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Peliganga LB, Horta MAP, Lewis-Ximenez LL. Enduring Challenges despite Progress in Preventing Mother-to-Child Transmission of Hepatitis B Virus in Angola. Pathogens 2022; 11:pathogens11020225. [PMID: 35215168 PMCID: PMC8874832 DOI: 10.3390/pathogens11020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 02/01/2023] Open
Abstract
Sub-Saharan Africa has one of the highest rates of hepatitis B virus (HBV) infection globally, with an incidence of 1.5 million and 0.8 million yearly deaths, which drives synergistic efforts towards its elimination. To assess the risk of mother-to-child transmission of HBV infection, a cross-sectional study was conducted on 1012 pregnant women in Angola to investigate HBV serological and molecular profiles. The prevalence of HBV was 8.7% (n = 88), with hepatitis B core IgM antibody (anti-HBc IgM) positivity identified in 12.8%, hepatitis B “e” antigen (HBeAg) positivity in 30%, and HBV DNA ≥ 200,000 IU/mL in 28.2%. Family tracking studied 44 children, of which 11 (25%) received at least two doses of the hepatitis B vaccine. HBV was detected in 10/44 (22.7%) children, with vaccination reported in one infected child. Further testing identified anti-HBc IgM positivity in 3/10 (30%), HBeAg positivity in 55%, and both seromarkers in 20%. The results revealed the importance of antenatal HBV screening, antiviral prophylaxis for mothers with high viral loads or HBeAg positivity, and timely first-dose hepatitis B vaccines in newborns. Anti-HBc IgM positivity among pregnant women and children highlights prophylactic measures worth considering, including antenatal hepatitis B vaccination and catch-up vaccination to young children.
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Affiliation(s)
- Luis Baião Peliganga
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil;
- Disease Control Department, National Directorate of Public Health, Ministry of Health, Luanda, Angola
- Internal Medicine Investigation Department, Faculdade de Medicina da Universidade Agostinho Neto, Luanda, Angola
| | | | - Lia Laura Lewis-Ximenez
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil;
- Correspondence: ; Tel.: +55-(21)-991-921-519
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2
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Moutchia J, Njouom R, Rumpler E, Besombes C, Texier G, Tejiokem M, Crépey P, Fontanet A, Shimakawa Y. Maternal age at first childbirth and geographical variation in HBV prevalence in Cameroon: Important role of mother-to-child transmission. Clin Infect Dis 2021; 74:836-845. [PMID: 34125878 DOI: 10.1093/cid/ciab548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The prevalence of hepatitis B virus (HBV) infection varies geographically around the world. However, the underlying reasons for this variation are unknown. Using a nationally representative population-based sample from all 58 administrative divisions in Cameroon, we examined the association between median maternal age at first childbirth in a preceding generation, a proxy for the frequency of mother-to-child transmission (MTCT) of HBV in a region, and the risk of chronic HBV infection, defined as positive surface antigen (HBsAg), in the index generation. METHODS We estimated a division-specific median maternal age at first childbirth using historical data from Demographic Health Surveys (DHS) in 1991/1998/2004/2011. We tested HBsAg in 2011 DHS participants. We used maps to display spatial variation and spatial models for the analysis. RESULTS In 14,150 participants (median 27 years old, 51% females), the overall weighted prevalence of HBsAg was 11.9% (95%CI: 11.0-12.8), with a wide geographical variation across the divisions (range: 6.3-23.7%). After adjusting for confounding factors and spatial dependency, lower maternal age at first childbirth was significantly associated with positive HBsAg at the division level (β: 1.89 [95%CI: 1.26-2.52], p<0.001), and at the individual level (OR: 1.20 [95%CI: 1.04-1.39], p=0.016). A similar ecological correlation was observed across other African countries. CONCLUSIONS The significant association between the maternal age at first childbirth and HBsAg-positivity suggests a crucial role of MTCT in maintaining high HBV endemicity in some areas in Cameroon. This underlines an urgent need to effectively prevent MTCT in order to achieve WHO's global hepatitis elimination goals.
