nigeria
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9
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Abstract
Hepatitis B virus (HBV) causes life-threatening liver disease. It is transmitted through a horizontal route or a mother-to-infant route, and the latter is the major route in endemic areas. Prevention of HBV infection by immunization is the best way to eliminate HBV-related diseases. The HBV vaccine is the first human vaccine using a viral antigen from infected persons, which is safe and effective. Either passive immunization by hepatitis B immunoglobulin (HBIG) or active immunization by HBV vaccine is effective, and a combination of both yields the best efficacy in preventing HBV infection. The impact of universal HBV immunization is huge, with 90%-95% effectiveness in preventing chronic HBV infection. It is the first cancer preventive vaccine with a protective efficacy against hepatocellular carcinoma (HCC) of ∼ 70%. Nevertheless, further effort is still needed to avoid vaccine failure and to increase the global coverage rate.
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Affiliation(s)
- Mei-Hwei Chang
- Department of Pediatrics, National Taiwan University Hospital, Taipei 10016, Taiwan Hepatitis Research Center, National Taiwan University Hospital, Taipei 10016, Taiwan
| | - Ding-Shinn Chen
- Hepatitis Research Center, National Taiwan University Hospital, Taipei 10016, Taiwan Internal Medicine, National Taiwan University Hospital, Taipei 10016, Taiwan Genomics Research Center, Academia Sinica, Nankang 11529, Taiwan
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10
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Prophylactic vaccination against hepatitis B: achievements, challenges and perspectives. Med Microbiol Immunol 2014; 204:39-55. [PMID: 25523195 DOI: 10.1007/s00430-014-0373-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/01/2014] [Indexed: 02/06/2023]
Abstract
Large-scale vaccination against hepatitis B virus (HBV) infection started in 1984 with first-generation vaccines made from plasma of chronic carriers containing HBV surface antigen (HBsAg). Thereafter, it was replaced in most countries by second-generation vaccines manufactured in yeast cells transformed with gene S encoding HBsAg. Both generations of vaccines have been applied for universal neonate and early childhood vaccination worldwide and have led to a 70-90 % decrease in chronic HBV carrier rates. However, 10-30% of newborns from HBsAg/HBeAg-positive mothers cannot be protected by passive/active vaccination alone and become chronic HBV carriers themselves. Asymptomatic occult HBV infections are frequent even in those who have protective levels of anti-HBs. Suboptimal protection may be due to heterologous HBsAg subtypes that are present in 99% of HBV carriers worldwide. Second-generation vaccines contain partially misfolded HBsAg and lack preS1 antigen that carries the major HBV attachment site and neutralizing epitopes. Third-generation vaccines produced in mammalian cells contain correctly folded HBsAg and neutralizing epitopes of the preS antigens, induce more rapid protection, overcome nonresponse to second-generation vaccines and, most importantly, may provide better protection for newborns of HBV-positive mothers. PreS/S vaccines expressed in mammalian cells are more expensive to manufacture, but introduction of more potent HBV vaccines should be considered in regions with a high rate of vertical transmission pending assessment of health economics and healthcare priorities. With optimal vaccines and vaccination coverage, eradication of HBV would be possible.
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11
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Dunkelberg JC, Berkley EMF, Thiel KW, Leslie KK. Hepatitis B and C in pregnancy: a review and recommendations for care. J Perinatol 2014; 34:882-91. [PMID: 25233195 PMCID: PMC4777346 DOI: 10.1038/jp.2014.167] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/31/2014] [Accepted: 08/06/2014] [Indexed: 12/17/2022]
Abstract
Our objective was to provide a comprehensive review of the current knowledge regarding pregnancy and hepatitis B virus (HBV) or hepatitis C virus (HCV) infection as well as recent efforts to reduce the rate of mother-to-child transmission (MTCT). Maternal infection with either HBV or HCV has been linked to adverse pregnancy and birth outcomes, including MTCT. MTCT for HBV has been reduced to approximately 5% overall in countries including the US that have instituted postpartum neonatal HBV vaccination and immunoprophylaxis with hepatitis B immune globulin. However, the rate of transmission of HBV to newborns is nearly 30% when maternal HBV levels are greater than 200 000 IU ml(-1) (>6 log10 copies ml(-1)). For these patients, new guidelines from the European Association for the Study of the Liver (EASL) and the Asian Pacific Association for the Study of the Liver (APASL) indicate that, in addition to neonatal vaccination and immunoprophylaxis, treating with antiviral agents such as tenofovir disoproxil fumarate or telbivudine during pregnancy beginning at 32 weeks of gestation is safe and effective in preventing MTCT. In contrast to HBV, no therapeutic agents are yet available or recommended to further decrease the risk of MTCT of HCV, which remains 3 to 10%. HCV MTCT can be minimized by avoiding fetal scalp electrodes and birth trauma whenever possible. Young women with HCV should be referred for treatment post delivery, and neonates should be closely followed to rule out infection. New, better-tolerated treatment regimens for HCV are now available, which should improve outcomes for all infected individuals.
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Affiliation(s)
- JC Dunkelberg
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - EMF Berkley
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - KW Thiel
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - KK Leslie
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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12
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Fan L, Owusu-Edusei K, Schillie SF, Murphy TV. Cost-effectiveness of testing hepatitis B-positive pregnant women for hepatitis B e antigen or viral load. Obstet Gynecol 2014; 123:929-937. [PMID: 24785842 PMCID: PMC4682356 DOI: 10.1097/aog.0000000000000124] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of testing pregnant women with hepatitis B (hepatitis B surface antigen [HBsAg]-positive) for hepatitis B e antigen (HBeAg) or hepatitis B virus (HBV) DNA, and administering maternal antiviral prophylaxis if indicated, to decrease breakthrough perinatal HBV transmission from the U.S. health care perspective. METHODS A Markov decision model was constructed for a 2010 birth cohort of 4 million neonates to estimate the cost-effectiveness of two strategies: testing HBsAg-positive pregnant women for 1) HBeAg or 2) HBV load. Maternal antiviral prophylaxis is given from 28 weeks of gestation through 4 weeks postpartum when HBeAg is positive or HBV load is high (10 copies/mL or greater). These strategies were compared with the current recommendation. All neonates born to HBsAg-positive women received recommended active-passive immunoprophylaxis. Effects were measured in quality-adjusted life-years (QALYs) and all costs were in 2010 U.S. dollars. RESULTS The HBeAg testing strategy saved $3.3 million and 3,080 QALYs and prevented 486 chronic HBV infections compared with the current recommendation. The HBV load testing strategy cost $3 million more than current recommendation, saved 2,080 QALYs, and prevented 324 chronic infections with an incremental cost-effectiveness ratio of $1,583 per QALY saved compared with the current recommendations. The results remained robust over a wide range of assumptions. CONCLUSION Testing HBsAg-positive pregnant women for HBeAg or HBV load followed by maternal antiviral prophylaxis if HBeAg-positive or high viral load to reduce perinatal hepatitis B transmission in the United States is cost-effective.
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MESH Headings
- Antibiotic Prophylaxis/economics
- Antiviral Agents/economics
- Antiviral Agents/therapeutic use
- Cost-Benefit Analysis
- DNA, Viral/blood
- DNA, Viral/economics
- Female
- Hepatitis B Surface Antigens/blood
- Hepatitis B e Antigens/blood
- Hepatitis B e Antigens/economics
- Hepatitis B virus/genetics
- Hepatitis B virus/immunology
- Hepatitis B, Chronic/blood
- Hepatitis B, Chronic/drug therapy
- Hepatitis B, Chronic/economics
- Hepatitis B, Chronic/transmission
- Humans
- Immunization, Passive/economics
- Infant, Newborn
- Infectious Disease Transmission, Vertical/economics
- Infectious Disease Transmission, Vertical/prevention & control
- Pregnancy
- Quality-Adjusted Life Years
- Serologic Tests/economics
- Vaccination/economics
- Viral Load/economics
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Affiliation(s)
- Lin Fan
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Eng NF, Bhardwaj N, Mulligan R, Diaz-Mitoma F. The potential of 1018 ISS adjuvant in hepatitis B vaccines: HEPLISAV™ review. Hum Vaccin Immunother 2013; 9:1661-72. [PMID: 23732907 PMCID: PMC3906263 DOI: 10.4161/hv.24715] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/08/2013] [Accepted: 04/16/2013] [Indexed: 12/18/2022] Open
Abstract
Hepatitis B (HBV) virus infects the liver, and upon chronic infection, can cause liver cirrhosis and hepatocellular carcinoma. Despite universal vaccination programs against the virus, HBV still affects over 2 billion people worldwide, with over 240 million developing a chronic infection. While current alum-adjuvanted vaccines have shown efficacy in promoting seroprotection in healthy adults, 5-10% of immune-competent populations fail to achieve long-lasting seroprotection from these formulations. Furthermore, a large proportion of immunocompromised patients fail to achieve seroprotective antibody titers after receiving these vaccines. A novel vaccine candidate, HEPLISAV™, uses immunostimulatory sequences (ISS), in its formulation that helps induce a robust humoral and cell mediated immunity against HBV. In Phase III clinical trials, HEPLISAV™ has been shown to elicit seroprotective antibody titers with fewer immunizations. Similar safety profiles are demonstrated when compared with current HBV vaccines. For these reasons, HEPLISAV™ is an attractive vaccine to combat this global disease.