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Affiliation(s)
- Jude Moutchia
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.,REPERES « Recherche en Pharmaco-Epidémiologie et Recours aux Soins » - EA 7449, Université Rennes, Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | - Richard Njouom
- Department of Virology, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Eva Rumpler
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Camille Besombes
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Gaëtan Texier
- Department of Epidemiology and Public Health, Centre Pasteur du Cameroun, Yaoundé, Cameroon.,Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France
| | - Mathurin Tejiokem
- Department of Epidemiology and Public Health, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Pascal Crépey
- REPERES « Recherche en Pharmaco-Epidémiologie et Recours aux Soins » - EA 7449, Université Rennes, Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | - Arnaud Fontanet
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.,PACRI unit, Conservatoire National des Arts et Métiers, Paris, France
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
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Hønge BL, Olesen JS, Jensen MM, Jespersen S, da Silva ZJ, Rodrigues A, Laursen AL, Wejse C, Krarup H, Aaby P, Erikstrup C. Hepatitis B and C in the adult population of Bissau, Guinea-Bissau: a cross-sectional survey. Trop Med Int Health 2019; 25:255-263. [PMID: 31746078 DOI: 10.1111/tmi.13335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Hepatitis B virus (HBV) and hepatitis C virus (HCV) are prevalent in West Africa. To address the WHO 2030 goals of a 90% reduction in incidence and a 65% reduction in mortality for both infections, we assessed the prevalence of HBV and HCV from surveys in the general population. METHODS Participants in this cross-sectional survey were included from randomly selected houses in a demographic surveillance site in Bissau, Guinea-Bissau. Participants were interviewed and had a blood sample drawn for viral analyses (HBsAg, anti-HBs, anti-HBc, anti-HCV and HCV RNA). Risk factors of HBV and HCV infection were determined by binomial regression adjusted for sex and age. RESULTS A total of 2715 participants were included in this study. The overall HBsAg prevalence was 18.7% (95% CI: 17.3-20.2%). HBsAg was associated with male sex (adjusted risk ratio (aRR): 1.64), and prevalence decreased with age >34 years. HBV exposure was found in 91.9% of participants. Although 72.6% of individuals without sexual debut had been exposed to HBV, ever engaging in a sexual relationship was associated with higher risk of HBV exposure (aRR 1.18). The anti-HCV prevalence was 0.5% (95% CI: 0.3-0.9%), and 78.6% of those had detectable HCV RNA. Risk factors for anti-HCV sero-positivity were age above 55 (aRR 10.60), a history of blood transfusion (aRR 5.07) and being in a polygamous marriage (aRR 3.52). CONCLUSION In Guinea-Bissau initiatives to implement treatment and widespread testing are needed to reach the WHO 2030 goals.
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Affiliation(s)
- Bo Langhoff Hønge
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Steen Olesen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Mose Jensen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Sanne Jespersen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Zacarias José da Silva
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,National Public Health Laboratory, Bissau, Guinea-Bissau
| | | | - Alex Lund Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Wejse
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,GloHAU, Center for Global Health, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Henrik Krarup
- Section of Molecular Diagnostics, Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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Hassan MA, Kim WR, Li R, Smith CI, Fried MW, Sterling RK, Ghany MG, Wahed AS, Ganova-Raeva LM, Roberts LR, Lok ASF. Characteristics of US-Born Versus Foreign-Born Americans of African Descent With Chronic Hepatitis B. Am J Epidemiol 2017; 186:356-366. [PMID: 28525625 DOI: 10.1093/aje/kwx064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/14/2016] [Indexed: 12/14/2022] Open
Abstract
Hepatitis B virus (HBV) infection is more common in African Americans than in white Americans. We compared the epidemiologic, clinical, and virological characteristics of US-born African Americans (USAAs) to those of foreign-born African Americans (FBAAs) with chronic hepatitis B. The adult cohort study of the Hepatitis B Research Network enrolls patients with HBV infection from 21 clinical sites in the United States and Canada. A total of 237 (15%) of the adult participants with chronic HBV infection that were enrolled from January 20, 2011, to October 2, 2013, were of African descent, including 57 USAAs and 180 FBAAs (76%). Compared with FBAAs, USAAs were older and more likely to have acquired HBV through sexual exposure, to be HBeAg-positive, to have higher HBV DNA levels, and to be infected with HBV genotype A2. FBAAs from West Africa were more likely to have elevated serum alanine aminotransferase (72% vs. 50%; P < 0.01) and higher HBV DNA levels (median, 3.2 log10 IU/mL vs. 2.8 log10 IU/mL; P = 0.03) compared with East African FBAAs. The predominant HBV genotype among West African FBAAs was E (67%), whereas genotypes A (78%) and D (16%) were common in East African FBAAs. Significant differences were found between USAAs and FBAAs, highlighting the need for tailored strategies for prevention and management of chronic HBV infection for African Americans.
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Shimakawa Y, Lemoine M, Njai HF, Bottomley C, Ndow G, Goldin RD, Jatta A, Jeng-Barry A, Wegmuller R, Moore SE, Baldeh I, Taal M, D'Alessandro U, Whittle H, Njie R, Thursz M, Mendy M. Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia. Gut 2016; 65:2007-2016. [PMID: 26185161 DOI: 10.1136/gutjnl-2015-309892] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/15/2015] [Accepted: 06/25/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The natural history of chronic HBV infection in sub-Saharan Africa is unknown. Data are required to inform WHO guidelines that are currently based on studies in Europe and Asia. METHODS Between 1974 and 2008, serosurveys were repeated in two Gambian villages, and an open cohort of treatment-naive chronic HBV carriers was recruited. Participants were followed to estimate the rates of hepatitis B e (HBeAg) and surface antigen (HBsAg) clearance and incidence of hepatocellular carcinoma (HCC). In 2012-2013, a comprehensive liver assessment was conducted to estimate the prevalence of severe liver disease. RESULTS 405 chronic carriers (95% genotype E), recruited at a median age of 10.8 years, were followed for a median length of 28.4 years. Annually, 7.4% (95% CI 6.3% to 8.8%) cleared HBeAg and 1.0% (0.8% to 1.2%) cleared HBsAg. The incidence of HCC was 55.5/100 000 carrier-years (95% CI 24.9 to 123.5). In the 2012-2013 survey (n=301), 5.5% (95% CI 3.4% to 9.0%) had significant liver fibrosis. HBV genotype A (versus E), chronic aflatoxin B1 exposure and an HBsAg-positive mother, a proxy for mother-to-infant transmission, were risk factors for liver fibrosis. A small proportion (16.0%) of chronic carriers were infected via mother-to-infant transmission; however, this population represented a large proportion (63.0%) of the cases requiring antiviral therapy. CONCLUSIONS The incidence of HCC among chronic HBV carriers in West Africa was higher than that in Europe but lower than rates in East Asia. High risk of severe liver disease among the few who are infected by their mothers underlines the importance of interrupting perinatal transmission in sub-Saharan Africa.
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Affiliation(s)
- Yusuke Shimakawa
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Maud Lemoine
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- Department of Hepatology, Imperial College London, London, UK
| | | | - Christian Bottomley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gibril Ndow
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Banjul, The Gambia
| | - Robert D Goldin
- Department of Hepatology, Imperial College London, London, UK
| | | | | | - Rita Wegmuller
- MRC International Nutrition Group, MRC Keneba, West Kiang, The Gambia
| | - Sophie E Moore
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- MRC International Nutrition Group, MRC Keneba, West Kiang, The Gambia
| | | | - Makie Taal
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hilton Whittle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ramou Njie
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Banjul, The Gambia
| | - Mark Thursz
- Department of Hepatology, Imperial College London, London, UK
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC), Lyon, France
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6
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Howell J, Ladep N, Nayagam S, Lemoine M, Garside D, Crossey M, Okeke E, Njie R, Ka M, Taal M, Thursz M, Taylor-Robinson S. PROLIFICA: a story of West African clinical and research collaborations to target hepatitis B-related hepatocellular carcinoma in West Africa. QJM 2016; 109:373-375. [PMID: 26106184 PMCID: PMC5916344 DOI: 10.1093/qjmed/hcv118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- J. Howell
- From the
Department of Medicine, Imperial College London, St Mary’s Campus, South Wharf Road, London W2 1NY, UK
| | - N.G. Ladep
- From the
Department of Medicine, Imperial College London, St Mary’s Campus, South Wharf Road, London W2 1NY, UK
- Department of Medicine, Jos University Teaching Hospital, Plateau State, Nigeria
| | - S. Nayagam
- From the
Department of Medicine, Imperial College London, St Mary’s Campus, South Wharf Road, London W2 1NY, UK
- Department of Viral Hepatitis, Medical Research Council (The Gambia Unit), Atlantic Boulevard, Fajara, Gambia
- Department of Medicine, Centre hospitalier régional de Thiès et UFR des Sciences de la Santé de Thiès, Thiès, Sénégal and
| | - M. Lemoine
- From the
Department of Medicine, Imperial College London, St Mary’s Campus, South Wharf Road, London W2 1NY, UK
- Department of Viral Hepatitis, Medical Research Council (The Gambia Unit), Atlantic Boulevard, Fajara, Gambia
- Department of Medicine, Royal Victoria Teaching Hospital, Independence Drive, Banjul, Gambia
| | - D.A. Garside
- From the
Department of Medicine, Imperial College London, St Mary’s Campus, South Wharf Road, London W2 1NY, UK
| | - M.M.E. Crossey
- From the
Department of Medicine, Imperial College London, St Mary’s Campus, South Wharf Road, London W2 1NY, UK
| | - E. Okeke
- Department of Medicine, Jos University Teaching Hospital, Plateau State, Nigeria
| | - R. Njie
- Department of Viral Hepatitis, Medical Research Council (The Gambia Unit), Atlantic Boulevard, Fajara, Gambia
| | - M.M. Ka
- Department of Medicine, Centre hospitalier régional de Thiès et UFR des Sciences de la Santé de Thiès, Thiès, Sénégal and
| | - M. Taal
- Department of Medicine, Royal Victoria Teaching Hospital, Independence Drive, Banjul, Gambia
| | - M.R. Thursz
- From the
Department of Medicine, Imperial College London, St Mary’s Campus, South Wharf Road, London W2 1NY, UK
| | - S.D. Taylor-Robinson
- From the
Department of Medicine, Imperial College London, St Mary’s Campus, South Wharf Road, London W2 1NY, UK
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7
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Kramvis A. The clinical implications of hepatitis B virus genotypes and HBeAg in pediatrics. Rev Med Virol 2016; 26:285-303. [PMID: 27139263 PMCID: PMC5084815 DOI: 10.1002/rmv.1885] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 12/12/2022]
Abstract
Although a successful vaccine against HBV has been implemented in 184 countries, eradication of hepatitis B virus (HBV) is still not on the horizon. There are over 240 million chronic carriers of HBV globally. The risk of developing chronic hepatitis ranges from >90% in newborns of hepatitis Be antigen (HBeAg)‐positive mothers, 25%–35% in children under 5 years of age and <5% in adults. HBeAg, a non‐particulate viral protein, is a marker of HBV replication. This is the only HBV antigen to cross the placenta, leading to specific unresponsiveness of helper T cells to the capsid protein and HBeAg in newborns. HBeAg is tolerated in utero and acts as a tolerogen after birth. Perinatal transmission is frequent when mothers are HBeAg‐positive, whereas it occurs less frequently when mothers are HBeAg‐negative. Sequence heterogeneity is a feature of HBV. Based on an intergroup divergence >7.5% across the complete genome, HBV is classified phylogenetically into at least nine genotypes. With between ~4% and 8% intergroup nucleotide divergence, genotypes A–D, F, H and I are classified further into subgenotypes. HBV genotypes/subgenotypes may have distinct geographical distribution and can develop different mutations in the regions of the HBV genome that code for HBeAg. These differences can be related to the role of HBV genotypes to the natural history of infection and mode of transmission. Thus genotypes/subgenotypes of HBV can be responsible for the different natural history of infection and modes of transmission in children, found in various regions of the world, where different genotypes/subgenotypes prevail. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anna Kramvis