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Affiliation(s)
- Nelson F Eng
- Advanced Medical Research Institute of Canada; Sudbury, ON Canada
| | - Nitin Bhardwaj
- Advanced Medical Research Institute of Canada; Sudbury, ON Canada
| | - Rebecca Mulligan
- Advanced Medical Research Institute of Canada; Sudbury, ON Canada
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Hepatitis B virus surface antigen assembly function persists when entire transmembrane domains 1 and 3 are replaced by a heterologous transmembrane sequence. J Virol 2010; 85:2439-48. [PMID: 21177825 DOI: 10.1128/jvi.02061-10] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Native hepatitis B surface antigen (HBsAg) spontaneously assembles into 22-nm subviral particles. The particles are lipoprotein micelles, in which HBsAg is believed to span the lipid layer four times. The first two transmembrane domains, TM1 and TM2, are required for particle assembly. We have probed the requirements for particle assembly by replacing the entire first or third TM domain of HBsAg with the transmembrane domain of HIV gp41. We found that either TM domain of HBsAg could be replaced, resulting in HBsAg-gp41 chimeras that formed particles efficiently. HBsAg formed particles even when both TM1 and TM3 were replaced with the gp41 domain. The results indicate remarkable flexibility in HBsAg particle formation and provide a novel way to express heterologous membrane proteins that are anchored to a lipid surface by their own membrane-spanning domain. The membrane-proximal exposed region (MPER) of gp41 is an important target of broadly reactive neutralizing antibodies against HIV-1, and HBsAg-MPER particles may provide a good platform for future vaccine development.
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Komatsu H, Inui A, Sogo T, Hiejima E, Tateno A, Klenerman P, Fujisawa T. Cellular immunity in children with successful immunoprophylactic treatment for mother-to-child transmission of hepatitis B virus. BMC Infect Dis 2010; 10:103. [PMID: 20423521 PMCID: PMC2879245 DOI: 10.1186/1471-2334-10-103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 04/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The administration of hepatitis B immunoglobulin followed by hepatitis B vaccine can result in a protective efficacy of almost 90% in mother-to-child transmission of hepatitis B virus (HBV). However, little is known about immunity against HBV infection in children after immunoprophylactic treatment. We tried to assess the association between T-cell responses and viremia in children after successful prophylactic treatment. METHODS Thirteen children and their 8 HBV carrier mothers (8 families), who were positive for human leukocyte antigen (HLA)-A24, were enrolled in this study. All of the 13 children received immunoprophylactic treatment and became negative for hepatitis B surface antigen (HBsAg) after birth. HBV-specific cytotoxic T lymphocyte (CTL) responses were evaluated using IFNgamma - enzyme-linked immunosorbent spot (ELISPOT) and major histocompatibility complex class I peptide pentamer assays. Serum HBV DNA was measured by real-time PCR. RESULTS Significant HBV-specific T-cell responses were detected in 2 (15%) of the 13 children by ELISPOT. However, the frequency of HLA-A24-HBV-specific CTLs was very low in both HBV carrier mothers and children using pentamers. Of the 13 children, 4 (31%) were positive for serum HBV DNA. However, the levels of serum HBV DNA were 100 copies/ml or less. One of the 2 children in whom significant HBV-specific CTL responses were detectable was positive for serum HBV DNA. CONCLUSIONS HBV core and polymerase-specific T-cell responses were detected and a low-dose viremia was observed in children after successful immunoprophylaxis treatment. Although the presence of viremia was not related to HBV-specific T-cell responses, CTLs might play a role in the control of HBV infection in children born to HBsAg-positive mothers after immunoprophylactic treatment.
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Affiliation(s)
- Haruki Komatsu
- Department of Pediatrics, Yokohama Eastern Hospital, 3-6-1 Shimosueyoshi Tsurumi Yokohama, Kanagawa 230-0012, Japan.
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Clements CJ, Coghlan B, Creati M, Locarnini S, Tedder RS, Torresi J. Global control of hepatitis B virus: does treatment-induced antigenic change affect immunization? Bull World Health Organ 2009; 88:66-73. [PMID: 20428355 DOI: 10.2471/blt.08.065722] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Revised: 05/04/2009] [Accepted: 05/14/2009] [Indexed: 12/23/2022] Open
Abstract
Since its widespread introduction, the hepatitis B vaccine has become an essential part of infant immunization programmes globally. The vaccine has been particularly important for countries where the incidence of hepatitis B virus-related hepatocellular carcinoma is high. Effective treatment options for individuals with chronic hepatitis B infection were limited until 1998 when lamivudine, the first nucleoside analogue drug, was introduced. As a single treatment agent, however, lamivudine has a significant drawback: it induces lamivudine-resistant hepatitis B virus strains that may pose a risk to the global hepatitis B immunization programme. Mutations associated with drug treatment can cause changes to the surface antigen protein, the precise part of the virus that the hepatitis B vaccine mimics. However, the emergence of antiviral drug-associated potential vaccine escape mutants (ADAP-VEMs) in treated patients does not necessarily pose a significant, imminent threat to the global hepatitis B immunization programme. Nonetheless, there is already evidence that current treatment regimens have resulted in the selection of stable ADAP-VEMs. Treatment is currently intended to prevent the long-term complications of hepatitis B virus infection, with little consideration given to potential adverse public health impacts. To address individual and public health concerns, trials are urgently needed to find the optimal combination of existing drugs that are effective but do not induce the emergence of ADAP-VEMs. This paper examines the mechanism of antiviral drug-selected changes in the portion of the viral genome that also affects the surface antigen, and explores their potential impact on current hepatitis B immunization programmes.
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Abstract
Immunization is the most effective way to prevent transmission of HBV and, hence, the development of acute or chronic hepatitis B. The national strategy to eliminate transmission of the virus in the United States includes vaccination of all newborn infants, children, adolescents, and high-risk adults. Postexposure prophylaxis is also advocated, depending on the vaccination and anti-HBs status of the exposed person. Seroprotection after vaccination, defined as anti-HBs > or = 10 mIU/mL, is achieved in over 95% of all vaccinees. The hepatitis B vaccines are very well tolerated with usually minimal adverse effects. Predictors of non-response include increasing age, male gender, obesity, tobacco smoking, and immunocompromising chronic dis-ease. For those who remain nonresponders after the second series of vaccination, adjuvants such as GM-CSF may be considered, but their results are variable.
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Affiliation(s)
- Andy S Yu
- Pacific Gastroenterology, 2101 Forest Avenue, Suite 106, San Jose, CA 95128, USA
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18
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Genetic and proteomic analysis of the MHC class I repertoire from four ovine haplotypes. Immunogenetics 2008; 60:177-84. [PMID: 18270697 DOI: 10.1007/s00251-008-0276-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 01/17/2008] [Indexed: 10/22/2022]
Abstract
Immunity to livestock diseases can be studied directly in the target animal, but its elucidation is often constrained by the lack of major histocompatibility complex (MHC)-defined animals. To address this issue, we have established an MHC-defined sheep resource flock generated around four diverse MHC haplotypes. Initial characterisation of the repertoire of transcribed MHC class I genes identified three class I transcripts associated with each haplotype. Nucleotide sequence, transcript abundance and phylogenetic analysis indicated that they represent alleles at up to four polymorphic loci that vary in number between the different haplotypes. The functional significance of each of these genes is evaluated here using complementary molecular genetic and proteomic approaches. We determine which genes give rise to proteins that localise to the surface of transfected cells. In addition, we provide data to support the generation of expressed products, based on immunoprecipitation of class I products from animals homozygous for each of the four MHC haplotypes followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. This provides a clearer picture of the number of MHC class I loci in sheep and allows more rational prediction of their classical (class Ia) or non-classical (class Ib) nature. On the basis of the cellular localisation, phylogenetic and transcriptional analyses, we propose that the ovine MHC comprises a minimum of eight class I loci, with considerable variation between haplotypes.
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Plitt SS, Somily AM, Singh AE. Outcomes from a Canadian public health prenatal screening program for hepatitis B: 1997-2004. Canadian Journal of Public Health 2007. [PMID: 17626383 DOI: 10.1007/bf03403711] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Without appropriate prophylaxis, the rate of vertical transmission of hepatitis B virus (HBV) can be as high as 95%. Alberta's provincial prenatal program screens all pregnant women for HBV, and provides prophylaxis to infants born to HBV-infected women. Canadian data on the outcomes of such programs are limited. METHODS We conducted a retrospective review of data from pregnant Albertan women who were Hepatitis B Surface Antigen (HBsAg) positive from 1997-2004. We describe the frequency of hepatitis B immunoglobulin (HBIG) and vaccine administration, follow-up serology and pregnancy outcomes. RESULTS In total, 1,485 HBsAg-positive pregnant women were identified; an average of 186 women annually (range: 125-216). Of the 980 infants eligible to have completed prophylaxis and serological follow-up, 82.0% were appropriately immunized and serologically tested, 11.3% had complete immunization but no serology testing and 6.6% were incompletely immunized. Of infants with complete immunization and follow-up, 3.7% failed to mount an immune response and 2.1% were infected. CONCLUSION A high proportion of infants born to carrier mothers are receiving appropriate post-natal prophylaxis in Alberta. Future research should examine maternal factors that may increase the vertical transmission of HBV.
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Affiliation(s)
- Sabrina S Plitt
- Centre for Infectious Disease Control and Prevention, Public Health Agency of Canada, Ottawa, ON
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20
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Chen D, Kaplan LA. Performance of a new-generation chemiluminescent assay for hepatitis B surface antigen. Clin Chem 2006; 52:1592-8. [PMID: 16762998 DOI: 10.1373/clinchem.2005.064063] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The usual criteria for analysis of hepatitis B surface antigen (HBsAg) are detection of HBsAg and result confirmation by antibody neutralization. We observed that with the Immulite 2000 HBsAg assay [Diagnostics Product Corporation (DPC)] a relatively high percentage of weakly reactive (WR) samples did not pass the neutralization step. METHODS For each of 3 lots of Immulite 2000 HBsAg reagent (DPC), we collected and analyzed HBsAg data from approximately 3000 to 4000 patient blood samples and compared these data with HBsAg data from 3393 samples tested with the Abbott Auszyme assay. For 127 samples with initially WR detection signals (relative signal/cutoff index of 1.00-2.5) on the Immulite 2000 HBsAg assay, we then measured hepatitis B (HB) viral load and/or other HB serologic markers. RESULTS The Immulite 2000 HBsAg assay produced more initially reactive results than the Abbott Auszyme method. Many of these reactive samples, however, were WR and did not meet the confirmation criteria in the neutralization test. Moreover, DNA PCR testing indicated that 22 of the 38 WR samples (58%) that did meet the confirmation criteria had no detectable HB viral DNA. CONCLUSIONS Immulite 2000 HBsAg assay results include a unique group of WR samples that are associated with both false-positive and false-negative results, regardless of neutralization status, and require careful interpretation. WR HBsAg samples should be reported as confirmed HBsAg reactive only if the samples not only meet the neutralization criteria but also are positive for other HB serologic markers such as anti-HB core total and anti-HB core IgM.
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Affiliation(s)
- Dan Chen
- Department of Pathology, New York University, School of Medicine, Clinical Chemistry Laboratory of Bellevue Hospital, New York, NY 10016, USA.
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21
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Papaevangelou V, Hadjichristodoulou C, Cassimos D, Theodoridou M. Adherence to the screening program for HBV infection in pregnant women delivering in Greece. BMC Infect Dis 2006; 6:84. [PMID: 16681862 PMCID: PMC1475591 DOI: 10.1186/1471-2334-6-84] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 05/09/2006] [Indexed: 01/01/2023] Open
Abstract
Background Hepatitis B infection (HBV) is a major Public Health Problem. Perinatal transmission can be prevented with the identification of HBsAg(+) women and administration of immunoprophylaxis to their newborns. A national prevention programme for HBV with universal screening of pregnant women and vaccination of infants is in effect since 1998 in Greece. Methods To evaluate adherence to the national guidelines, all women delivering in Greece between 17–30/03/03 were included in the study. Trained health professionals completed a questionnaire on demographic data, prenatal or perinatal screening for HBsAg and the implementation of appropriate immunoprophylaxis. Results During the study period 3,760 women delivered. Prenatal screening for HBsAg was documented in 91.3%. Greek women were more likely to have had prenatal testing. HBsAg prevalence was 2.89% (95%CI 2.3–3.4%). Higher prevalence of HBV-infection was noted in immigrant women, especially those born in Albania (9.8%). Other risk factors associated with maternal HBsAg (+) included young maternal age and absence of prenatal testing. No prenatal or perinatal HBsAg testing was performed in 3.2% women. Delivering in public hospital and illiteracy were identifiable risk factors for never being tested. All newborns of identified HBsAg (+) mothers received appropriate immunoprophylaxis. Conclusion The prevalence of HBsAg in Greek pregnant women is low and comparable to other European countries. However, immigrant women composing almost 20% of our childbearing population, have significant higher prevalence rates. There are still women who never get tested. Universal vaccination against HBV at birth and reinforcement of perinatal testing of all women not prenatally tested should be discussed with Public Health Authorities.
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Affiliation(s)
- Vassiliki Papaevangelou
- 2Department of Pediatrics, University of Athens, Children's' Hospital "A. Kyriakou", Goudi 11527, Athens, Greece
| | | | - Dimitrios Cassimos
- Department of Pediatrics, University of Thrace, Alexandroupoli 68100, Greece
| | - Maria Theodoridou
- 1Department of Pediatrics, University of Athens, Children's' Hospital "A. Sophia", Goudi 11527, Athens, Greece
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Chen D, Kaplan L, Liu Q. Evaluation of two chemiluminescent immunoassays of ADVIA centaur for hepatitis B serology markers. Clin Chim Acta 2005; 355:41-5. [PMID: 15820476 DOI: 10.1016/j.cccn.2004.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 11/30/2004] [Accepted: 11/30/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study evaluated the performance of 2 Bayer Hepatitis B Chemiluminescent Assays by comparing their performance to the corresponding DPC Immulite 2000 assays. METHODS 953 samples were tested by both Immulite 2000 and Centaur HBsAg methods; and 75 samples were tested by both Immulite 2000 and Centaur anti-HBc IgM methods. RESULTS The overall agreement between Immulite 2000 and ADVIA Centaur anti-HBc IgM assays was 100%. The agreement between Immulite 2000 and Centaur HBsAg assays was 100% for Immulite 2000 positive samples. The overall agreement for HBsAg negative samples was 99.9% after confirmation result was included. However, discrepancy between the 2 assays was observed in 53 samples which were tested initially as "weakly reactive"(index 1.0-1.95) but were not confirmed subsequently by the neutralization test on Immulite 2000. All 53 samples tested negative by Centaur HBsAg assay at the initial run. Furthermore, one Immulite 2000 HBsAg negative sample was reactive and confirmed by Centaur assay. CONCLUSIONS While the performance of Bayer Hepatitis B HBsAg and aHBc IgM assays are in good agreement with corresponding DPC assays, the Bayer HBsAg assay is more efficient than the Immulite 2000 assay with its better separation of signal and background noise, and its complete automation features.
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Affiliation(s)
- Dan Chen
- Department of Pathology, New York University, School of Medicine, Clinical Chemistry Laboratory of Bellevue Hospital, USA.
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Hou J, Liu Z, Gu F. Epidemiology and Prevention of Hepatitis B Virus Infection. Int J Med Sci 2005; 2:50-57. [PMID: 15968340 PMCID: PMC1142225 DOI: 10.7150/ijms.2.50] [Citation(s) in RCA: 224] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 01/01/2005] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B is one of the most common infectious diseases globally. It has been estimated that there are 350 million chronic hepatitis B virus (HBV) carriers worldwide. The prevalence of chronic HBV infection varies geographically, from high (>8%), intermediate (2-7%) to low (<2%) prevalence. HBeAg-negative chronic hepatitis B (e-CHB) and occult HBV infection are two special clinical entities, and the prevalence and clinical implications remain to be explored. The predominant routes of transmission vary according to the endemicity of the HBV infection. In areas with high HBV endemicity, perinatal transmission is the main route of transmission, whereas in areas with low HBV endemicity, sexual contact amongst high-risk adults is the predominant route. HBV has been classified into 7 genotypes, i.e. A to G, based on the divergence of entire genome sequence and HBV genotypes have distinct geographical distributions. Three main strategies have been approved to be effective in preventing HBV infection. They are behavior modification, passive immunoprophylaxis, and active immunization. The implement of mass HBV immunization program is recommended by the WHO since 1991, and has dramatically decreased the prevalence of HBV infection and HCC in many countries.