- Hepatitis Virus Diversity Research Unit (HVDRU), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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8
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Ikobah J, Okpara H, Elemi I, Ogarepe Y, Udoh E, Ekanem E. The prevalence of hepatitis B virus infection in Nigerian children prior to vaccine introduction into the National Programme on Immunization schedule. Pan Afr Med J 2016; 23:128. [PMID: 27279955 PMCID: PMC4885699 DOI: 10.11604/pamj.2016.23.128.8756] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/07/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction Hepatitis B virus infection is a major global health problem of public health importance. In a bid to control the infection, the Nigerian government in 2004 introduced hepatitis B vaccine into the National Program on Immunization. There are no studies on the prevalence of hepatitis B in adolescent prior to 2004. The study was aimed at determining the seroprevalence and predictors of viral Hepatitis B in Nigerian children aged 11-19 years. Methods A cross sectional analytical study was conducted in July 2014. Multi-staged sampling technique was used to select 749 children from six secondary schools in Calabar, Cross River State, Nigeria. Ethical clearance was obtained from the Cross River State Medical Ethical Committee. A validated structured interviewer administered questionnaire was used to obtain information from participants following parental consent. Blood samples were obtained for qualitative detection of HBsAg using rapid chromatographic immunoassays with test kits from ABON (China) having sensitivity, specificity and accuracy of >99%, 97% and 98.5% respectively. Data was analyzed using SPSS version 20.2. Results Nine of the749 students screened were positive for HBsAg giving an overall prevalence of 1.2%. The sex specific prevalence was 0.8% for males and 1.8% for females. After multivariate analysis, age was the predictor of hepatitis B infection (OR 3.92; 95% CI 1.22-12.63; p-value 0.02). Conclusion The prevalence of HBV infection was low. Despite the low prevalence, the introduction of the vaccine is justifiable in view of the public health importance of the infection.
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Affiliation(s)
- Joanah Ikobah
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Henry Okpara
- Department of Chemical Pathology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Iwasam Elemi
- Department ofCommunity Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Yeonun Ogarepe
- Department of Chemical Pathology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Ekong Udoh
- Department of Paediatrics, University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria
| | - Emmanuel Ekanem
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
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9
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Shimakawa Y, Lemoine M, Bottomley C, Njai HF, Ndow G, Jatta A, Tamba S, Bojang L, Taal M, Nyan O, D'Alessandro U, Njie R, Thursz M, Hall AJ. Birth order and risk of hepatocellular carcinoma in chronic carriers of hepatitis B virus: a case-control study in The Gambia. Liver Int 2015; 35:2318-26. [PMID: 25728498 DOI: 10.1111/liv.12814] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/23/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Early age at infection with Hepatitis B virus (HBV) increases the risk of chronic infection. Moreover, early HBV infection may further independently increase the risk of hepatocellular carcinoma (HCC) beyond its effect on chronicity. METHODS The distribution of birth order, a proxy for mode and timing of HBV transmission, was compared in The Gambia between hepatitis B surface antigen (HBsAg)-positive HCC cases recruited from hospitals (n = 72) and two HBsAg-positive control groups without HCC: population-based controls from a community HBV screening (n = 392) and hospital-based controls (n = 63). RESULTS HCC risk decreased with increasing birth order in the population-based case-control analysis. Using first birth order as the reference, the odds ratios were 0.52 (95% CI: 0.20-1.36), 0.52 (0.17-1.56), 0.57 (0.16-2.05) and 0.14 (0.03-0.64) for second, third, fourth and greater than fourth birth order respectively (P = 0.01). A similar inverse association was observed in the hospital-based case-control comparison (P = 0.04). CONCLUSIONS Compared to controls, HCC cases had earlier birth order, a proxy for young maternal age and maternal HBV viraemia at birth. This finding suggests that in chronic HBV carriers perinatal mother-to-infant transmission may increase HCC risk more than horizontal transmission. Providing HBV vaccine within 24 h of birth to interrupt perinatal transmission might reduce the incidence of HCC in The Gambia.