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Affiliation(s)
- Jinlin Hou
- 1Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Nanfang Medical University, Guangzhou, China
| | - Zhihua Liu
- 1Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Nanfang Medical University, Guangzhou, China
| | - Fan Gu
- 2Tongji Medical College, Huazhong University of Science &Technology, Wuhan, China
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Abstract
Liver disease is an uncommon complication of pregnancy, although one that must be recognized early because of its potential for grave consequences for mother and child. Because of increased awareness and rapid triage of patients, maternal and fetal outcomes have improved significantly over the last 30 years.
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Affiliation(s)
- Sheeten Doshi
- Division of Digestive Diseases, University of Cincinnati, 231 Albert B. Sabin Way, M.L. 0595, Cincinnati, OH 45267-0595, USA
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Noto H, Terao T, Ryou S, Hirose Y, Yoshida T, Ookubo H, Mito H, Yoshizawa H. Combined passive and active immunoprophylaxis for preventing perinatal transmission of the hepatitis B virus carrier state in Shizuoka, Japan during 1980-1994. J Gastroenterol Hepatol 2003; 18:943-9. [PMID: 12859724 DOI: 10.1046/j.1440-1746.2003.03092.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Efficacy and limits in preventing perinatal infection with hepatitis B virus (HBV) have been examined in a model area in Japan. METHODS In Shizuoka (population of 3.6 million), immunoprophylaxis of perinatal HBV infection was started in 1980 in four institutions (Hamamatsu Medical College, Shimada City Hospital, Shizuoka Kodomo Hospital and Numazu City Hospital). Babies born to carrier mothers with hepatitis B e antigen (HBeAg) in serum received hepatitis B immune globulins at birth and 2 months thereafter and vaccines at 2, 3 and 5 months after birth. RESULTS Overall, 980 of the 1030 babies born to HBeAg-positive carrier mothers were protected by the immunoprophylaxis during the 15 years from 1980 to 1994 with an efficacy of 95.1%. From 1986 to 1994 while the national immunoprophylaxis was conducted, 329,674 of the 346,637 (95.1%) expectant mothers were tested, and 2081 (0.63%) of them were positive for hepatitis B surface antigen (HBsAg). The immunoprophylaxis was given only to babies born to 764 (36.7%) of the 2081 mothers who tested positive for HBeAg. Of the 494 babies receiving immunoprophylaxis, in whom HBsAg was followed monthly after birth, 462 (93.5%) were protected. The HBV carrier state developed in the remaining 32 (6.5%) babies, 10 of whom (31.3% of the 32) turned positive for HBsAg within 1 month after birth, most likely owing to infection in utero. CONCLUSIONS Passive-active immunoprophylasxis of high-risk babies was highly efficacious in preventing perinatal transmission of the HBV carrier state. Most failures (approximately 70%) occurred in the high-risk babies who were exposed to HBV after birth, and would have been avoided by careful and extensive execution of the immunoprophylaxis.
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Affiliation(s)
- Hiroshi Noto
- Department of Obstetrics, Hamamatsu Medical College, Shizuoka, Japan
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Euler GL, Copeland JR, Rangel MC, Williams WW. Antibody response to postexposure prophylaxis in infants born to hepatitis B surface antigen-positive women. Pediatr Infect Dis J 2003; 22:123-9. [PMID: 12586975 DOI: 10.1097/01.inf.0000048677.32881.fa] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Annually 20,000 infants are born to hepatitis B surface antigen (HBsAg)-positive US women. Without prophylaxis 30% risk chronic hepatitis B virus infection, and 25% of those risk dying from resulting liver cirrhosis or liver cancer as adults. METHODS We attempted to interview each HBsAg-positive pregnant woman reported to the health department between 1992 and 1997, to provide their infants with immunoprophylaxis at birth and in the clinic or home and to serotest at 9 to 15 months of age. RESULTS Of 879 women reported, 92% enrolled; 787 delivered 796 live infants; 91% of infants received hepatitis B immunoglobulin; 98, 95 and 89% received hepatitis B vaccine (HepB) Doses 1, 2 and 3, respectively; and 80% were serotested. Of these 2.2% were HBsAg-positive and 97% had antibody to HBsAg (anti-HBs) of > or =10 mIU/ml. Anti-HBs concentrations measured in 504 infants were 10 to 99 mIU/ml (25%), 100 to 999 mIU/ml (43%) and > or =1000 mIU/ml (29%). Serotesting was less likely among infants of mothers <20 years of age [odds ratio (OR) 2.5]; white, non-Hispanic (OR 2.8); or with a household income of <$15,000/year (OR 2.0). Lower antibody titers were found when serotesting at 4 to 12 months than at <4 months after HepB-3 (OR 1.8 to 4.4), with HepB-3 receipt <6 months after HepB-2 (OR 2.5) and when household income was <$15,000/year (OR 2.1). CONCLUSIONS Centralized case management with home visits resulted in high rates of complete immunoprophylaxis and postvaccination testing among infants born to HBsAg-positive women. Perinatal immunoprophylaxis was immunogenic under routine public health use, with higher anti-HBs titers occurring in infants tested <4 months postvaccination. Because infants in households with low income had higher rates of nonprotective antibody responses, they may benefit from extra efforts to ensure that serotesting is conducted postvaccination.
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Affiliation(s)
- Gary L Euler
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Torresi J. The virological and clinical significance of mutations in the overlapping envelope and polymerase genes of hepatitis B virus. J Clin Virol 2002; 25:97-106. [PMID: 12367644 DOI: 10.1016/s1386-6532(02)00049-5] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The potential for hepatitis B virus (HBV) to alter its genome is considerable. This occurs because the virus utilizes a reverse transcription step in replicating the viral genome. Like human immunodeficiency virus, the reverse transcriptase of HBV is error prone and as a consequence of specific selection pressures within a host a population of viral quasispecies emerges. HBV mutants with survival advantages over the wild type virus appear within the selective in vivo environment. Some of these viruses include HBV vaccine escape and anti-viral resistant mutants that have changes in the envelope (S) and polymerase genes, respectively. In addition, the genome of HBV is organised in to overlapping reading frames. The S gene is completely overlapped by the polymerase gene. As a consequence, mutations in the S gene may produce changes in the overlapping polymerase gene. Similarly, mutations in the polymerase gene may produce changes in the S gene. The virological and clinical significance of such overlapping mutations is unclear. However, we have shown that certain mutations in either the S or polymerase gene produce functionally significant changes in the respective overlapping gene. Treatment of chronic hepatitis B carriers with long-term lamivudine (LMV) results in the selection of HBV mutants that are resistant to this nucleoside analogue. The polymerase mutations associated with LMV resistance produce changes in the overlapping S gene and in its envelope protein (hepatitis B small antigen, HBsAg) that results in a reduced antigenicity of the HBsAg protein. The selection of vaccine escape mutants by HBV vaccination or hepatitis B immune globulin is associated with changes in the S gene that are accompanied by mutations in the fingers sub-domain of the polymerase protein. When combined with polymerase mutations that are associated with resistance to LMV the changes within the fingers sub-domain of the viral enzyme behave as compensatory mutations that are able to restore the replication of LMV resistant HBV. The ability to change a viral protein by mutations in an overlapping but unrelated viral gene may produce HBV mutants with altered antigenicity and/or replication and a natural history that may be distinctly different to wild type HBV.
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Affiliation(s)
- Joseph Torresi
- Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville, Vic., Australia.
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Abstract
Hepatitis B, a major viral infection that can lead to cirrhosis and hepatocellular carcinoma, is the ninth most common cause of death worldwide. Prevention of hepatitis B virus transmission is key to reducing the spread of this serious condition. Management of chronic hepatitis B requires significant knowledge of approved pharmacotherapeutic agents and their limitations. Today, agents approved by the Food and Drug Administration for this infection are interferon-alpha-2b and lamivudine. Newer agents are being developed and hold promise: adefovir, famciclovir, ganciclovir, lobucavir, entecavir, emtricitabine, L-deoxythymidine, clevudine, a therapeutic vaccine, and thymosin alpha-1. Therapeutic options for managing hepatitis infection after liver transplantation are also evolving. These include hepatitis B immunoglobulin and nucleoside analogues.
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Affiliation(s)
- Anastasia Rivkina
- Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, New York, USA.
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Abstract
BACKGROUND In 1991 the Advisory Committee on Immunization Practices (ACIP) developed a comprehensive strategy to eliminate the transmission of hepatitis B virus in the United States, which includes immunization of all infants. Today, as the number of recommended childhood vaccinations increases, combination vaccines are needed to simplify the immunization schedule and improve coverage levels. METHODS A review of the literature was performed to determine the considerations that should be taken when hepatitis B virus vaccine (HepB) is included as part of a combination vaccine. RESULTS A combination vaccine that incorporates HepB and other routine infant vaccine antigens has been developed for administration at 2, 4 and 6 months of age. Clinical studies have demonstrated that administration of HepB, either as a monovalent or combination vaccine at 2, 4 and 6 months of age, induces a seroprotective immune response similar to that achieved with monovalent HepB administered at 0, 1 and 6 months of age. In addition the combination vaccine results in similar or fewer adverse reactions compared with separate administration of its components. Infants given a dose of monovalent HepB at birth will receive a total of four doses of HepB when the combination is used. The extra dose of HepB has not led to increased adverse reactions. CONCLUSIONS A HepB-containing combination vaccine administered at 2, 4 and 6 months of age is as safe and immunogenic as separate administration of its components and will help simplify the childhood immunization schedule.
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Affiliation(s)
- D P Greenberg
- Center for Vaccine Research, Children's Hospital of Pittsburgh, PA 15213-2583, USA.
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Lewis E, Shinefield HR, Woodruff BA, Black SB, Destefano F, Chen RT, Ensor R. Safety of neonatal hepatitis B vaccine administration. Pediatr Infect Dis J 2001; 20:1049-54. [PMID: 11734710 DOI: 10.1097/00006454-200111000-00009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether hepatitis B vaccination of newborns increases the incidence of fever and/or suspected sepsis. METHODS A prospective clinical study was undertaken at the Kaiser Permanente San Francisco Medical Center involving normal full term newborns born between November 1, 1991, and April 30, 1994. During this time 3302 infants were vaccinated within 21 days of birth with hepatitis B vaccine, and 2353 were not. Clinical and demographic data were collected from Kaiser Permanente's existing clinical information systems, and laboratory data for blood and cerebrospinal fluid (CSF) cultures were obtained from the comprehensive automated regional laboratory reporting system. RESULTS There were no significant differences between vaccinated and unvaccinated newborns in the proportion of infants who received care for fever (0.8% vaccinated and 1.1% unvaccinated, P = 0.28), allergic reactions, seizures or other neurologic events in the first 21 days of life. Vaccinated newborns were significantly less likely to undergo microbiologic evaluation for possible sepsis. Among vaccinated newborns 4.0% had blood cultures and 1.6% had CSF cultures. Among infants who were not vaccinated 8.3% had blood cultures and 1.6% had CSF cultures (P <0.001 for both tests). CONCLUSION This study found no evidence that newborn hepatitis B vaccination is associated with an increase in the number of febrile episodes, sepsis evaluations or allergic or neurologic events. In addition our data did not support any increase in medical procedures attributed to receipt of hepatitis B vaccine.
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Affiliation(s)
- E Lewis
- Kaiser Permanente Vaccine Study Center, Oakland, CA 94610, USA
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31
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Young MD, Rosenthal MH, Dickson B, Du W, Maddrey WC. A multi-center controlled study of rapid hepatitis B vaccination using a novel triple antigen recombinant vaccine. Vaccine 2001; 19:3437-43. [PMID: 11348708 DOI: 10.1016/s0264-410x(01)00054-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatitis B vaccines have been available for 20 years, however, the disease still remains a global problem. Clearly, the protection of at-risk groups could be improved if a more potent vaccine with a shorter vaccination regimen were available. Hepacare is new recombinant vaccine, which contains three of the surface antigens of the HB virus and has higher immunogenicity than present single antigen (HBsAg only) vaccines. This study evaluates the potential for developing seroprotection rapidly and the viability of a 1 month/two dose regimen. A total of 400 adult subjects were vaccinated using either the present accelerated 2 month/three dose regimen of Engerix-B or a 1 month/two dose regimen of a novel triple antigen vaccine (Hepacare). Both vaccines were well tolerated. Four weeks after a single dose, the seroprotective rates for Engerix-B and the triple antigen vaccine were 5 and 17%, respectively. By month 2, 4 weeks after two doses of vaccine, it was 38 and 61%. Finally by month 3, 4 weeks after a third dose of Engerix-B or placebo, respectively, the seroprotection rates were 71 and 82%. The geometric mean titres (GMTs), of these responders was then 119 and 120 IU/l, respectively. Both vaccines were well tolerated. At all points up to and including 3 months after beginning vaccination, the novel 1 month/two dose regimen of Hepacare was significantly more effective in producing seroporotective titres than the 2 month/three dose regimen of Engerix-B (P = 0.001).
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Affiliation(s)
- M D Young
- Medeva Group Development, 1265 Drummers Lane, Suite 300, Wayne, PA 19087, USA.
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32
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Abstract
Many recent and significant advances in the field of chronic viral hepatitis, including therapy, suggest that an update on chronic hepatitis is timely. Chronic hepatitis B virus infection remains a significant worldwide cause of liver cirrhosis and hepatocellular carcinoma, despite the wide availability of a long established and effective vaccine. Transmission occurs via perinatal, sexual, and parenteral routes (particularly intravenous drug abuse and although blood products still carry a risk, this is now extremely low in Western countries). Only a minority of infected adult cases develop chronic hepatitis but in children under 1 year, 90% develop chronic hepatitis. The clinical spectrum of chronic liver injury ranges from mild inflammation to end stage liver cirrhosis. Interferon alfa has been the mainstay of treatment for patients with active disease but nucleoside analogues (lamivudine and adefovir) are now available with similar efficacy. Patients with end stage liver disease and hepatocellular carcinoma can be offered transplantation but infection in the graft is commonplace. The combination of hepatitis B immunoglobulin and newer antiviral drugs reduce the incidence and severity of graft infection significantly. The hepatitis C virus epidemic of the latter half of the 20th century now affects more than 1% of populations worldwide. This RNA virus is spread parenterally and is becoming the leading indication for liver transplantation. The majority of patients develop chronic hepatitis, which may be progressive, evolving to significant liver disease (cirrhosis or hepatocellular carcinoma) in about 20% cases after decades. Treatment with the combination of interferon alfa and ribavirin is successful in up to 40% cases. Liver transplantation is a therapeutic option for some but graft infection is universal and often complicated by progressive liver fibrosis. A vaccine remains a remote prospect so that prevention is crucial. Hepatitis D virus infection occurs on a background of hepatitis B virus infection and can also cause liver damage. The response to antiviral therapy is poor. The newer "hepatitis" viruses G and TT do not cause significant liver injury.
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MESH Headings
- AIDS-Related Opportunistic Infections/immunology
- AIDS-Related Opportunistic Infections/therapy
- Antiviral Agents/therapeutic use
- Drug Therapy, Combination
- Enzyme-Linked Immunosorbent Assay/methods
- Female
- Hepatitis B Surface Antigens/immunology
- Hepatitis B Vaccines/therapeutic use
- Hepatitis B e Antigens/immunology
- Hepatitis, Chronic/immunology
- Hepatitis, Chronic/therapy
- Hepatitis, Chronic/virology
- Hepatitis, Viral, Human/immunology
- Hepatitis, Viral, Human/therapy
- Hepatitis, Viral, Human/virology
- Humans
- Immunoblotting/methods
- Liver Transplantation/immunology
- Liver Transplantation/methods
- Male
- Polymerase Chain Reaction/methods
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Affiliation(s)
- K Walsh
- Box 157, Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
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Heijtink RA, van Bergen P, Paulij WP, de Man RA, Osterhaus AD. Anti-HBs characteristics after hepatitis B immunisation with plasma-derived and recombinant DNA-derived vaccines. Vaccine 2000; 18:1531-8. [PMID: 10618551 DOI: 10.1016/s0264-410x(99)00433-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hepatitis B surface antigen derived from chronic hepatitis B carriers has been replaced almost completely by recombinant DNA-derived HBsAg for use as hepatitis B vaccine. Similarly, recombinant DNA-derived HBsAg is replacing plasma-derived HBsAg in standard anti-HBs assays. We analysed the influence of a change from plasma-derived HBsAg to recombinant DNA-derived HBsAg on antigen presentation in immunoassays and the characteristics of the anti-HBs antibodies after immunisation. Antigens and/or antibodies were subjected to three types of experiments: (a) binding of 'a'-loop specific monoclonal (anti-S) antibody conjugates to immobilised vaccine-HBsAg; (b) binding of post-vaccination anti-HBs to immobilised (vaccine-)HBsAg and (c) inhibition of HBsAg binding to immobilised monoclonal anti-HBs after pre-incubation with post-vaccination antibodies. Our results show that, in both antigen presentation and anti-HBs binding properties, yeast recombinant HBsAg and related antibodies could be clearly distinguished from plasma-derived HBsAg and related antibodies. Divergent results were also obtained in the inhibition assay with recombinant DNA-derived HBsAg but not with serum HBsAg from the vaccine HBsAg subtype. It is concluded that both antigen presentation in vaccines and in anti-HBs assays can markedly influence the quantitation anti-HBs response. It is suggested that a challenge with an heterologous hepatitis B virus may encounter reduced efficacy of vaccine antibodies.