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Affiliation(s)
- Yusuke Shimakawa
- Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France
| | - Maud Lemoine
- Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia
- Department of Hepatology, Imperial College London, London, UK
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Harr Freeya Njai
- Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia
| | - Gibril Ndow
- Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia
- The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, The Gambia, Banjul, The Gambia
| | - Abdoulie Jatta
- Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia
| | - Saydiba Tamba
- Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia
| | - Lamin Bojang
- Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia
| | - Makie Taal
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Ousman Nyan
- Edward Francis Small Teaching Hospital, The Gambia, Banjul, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ramou Njie
- Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia
- The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, The Gambia, Banjul, The Gambia
| | - Mark Thursz
- Department of Hepatology, Imperial College London, London, UK
| | - Andrew J Hall
- International Agency for Research on Cancer (IARC), Lyon, France
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10
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Chotun N, Nel E, Cotton MF, Preiser W, Andersson MI. Hepatitis B virus infection in HIV-exposed infants in the Western Cape, South Africa. Vaccine 2015; 33:4618-22. [DOI: 10.1016/j.vaccine.2015.06.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/31/2015] [Accepted: 06/19/2015] [Indexed: 12/22/2022]
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Njai HF, Shimakawa Y, Sanneh B, Ferguson L, Ndow G, Mendy M, Sow A, Lo G, Toure-Kane C, Tanaka J, Taal M, D'alessandro U, Njie R, Thursz M, Lemoine M. Validation of rapid point-of-care (POC) tests for detection of hepatitis B surface antigen in field and laboratory settings in the Gambia, Western Africa. J Clin Microbiol 2015; 53:1156-63. [PMID: 25631805 PMCID: PMC4365211 DOI: 10.1128/jcm.02980-14] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/20/2015] [Indexed: 01/02/2023] Open
Abstract
Hepatitis B virus (HBV) infection is a leading cause of death in sub-Saharan Africa (SSA). Point-of-care tests for hepatitis B surface antigen (HBsAg) could be an ideal tool for a large-scale HBV screening/treatment program in SSA. Using data from the PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa) program, we conducted a cross-sectional study to assess the diagnostic accuracy of three point-of-care tests (Determine, Vikia, and Espline) for the detection of HBsAg in the field or a laboratory setting in the Gambia. In the field, we used finger-prick whole blood for the Determine and Vikia tests and dried blood spots for the reference standard test (AxSYM HBsAg enzyme-linked immunosorbent assay [ELISA]). In the laboratory we used serum for the Determine, Espline, and reference test (Architect chemiluminescent microparticle immunoassay). Of 773 participants recruited at the community and 227 known chronic HBV carriers (1,000 subjects in total), 293 were positive for HBsAg. The sensitivity and specificity of the Determine test were 88.5% and 100% in the field and 95.3% and 93.3% in the laboratory setting, respectively. The sensitivity and specificity were 90.0% and 99.8% for the Vikia test (in the field) and 93.9% and 94.7% for the Espline test (in the laboratory). There was no evidence that one kit was better than another. Most of the patients with false-negative results (18/19) were classified as inactive chronic carriers. In summary, the three point-of-care tests had acceptable ranges of diagnostic accuracy. These tests may represent accurate, rapid, and inexpensive alternatives to serology testing for the screening of HBV infection at field level in SSA.