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Affiliation(s)
- R A Heijtink
- Department of Virology, Erasmus Medical Centre Rotterdam, Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, Netherlands.
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Yusuf HR, Coronado VG, Averhoff FA, Maes EF, Rodewald LE, Battaglia MP, Mahoney FJ. Progress in coverage with hepatitis B vaccine among US children, 1994-1997. Am J Public Health 1999; 89:1684-9. [PMID: 10553389 PMCID: PMC1508968 DOI: 10.2105/ajph.89.11.1684] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study was done to assess progress in hepatitis B vaccination of children from 1994 through 1997. METHODS We used data from the National Immunization Survey (NIS), a random-digit-dialed telephone survey that includes a mail survey to verify vaccination providers' records. The NIS is conducted in 78 geographic areas (50 states and 28 selected urban areas) in the United States. RESULTS A total of 32,433 household interviews were completed in the 1997 NIS. An estimated 83.7% of children aged 19 to 35 months received 3 or more doses of hepatitis B vaccine. Coverage with 3 doses was greater (86.7%) among children in states that had day care entry requirements for hepatitis B vaccination than among children in states without such requirements (83.0%) and was greater among children from families with incomes at or above the poverty level (85.0%) than among children below the poverty level (80.6%). Hepatitis B vaccination of children increased from 1994 through 1996, from 41% to 84%, but coverage reached a constant level of 84% to 85% in 1996/97. CONCLUSION Although substantial progress has been made in fully vaccinating children against hepatitis B, greater efforts are needed to ensure that all infants receive 3 doses of hepatitis B vaccine.
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Affiliation(s)
- H R Yusuf
- Immunization Services Division, Atlanta, Ga. 30333, USA
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35
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Linder N, Raz M, Sirota L, Reichman B, Lubin D, Kuint J, Cohen AH, Barzilai A. Unexplained fever in neonates may be associated with hepatitis B vaccine. Arch Dis Child Fetal Neonatal Ed 1999; 81:F206-7. [PMID: 10525025 PMCID: PMC1721007 DOI: 10.1136/fn.81.3.f206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To investigate whether hepatitis B vaccination has increased the number of cases of unexplained neonatal fever. METHOD The files of all infants born from 1 January 1991 to 31 December 1992, in whom a diagnosis of "injected antibiotic" or "disease of temperature regulation" was recorded, were reviewed. Those who had unexplained fever of 38 degrees C or higher during the first three days of life were divided into two groups: infants who did not receive the hepatitis B vaccine (1991) and infants who did (1992). RESULTS In 1992 the incidence of unexplained fever in hepatitis B vaccinated neonates was significantly higher than in the 1991 group of pre-vaccination neonates (35 out of 5819 (0.6%) vs 14 out of 5010 neonates (0.28%) respectively, p=0.013). CONCLUSIONS The increase in the number of cases of unexplained neonatal fever seems to be associated with the introduction of routine hepatitis B vaccination on the first day of life. The possibility that an excess number of neonates will undergo unnecessary procedures and treatment to diagnose unexplained fever justifies planning a controlled study to determine whether these preliminary findings point to a significant problem.
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Affiliation(s)
- N Linder
- Department of Neonatology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petah Tikva 49202, Israel
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36
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Niu MT, Rhodes P, Salive M, Lively T, Davis DM, Black S, Shinefield H, Chen RT, Ellenberg SS. Comparative safety of two recombinant hepatitis B vaccines in children: data from the Vaccine Adverse Event Reporting System (VAERS) and Vaccine Safety Datalink (VSD). J Clin Epidemiol 1998; 51:503-10. [PMID: 9635999 DOI: 10.1016/s0895-4356(98)00014-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preliminary review of data from the Vaccine Adverse Event Reporting System (VAERS), 1991-1994, revealed that more serious adverse events were reported in children who received a specific brand of recombinant hepatitis B (HepB) vaccine. OBJECTIVE To compare the post-marketing safety experience of the two recombinant HepB vaccines licensed for use in infants and children in the United States. DESIGN Review of a case series derived from passive surveillance data in the national VAERS. A retrospective cohort study using data from one health maintenance organization participating in Vaccine Safety Datalink (VSD), a computerized record linkage system. POPULATIONS STUDIED: U.S. children, ages birth-10 years for whom adverse events after HepB vaccine were reported to VAERS, 1991-1994. Children, ages birth-6 years, who received HepB vaccine at Kaiser Permanente Medical Care Program, Northern California, 1991-1994. MAIN OUTCOME MEASURES VAERS reporting rates for each vaccine by manufacturer were calculated from the numbers of reported events occurring within 30 days of HepB vaccination and the number of doses distributed by the manufacturers. VSD event rates for each vaccine were calculated from the numbers of hospitalization or emergency room visits within 30 days of HepB vaccination and the number of vaccine doses administered to the cohort. RESULTS In VAERS, higher rates of serious events (i.e., life threatening or resulting in hospitalization or permanent disability) were reported in children who received Vaccine A vs. Vaccine B (relative risk [RR]: 3.13-8.18, P < 0.01), particularly by those vaccinated in the private (RR: 7.62-28.58, P < 0.01), but not public sector (RR: 2.12, P = 0.19). Similar types of events were reported in recipients of both vaccines. In contrast, analysis of VSD data showed no significant difference in rates of hospitalization or ER visits in children who received either HepB vaccine (RR: 0.96-1.25, P > 0.05). CONCLUSIONS Our investigation reveals that it is unlikely there is a true difference between rates of serious events temporally associated with the two HepB vaccines in children. This study demonstrates the dual roles played by VAERS and VSD in providing a more complete picture of the post-marketing safety profile of childhood vaccines, and underscores the importance of using other analytic studies to evaluate findings from passive surveillance systems of adverse events.
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Affiliation(s)
- M T Niu
- Division of Biostatistics and Epidemiology, Office of Establishment Licensing and Product Surveillance, Center for Biologic Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland, USA
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37
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del Canho R, Grosheide PM, Mazel JA, Heijtink RA, Hop WC, Gerards LJ, de Gast GC, Fetter WP, Zwijneberg J, Schalm SW. Ten-year neonatal hepatitis B vaccination program, The Netherlands, 1982-1992: protective efficacy and long-term immunogenicity. Vaccine 1997; 15:1624-30. [PMID: 9364693 DOI: 10.1016/s0264-410x(97)00080-7] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
From 1982 to 1989, 705 infants born to HBsAg-positive mothers entered the Dutch neonatal hepatitis B vaccination program and received passive-active hepatitis B immunization in three randomized controlled trials testing variations in time of starting active vaccination, dose and type of vaccine, and number of hepatitis B immunoglobulin (HBIg) injections. A meta-analysis of individual patient data of the three randomized trials was performed to determine which independent host and vaccination related factors influence protective efficacy and long-term immunogenicity, and to assess whether hepatitis B vaccination concomitant with standard DKTP vaccination provides optimal protection. Statistical methodology included multivariate logistic regression analysis. Eight infants (1.1%), all born to HBeAg-positive mothers, became HBsAg carriers within the first year of life. The protective efficacy rate (PER) of passive-active immunization at 12 months follow-up was 92% for the total group of children from 114 HBeAg-positive mothers with no significant differences between children starting active immunization at birth or at 3 months of age, between infants starting at 3 months of age receiving one or two doses of HBIg or between those receiving plasma derived or recombinant vaccine. The only factor that affected the PER significantly was the level of maternal HBV DNA; PER was 100% if maternal HBV DNA was < 150 pg ml-1 and 68% for HBV DNA levels > 150 pg ml-1. After 5 years of follow-up, the group that started active immunization at birth had significantly more infants with loss of seroprotection (anti-HBs levels < 10 IU l-1, 15%) than the corresponding group starting at 3 months of age (anti-HBs < 10 IU l-2, 2%). One of 35 children with loss of seroprotection at 2 years became a HBsAg carrier in the fifth year of follow-up. This meta-analysis shows that the protective efficacy of passive-active hepatitis B vaccination is mainly influenced by material HBV DNA levels, and independent of the time of starting active vaccination at birth or at 3 months of age; long-term immunity was enhanced by starting active vaccination concomitant with DKTP vaccination. These findings allow incorporation of hepatitis B vaccine into the standard infant immunization programs for countries with a passive-active immunization strategy for the control of hepatitis B. Additional measures are needed to protect neonates of highly viremic women.
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Affiliation(s)
- R del Canho
- Department of Internal Medicine II, University Hospital Dijkzigt, Rotterdam, Netherlands
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Abstract
The six agents identified thus far that cause viral hepatitis are reviewed, and their impact upon pregnancy is described. Although it is the most common cause of jaundice during pregnancy, viral hepatitis does not generally increase the risk of pregnancy complications, nor is it teratogenic. Vertical transmission of some types of viral hepatitis does occur, however.
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Affiliation(s)
- M J Dinsmoor
- Department of Obstetrics and Gynecology, Medical College of Virginia/Virginia Commonwealth University, Richmond, USA
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39
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Affiliation(s)
- S M Lemon
- Department of Medicine, University of North Carolina at Chapel Hill, 27599-7030, USA
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40
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Niu MT, Davis DM, Ellenberg S. Recombinant hepatitis B vaccination of neonates and infants: emerging safety data from the Vaccine Adverse Event Reporting System. Pediatr Infect Dis J 1996; 15:771-6. [PMID: 8878219 DOI: 10.1097/00006454-199609000-00007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the postmarketing safety of recombinant hepatitis B (HB) vaccine given to neonates and infants in the US. METHODS US reports associated with HB vaccination and received between January 1, 1991, and May 31, 1995, by the national Vaccine Adverse Events Reporting System (VAERS) were reviewed as a case series. RESULTS During 1991 through 1994, 12,520 (32%) VAERS reports were received for events temporally associated with administration of HB vaccine, of which 14% were received for neonates and infants. More reports described serious outcomes for neonates (< 0.1 year old) than for other age groups (40% vs. 6 to 15%). HB alone was administered to 58 (97%) neonates; review of these reports did not reveal unexpected serious events. Among infants (0.1 to 0.9 years old) 192 (9%) received HB vaccine alone and 1469 (66%) received HB in combination with diphtheria-tetanus-pertussis (DTP) vaccine. Similar serious adverse events reported in neonates and infants included fever, agitation and apnea. Events reported for infants receiving HB/DTP and DTP alone were similar and differed from reports filed for infants receiving HB vaccine alone, suggesting that these events may be associated with use of DTP vaccine. CONCLUSIONS This review shows no unexpected adverse events in neonates and infants given HB vaccine despite use of at least 12 million doses of vaccine given in these age groups. Although VAERS lacks the ability to distinguish coincidental events from true vaccine reactions, this database represents the largest case series of events temporally associated with HB vaccination of neonates and infants.
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Affiliation(s)
- M T Niu
- Division of Biostatistics and Epidemiology, Office of Establishment Licensing, US Food and Drug Administration, Rockville, MD 20852-1448, USA.
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41
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Dwyer MJ, McIntyre PG. Ante-natal screening for hepatitis B surface antigen: an appraisal of its value in a low prevalence area. Epidemiol Infect 1996; 117:121-31. [PMID: 8760959 PMCID: PMC2271686 DOI: 10.1017/s0950268800001217] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The costs and projected benefits of universal screening for hepatitis B virus (HBV) infection in pregnant women in East Anglia are calculated and compared with current practice. By adjusting data from West Midlands region for ethnicity, the prevalence of maternal hepatitis B surface-antigen (HBsAg) positivity in East Anglia is predicted to be 0.083% (1 in 1200). Published data on health risks of perinatal HBV infection and on immunisation efficacy are used to derive benefits of screening. The marginal direct cost of screening is identified from regional sources. Current clinical practice in East Anglia identifies 7 surface-antigen positive mothers per year, whereas 22 are expected. Routine antenatal screening in East Anglia would prevent 2.6 additional childhood carriers per year (compared with current practice), resulting in the prevention of 0.7 deaths per year occurring 40-50 years in the future. The direct cost per (undiscounted) life-year saved would be Pounds 2437, not including savings on treatment for chronic hepatitis B infection. Routine prenatal screening for maternal HBsAg should be introduced without delay and continue even if HBV vaccination is introduced into the UK childhood immunisation schedule.
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Affiliation(s)
- M J Dwyer
- Anglia and Oxford Regional Health Authority, Cambridge, UK
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42
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Greenberg DP, Vadheim CM, Wong VK, Marcy SM, Partridge S, Greene T, Chiu CY, Margolis HS, Ward JI. Comparative safety and immunogenicity of two recombinant hepatitis B vaccines given to infants at two, four and six months of age. Pediatr Infect Dis J 1996; 15:590-6. [PMID: 8823852 DOI: 10.1097/00006454-199607000-00006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the relative safety and immunogenicity of the two recombinant hepatitis B vaccines licensed in the United States with doses recommended for routine immunization of low risk infants and a schedule that corresponds with routine pediatric visits. METHODS Healthy infants were immunized at 2, 4 and 6 months of age with hepatitis B vaccine manufactured by either SmithKline Beecham (Engerix-B, 10 micrograms/dose, n = 228) or Merck and Co. (Recombivax HB, 2.5 micrograms/dose, n = 200). Adverse reactions were ascertained by parental reports and interviews and by review of medical records. Antibody concentrations to hepatitis B surface antigen (anti-HBs) were measured in sequential serum specimens by enzyme immunoassay. RESULTS Adverse reactions were mild and the rates were not significantly different between the two groups. After the first and second doses the rates of seropositivity (> or = 10 mIU/ml) and seroprotection (> or = 10 mIU/ml) were significantly higher in infants given SmithKline Beecham vaccine (P < 0.01). After the second and third doses infants given SmithKline Beecham vaccine also had significantly higher geometric mean anti-HBs concentrations compared with those given Merck vaccine (348.0 mIU/ml vs. 66.9 and 1914.8 mIU/ml vs. 514.8 mIU/ml, respectively, P < 0.001). Nevertheless after the third dose 99% of infants in both vaccine groups achieved seroprotective antibody concentrations. CONCLUSIONS Both recombinant hepatitis B vaccines were safe and immunogenic when administered concurrently with other pediatric vaccines at 2, 4 and 6 months of age, but earlier protective responses were observed with the SmithKline Beecham vaccine than with the Merck vaccine.
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Affiliation(s)
- D P Greenberg
- UCLA Center for Vaccine Research, Harbor-UCLA, Medical Center, Torrance, USA.
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43
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Greenberg DP, Vadheim CM, Marcy SM, Partridge S, Jing J, Chiu CY, Greene T, Margolis HS, Ward JI. Safety and immunogenicity of a recombinant hepatitis B vaccine administered to infants at 2, 4 and 6 months of age. The Kaiser-UCLA Vaccine Study Group. Vaccine 1996; 14:811-6. [PMID: 8817829 DOI: 10.1016/0264-410x(95)00228-s] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A recombinant hepatitis B vaccine was administered to over 5000 infants in a prospective, randomized and blinded study. Infants were given either recombinant hepatitis B vaccine (Engerix-B, SmithKline Beecham Pharmaceuticals, 10 micrograms dose-1) or a Haemophilus influenzae type b (Hib) conjugate vaccine at 2, 4 and 6 months of age simultaneously with diphtheria-tetanus-pertussis and oral polio vaccines. Adverse reactions were ascertained by parental reports and interviews, and review of medical records. Blood specimens collected from 269 infants given hepatitis B vaccine were assayed for antibody to hepatitis B surface antigen (anti-HBs) by enzyme immunoassay. Infants given hepatitis B vaccine experienced low rates of adverse reactions that were similar or lower than the rates in infants given Hib conjugate vaccine. The geometric mean anti-HBs concentrations were 9.6 mIU ml-1 after one dose, 333 mIU ml-1 after two doses and 1812 mIU ml-1 after three doses (99% had levels > or = 10 mIU ml-1). Antibody responses to diphtheria and tetanus toxoids were unaffected by simultaneous administration of hepatitis B or Hib conjugate vaccine. Engerix-B vaccine was safe and immunogenic when given with other routine childhood immunizations at 2, 4 and 6 months of age, and should provide long-term protection against hepatitis B virus infection.
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Affiliation(s)
- D P Greenberg
- UCLA Center for Vaccine Research, Harbor-UCLA Medical Center, Torrance 90502, USA
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Malamitsi-Puchner A, Papacharitonos S, Sotos D, Tzala L, Psichogiou M, Hatzakis A, Evangelopoulou A, Michalas S. Prevalence study of different hepatitis markers among pregnant Albanian refugees in Greece. Eur J Epidemiol 1996; 12:297-301. [PMID: 8884198 DOI: 10.1007/bf00145420] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aim of the study was to record the prevalence of the various types of viral hepatitis, especially hepatitis B, in pregnant Albanian refugees in Greece. The study comprised 500 pregnant refugees of mean age 25.1 +/- 4.6 years. In Albania, all women had lived in overcrowded houses and had been exposed to non throw-away needles and syringes. Various indices for all hepatitis types were determined. The prevalence of HBsAg was 13.4%, of anti-HBs 53%, of total anti-HBc 70.8%, of anti-HBc IgM 0.4%, of HBeAg 1.2%, of anti-HBe 58.6%, of anti-HAV 96.2%, of anti-HAV IgM 1%, of anti-HDV 0.4%, of anti-HCV 0.6% and of anti-HEV 2%. HBeAg was found positive in 7.5% of HBsAg carriers. Prevalence of hepatitis B markers, as determined by HBsAg and/or anti-HBs and/or total anti-HBc was significantly higher in those with a history of previous hospitalization in Albania (p = 0.01) and those with previous history of hepatitis (p = 0.02). The high prevalence of hepatitis B markers in pregnant Albanian refugees proves that HBV infection is highly endemic in Albania and the possibility of perinatal transmission to the offsprings urges for HBV vaccination programmes. On the other hand improvements in the socioeconomic conditions and the sanitation system in Albania is anticipated to reduce the incidence of HAV and HBV infections.