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Affiliation(s)
| | - Yusuke Shimakawa
- Medical Research Council Unit, the Gambia, Banjul, the Gambia Department of Epidemiology/Infectious Disease Control and Prevention, Hiroshima University, Hiroshima, Japan
| | - Bakary Sanneh
- National Public Health Laboratory, Banjul, the Gambia
| | - Lynne Ferguson
- Medical Research Council Unit, the Gambia, Banjul, the Gambia
| | - Gibril Ndow
- Medical Research Council Unit, the Gambia, Banjul, the Gambia
| | - Maimuna Mendy
- Laboratory Services and Biobank Group, International Agency for Research on Cancer, Lyon, France
| | - Amina Sow
- Laboratoire de Bacteriologie Virologie, Université Cheikh Anta Diop, CHU Le Dantec, Dakar, Senegal
| | - Gora Lo
- Laboratoire de Bacteriologie Virologie, Université Cheikh Anta Diop, CHU Le Dantec, Dakar, Senegal
| | - Coumba Toure-Kane
- Laboratoire de Bacteriologie Virologie, Université Cheikh Anta Diop, CHU Le Dantec, Dakar, Senegal
| | - Junko Tanaka
- Department of Epidemiology/Infectious Disease Control and Prevention, Hiroshima University, Hiroshima, Japan
| | - Makie Taal
- National Public Health Laboratory, Banjul, the Gambia
| | | | - Ramou Njie
- Medical Research Council Unit, the Gambia, Banjul, the Gambia Laboratory Services and Biobank Group, International Agency for Research on Cancer, Lyon, France
| | - Mark Thursz
- Department of Hepatology, Division of Medicine, Imperial College, London, United Kingdom
| | - Maud Lemoine
- Medical Research Council Unit, the Gambia, Banjul, the Gambia Department of Hepatology, Division of Medicine, Imperial College, London, United Kingdom
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Shimakawa Y, Lemoine M, Mendy M, Njai HF, D’Alessandro U, Hall A, Thursz M, Njie R. Population-based interventions to reduce the public health burden related with hepatitis B virus infection in the gambia, west Africa. Trop Med Health 2014; 42:59-64. [PMID: 25425952 PMCID: PMC4204052 DOI: 10.2149/tmh.2014-s08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In The Gambia, West Africa, the prevalence of chronic hepatitis B virus (HBV) infection in adults exceeds eight percent and hepatocellular carcinoma (HCC) has been the most frequent type of malignancy. Two population-based intervention studies to control HBV infection, namely, GHIS (Gambia Hepatitis Intervention Study) and PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa), are discussed. The GHIS started in 1986 as a nation-wide trial of the HBV vaccine to evaluate the effectiveness of infant HBV vaccination in preventing HCC in adulthood. The vaccine was progressively introduced into the Expanded Program of Immunization (EPI) of The Gambia over four years in a phased manner, called the "stepped-wedge" design. This was because instantaneous universal vaccination in the country was impossible for logistic and financial reasons. However, this design also allowed the study to have an unvaccinated control group which consisted of the newborns of the areas where HBV vaccine has not yet been incorporated in the EPI. To assess the outcome, a national cancer registry was founded and all HCC patients in this birth cohort are linked with the vaccine trial database. The study is still ongoing to answer whether the HBV vaccine in infancy prevent HCC in adulthood in The Gambia. Although the universal HBV vaccination since 1990 has been successful in reducing the prevalence of chronic HBV infection in young Gambians, the number of HCC cases may not decline over the next decades as people infected prior to the immunization program are likely to continue to develop the diseases. To reduce the HCC incidence through community-based screening of HBV infection and provision of antiviral therapy, the PROLIFICA project started in 2011. Study hypothesis and design of these two studies, GHIS and PROLIFICA, are further discussed.
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Affiliation(s)
- Yusuke Shimakawa
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Maud Lemoine
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- Department of Hepatology, Imperial College London, UK, Norfolk Place, London, W2 1NY, UK
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC). 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Harr Freeya Njai
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Umberto D’Alessandro
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Andrew Hall
- International Agency for Research on Cancer (IARC). 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Mark Thursz
- Department of Hepatology, Imperial College London, UK, Norfolk Place, London, W2 1NY, UK
| | - Ramou Njie
- Medical Research Council (MRC) Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- Gambia Hepatitis Intervention Study (GHIS), IARC, c/o MRC Unit, The Gambia, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
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Shimakawa Y, Bottomley C, Njie R, Mendy M. The association between maternal hepatitis B e antigen status, as a proxy for perinatal transmission, and the risk of hepatitis B e antigenaemia in Gambian children. BMC Public Health 2014; 14:532. [PMID: 24885392 PMCID: PMC4066313 DOI: 10.1186/1471-2458-14-532] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/23/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Early age at infection with hepatitis B virus (HBV) increases the risk of chronic HBV infection. In addition early age at infection may further increase the risk of persistent viral replication beyond its effect on chronicity. The effects of perinatal and early postnatal transmission on the risk of prolonged hepatitis B e antigenaemia in children with chronic HBV infection are not well documented in Africa. We examine these associations using maternal HBV sero-status and the number of HBV-positive older siblings as proxy measures for perinatal and early postnatal transmission, respectively. METHODS Hepatitis B e antigen (HBeAg)-positive mothers were identified in six population-based HBV sero-surveys conducted in The Gambia between 1986 and 1990. For every HBeAg-positive mother, a hepatitis B surface antigen (HBsAg)-positive HBeAg-negative mother and HBsAg-negative mother were randomly selected from the population surveyed. These mothers and their family members were tested for HBV sero-markers in a subsequent survey conducted between 1991 and 1993. RESULTS Thirty-eight HBeAg positive mothers and the same number of HBsAg-positive HBeAg-negative mothers and HBsAg-negative mothers participated in the study. Sixty-nine percent of their children also participated. There was a non-significant positive association between HBeAg prevalence in children and the number of HBeAg-positive older siblings (64.1%, 69.2% and 83.3% in children with 0, 1 and ≥2 HBeAg-positive older siblings, respectively). After adjusting for confounders, having an HBeAg-positive mother was a risk factor for HBeAg positivity in children carrying HBsAg (adjusted OR 4.5, 95% CI: 1.0-19.5, p = 0.04), whilst the number of HBeAg-positive older siblings was not. CONCLUSIONS Maternal HBeAg was associated with positive HBeAg in children with chronic HBV infection. This suggests that interrupting mother-to-infant transmission in sub-Saharan Africa might help reduce the burden of liver disease. A timely dose of HBV vaccine within 24 hours of birth, as recommended by WHO, should be implemented in sub-Saharan Africa.
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Affiliation(s)
- Yusuke Shimakawa
- Medical Research Council (MRC) Unit, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Ramou Njie
- Medical Research Council (MRC) Unit, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
- The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, West Africa, The Gambia
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, Lyon, CEDEX 08 69372, France
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De Paschale M, Ceriani C, Cerulli T, Cagnin D, Cavallari S, Ndayaké J, Zaongo D, Priuli G, Viganò P, Clerici P. Prevalence of HBV, HDV, HCV, and HIV infection during pregnancy in northern Benin. J Med Virol 2014; 86:1281-7. [PMID: 24777580 DOI: 10.1002/jmv.23951] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 12/17/2022]
Abstract
Pregnant women are not screened for HBsAg and anti-HCV antibodies in many African countries. As there are few data concerning the prevalence of HBV, HDV, and HCV serological markers in Benin, the aim of this study was to evaluate their 2011 prevalence in pregnant women undergoing HIV screening in a rural area of north Benin, and compare the data with those reported for the same area in 1986. The sera of 283 women were examined for HBsAg, anti-HBs, anti-HBc, anti-HCV, and anti-HIV 1/2 antibodies. In the case of HBsAg positivity, a search was made for the HBeAg, anti-HDV, and HBV genotypes; in the case of anti-HCV positivity, a search was made for the HCV genotypes. HBsAg, anti-HBs, anti-HBc, anti-HCV, and anti-HIV 1/2 were positive in respectively 44 (15.5%), 82 (29.0%), 234 (82.7%), 21 (7.4%), and nine samples (3.2%). Of the HBsAg-positive samples, five (11.4%) were positive for HBeAg, five (11.4%) for anti-HDV, and 19 for HBV genotype E. Of the anti-HCV-positive samples, five were positive for genotype 2a/2c and one for genotype 1a. The prevalence of anti-HBc alone (HBsAg and anti-HBs negative) was very high (41.3%). In comparison with the 1986 data, the prevalence of HBsAg and anti-HBc remained unchanged, that of HBeAg and anti-HDV had decreased, and that of anti-HIV 1/2 had increased. As these data confirm that HBV and HCV are highly endemic in the study area, it may be appropriate to introduce HBsAg and anti-HCV screening for pregnant women. J. Med. Virol. 86:1281-1287, 2014. © 2014 Wiley Periodicals, Inc.
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Andersson MI, Maponga TG, Ijaz S, Barnes J, Theron GB, Meredith SA, Preiser W, Tedder RS. The epidemiology of hepatitis B virus infection in HIV-infected and HIV-uninfected pregnant women in the Western Cape, South Africa. Vaccine 2013; 31:5579-84. [PMID: 23973500 PMCID: PMC3898695 DOI: 10.1016/j.vaccine.2013.08.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 07/31/2013] [Accepted: 08/09/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Persistent hepatitis B virus (HBV) infection is a major cause of morbidity and mortality in sub-Saharan Africa. The HIV epidemic has the potential to affect its biology. Immunisation protocols established in the pre-HIV era are based upon data showing predominantly horizontal infant transmission. This study aimed to determine whether HIV co-infection will change the epidemiology of HBV both by increasing infectivity and by favouring the escape of viruses bearing phenotypically altered HBsAg. METHODS This retrospective cross-sectional study used antenatal samples from the 2008 Antenatal Sentinel HIV and Syphilis Prevalence Survey in the Western Cape, South Africa. All HIV-infected women were age and race-matched to HIV-uninfected women. Samples were tested for serological markers of HBV and HDV infection. HBV viral load, consensus sequencing and genotyping were performed. Luminex technology was used to determine HBsAg phenotype. All samples from HIV-infected women were tested for traces of antiretroviral drugs by mass spectrometry. RESULTS This study showed a trend toward loss of immune control of HBV in HIV-infected women with 3.4% of samples containing HBsAg, 18.9% contained HBeAg. In contrast, 2.9% of samples from HIV-uninfected women contained HBsAg and 17.1% of these HBeAg. The median HBV load in the HIV-infected group was 9.72×10(7)IU/ml and in the HIV-uninfected group 1.19×10(6)IU/ml. Genotyping showed 63/68 samples belonged to genotype A and the remainder genotype D. Mutations in the precore region were found in 35% and 33% of samples from HIV-infected and HIV-uninfected respectively. Although no major epitope ablation was found, marked variation in HBsAg profiles in HIV-infected group was demonstrated. No HDV infection was detected. CONCLUSION HIV-HBV co-infected women exhibit a degree of immune escape. One in six HBV-infected pregnant women, irrespective of HIV status is HBeAg seropositive. HBV immunization of newborns in sub-Saharan Africa should be implemented.