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Rustgi VK, Schleupner CJ, Krause DS. Comparative study of the immunogenicity and safety of Engerix-B administered at 0, 1, 2 and 12 months and Recombivax HB administered at 0, 1, and 6 months in healthy adults. Vaccine 1995; 13:1665-8. [PMID: 8719517 DOI: 10.1016/0264-410x(95)00118-k] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A randomized trial compared the safety and immunogenicity of Engerix-B (EB) 20 micrograms administered intramuscularly (IM) at 0, 1, 2, and 12 months with Recombivax HB (RHB) 10 micrograms administered IM at 0, 1, and 6 months in healthy adults. At months 3 and 6, significantly more subjects who received EB were seroprotected compared to those who received RHB (84 vs 67%, p = 0.0027; 95 vs 76%, p < 0.001, respectively). SP rates were similar between the vaccination groups approximately 1 year after administration of the initial dose (91 and 83%, respectively; p = 0.1). The vaccines were well tolerated with injection site pain being the most commonly reported adverse event.
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Affiliation(s)
- V K Rustgi
- Office of Medical Research, Fairfax Hospital, Falls Church, VA 22046, USA
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46
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Pardo M, Marriott E, Moliner MC, Quiroga JA, Carreño V. Risks and benefits of interferon-alpha in the treatment of hepatitis. Drug Saf 1995; 13:304-16. [PMID: 8785018 DOI: 10.2165/00002018-199513050-00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The high worldwide prevalence of chronic viral hepatitis, as well as its progressive course, have led to the performance of multiple clinical studies. The natural history of the disease is different depending on the infecting virus; thus, the evolution to liver cirrhosis and/or hepatocellular carcinoma for the hepatitis B, C and delta (D) viruses in chronic hepatitis is 15, 20 and 75%, respectively. Different therapeutic agents have been used in attempts to modify the natural course of these diseases, interferon-alpha (IFN alpha) having proved to be the most effective. In 30 to 50% of patients, treatment with IFN alpha has achieved inhibition of viral replication, as well as normalisation of aminotransferase levels. Moreover, in a majority of patients, histological improvement is observed, principally in piece-meal necrosis and portal inflammation. The dosage currently recommended for treatment of chronic hepatitis B is 30 to 35MU weekly for a minimum of 4 months; when there is a co-existing delta virus infection, the total dosage employed should be greater. For hepatitis C, the minimum effective dosage is 9MU weekly, and a treatment duration of 12 months is recommended. The administration of IFN alpha produces a series of dose-dependent adverse effects, which are reversible on suspension of the medication. The most frequent of these adverse reactions is the 'flu-like' syndrome, which is self-limited and generally well tolerated. Secondary haematological alterations (leucopenia and thrombocytopenia) are the most frequent cause of reduction in dosage or suspension of treatment, although the latter is not normally necessary. The proportion of patients requiring dosage modification or suspension of treatment fluctuates between 5 and 15%. Taking the evolution of chronic hepatitis into account, there can be no doubt that all patients with this disease should be offered treatment. At present, the drug of choice is IFN alpha, as it slows disease progression and it is generally well tolerated.
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Affiliation(s)
- M Pardo
- Hepatology Unit, Fundación Jiménez Díaz, Madrid, Spain
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47
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del Canho R, Grosheide PM, Voogd-Schotanus M, Huisman WM, Heijtink RA, Schalm SW. Immunogenicity of two different dosages (10 and 5 micrograms) of recombinant DNA hepatitis B vaccine in healthy neonates. Vaccine 1994; 12:1323-6. [PMID: 7856298 DOI: 10.1016/s0264-410x(94)80059-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The immunogenicity of a half (5 micrograms) and a full (10 micrograms) dosage of recombinant DNA yeast-derived hepatitis B vaccine (HB-Vax-DNA) in healthy neonates was assessed in order to compare two candidate dosages of vaccine. After randomization 174 newborns of HBsAg-negative mothers entered the study. Neonates received four doses of either 10 or 5 micrograms hepatitis B vaccine, according to the DTP-polio immunization schedule at months 3, 4, 5 and 11. No serious adverse reactions were observed; 15.5% of vaccinated newborns suffered mild transient local symptoms. The vaccine was highly immunogenic irrespective of dosage of vaccine; all infants developed anti-HBs levels > or = 10 IU l-1, 99% > or = 100 IU l-1. A dosage of 10 micrograms hepatitis B vaccine produced higher antibody levels than 5 micrograms hepatitis B vaccine after primary vaccination (first three doses) but not after booster vaccination (fourth dose) (p = 0.06 and 0.75, respectively). Either vaccine dosage can be recommended for incorporation in the Expanded Programme on Immunization in the Netherlands.
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Affiliation(s)
- R del Canho
- Department of Internal Medicine II, University Hospital Dijkzigt, Rotterdam, The Netherlands
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Affiliation(s)
- C E Stevens
- Laboratory of Epidemiology, New York Blood Center, NY 10021
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49
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Clayton S, Yang H, Guan J, Lin Z, Wang R. Hepatitis B control in China: knowledge and practices among village doctors. Am J Public Health 1993; 83:1685-8. [PMID: 8259795 PMCID: PMC1694926 DOI: 10.2105/ajph.83.12.1685] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To guide development of a hepatitis B control program in China, we investigated village doctors' sterilization practices, injection use, vaccination levels, and knowledge and counseling skills. METHODS The head doctor from each village health station in a rural county (n = 260) completed a self-administered questionnaire. RESULTS Of the respondents, 94.2% reported adequate sterilization of needles; however, inadequate sterilization of syringes and acupuncture needles was common. Injections were found to be frequent and profitable. Of head doctors, 16.2% reported that most infants in their villages are vaccinated against hepatitis B. There was very high knowledge of modes of hepatitis B transmission, but it was not used to formulate advice for a hypothetical carrier. Knowledge of the consequences, prevalence, and use of condoms to prevent sexual transmission was lower. CONCLUSIONS The sterilization of acupuncture needles, reuse of syringes, and frequent injections are practices that may transmit the hepatitis B virus. Research into issues of vaccine acceptance is needed to expand immunization. A review of treatment practices and better training in counseling for village doctors is suggested.
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Affiliation(s)
- S Clayton
- School of Public Health, University of California, Los Angeles 90024-1772
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Wisnom CJ, Lee RJ. Increased seroprevalence of hepatitis B in dental personnel necessitates awareness of revised pediatric hepatitis B vaccine recommendations. J Public Health Dent 1993; 53:231-4. [PMID: 8258785 DOI: 10.1111/j.1752-7325.1993.tb02709.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article presents data regarding occurrence of hepatitis B in health care workers and children living in their households. Also reviewed are recent revisions in pediatric hepatitis B vaccine recommendations. The purpose of this discussion is twofold: to provide information to assist dental personnel in the decision-making process regarding vaccination of infants, children, and adolescents in their households; and to increase knowledge to facilitate educational presentations. In the United States from 1979 to 1989 the prevalence of new acute hepatitis B cases increased by 37 percent. An estimated 1.25 million people with chronic hepatitis B are capable of infecting those within their immediate environment, including their families. Studies indicate that dental health care workers, through occupational exposure, may have a 10 times greater risk of becoming a chronic hepatitis B carrier than the average citizen. The World Health Organizations's Expanded Programme on Immunizations recommends that children receive vaccination in populations where hepatitis B is prevalent. The three-pronged approach for reducing pediatric transmission includes: (1) vaccination of infants born to infected mothers, (2) routine vaccination of children born to hepatitis-seronegative mothers, (3) identification and vaccination of specific groups of adolescents. Comprehension of these changes may increase compliance regarding vaccination of children in our household, as well as enhancing our educational presentations to patients, the community, and professional societies.
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Affiliation(s)
- C J Wisnom
- Department of Oral Medicine and Diagnostic Sciences, Baltimore College of Dental Surgery, Dental School University of Maryland 21201-1586
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