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Affiliation(s)
- M I Andersson
- Division of Medical Virology, University of Stellenbosch/National Health Laboratory Service, Tygerberg, South Africa.
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Lemoine M, Nayagam S, Thursz M. Viral hepatitis in resource-limited countries and access to antiviral therapies: current and future challenges. Future Virol 2013; 8:371-380. [PMID: 23662157 PMCID: PMC3646239 DOI: 10.2217/fvl.13.11] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic viral hepatitis is a major public health issue worldwide and mostly affects resource-limited countries. These regions combine a considerable set of barriers to containing the epidemic, including shortage of healthcare workers, poor medical infrastructures, insufficient screening and poor access to care and treatment. At a time when morbidity and mortality of chronic liver disease has been widely improved in wealthy countries by new innovative strategies and potent antiviral drugs, it is now urgent to face the challenges of better management of chronic hepatitis in resource-poor countries from the perspectives of global health and social justice.
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Affiliation(s)
- Maud Lemoine
- Medical Research Council, The Gambia Unit, Disease Control & Elimination theme, Liver Unit, Atlantic Road, Fajara, PO Box 273 Banjul, The Gambia
| | - Shevanthi Nayagam
- Imperial College London, Department of Hepatology & Gastroenterology, St Marys, Norfolk Place, London W2 1NY, UK
| | - Mark Thursz
- Imperial College London, Department of Hepatology & Gastroenterology, St Marys, Norfolk Place, London W2 1NY, UK
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Mendy M, Peterson I, Hossin S, Peto T, Jobarteh ML, Jeng-Barry A, Sidibeh M, Jatta A, Moore SE, Hall AJ, Whittle H. Observational study of vaccine efficacy 24 years after the start of hepatitis B vaccination in two Gambian villages: no need for a booster dose. PLoS One 2013; 8:e58029. [PMID: 23533578 PMCID: PMC3606345 DOI: 10.1371/journal.pone.0058029] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
Objectives To determine the duration of protection from hepatitis B vaccine given in infancy and early childhood and asses risk factors for HBV infection and chronic infection. Methods In 1984 infant HBV vaccination was started in two Gambian villages. Cross sectional serological surveys have been undertaken every 4 years to determine vaccine efficacy. In the current survey 84.6% of 1508 eligible participants aged 1–28 years were tested. A spouse study was conducted in females (aged 14 years and above) and their male partners. Results Vaccine efficacy against chronic infection with hepatitis B virus was 95.1% (95% confidence interval 91.5% to 97.1%), which did not vary significantly between age groups or village. Efficacy against infection was 85.4% (82.7% to 87.7%), falling significantly with age. Concentrations of hepatitis B antibody fell exponentially with age varying according to peak response: 20 years after vaccination only 17.8% (95% CI 10.1–25.6) of persons with a low peak response (10–99 mIU/ml) had detectable HBs antibody compared to 27% (21.9% to 32.2%) of those with a high peak response (>999 mIU/ml). Time since vaccination and a low peak response were the strongest risk factors for HBV infections; males were more susceptible, marriage was not a significant risk for females. Hepatitis B DNA was not detected after infection, which tested soley core antibody positive. An undetectable peak antibody response of <10 mIU/ml and a mother who was hepatitis B e antigen positive were powerful risk factors for chronic infection. Conclusions Adolescents and young adults vaccinated in infancy are at increased risk of hepatitis B infection, but not chronic infection. Married women were not at increased risk. There is no compelling evidence for the use of a booster dose of HBV vaccine in The Gambia.
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Affiliation(s)
- Maimuna Mendy
- Medical Research Council Laboratories, The Gambia, Banjul, the Gambia, West Africa.
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Harrison A, Lemey P, Hurles M, Moyes C, Horn S, Pryor J, Malani J, Supuri M, Masta A, Teriboriki B, Toatu T, Penny D, Rambaut A, Shapiro B. Genomic analysis of hepatitis B virus reveals antigen state and genotype as sources of evolutionary rate variation. Viruses 2012; 3:83-101. [PMID: 21765983 PMCID: PMC3136878 DOI: 10.3390/v3020083] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hepatitis B virus (HBV) genomes are small, semi-double-stranded DNA circular genomes that contain alternating overlapping reading frames and replicate through an RNA intermediary phase. This complex biology has presented a challenge to estimating an evolutionary rate for HBV, leading to difficulties resolving the evolutionary and epidemiological history of the virus. Here, we re-examine rates of HBV evolution using a novel data set of 112 within-host, transmission history (pedigree) and among-host genomes isolated over 20 years from the indigenous peoples of the South Pacific, combined with 313 previously published HBV genomes. We employ Bayesian phylogenetic approaches to examine several potential causes and consequences of evolutionary rate variation in HBV. Our results reveal rate variation both between genotypes and across the genome, as well as strikingly slower rates when genomes are sampled in the Hepatitis B e antigen positive state, compared to the e antigen negative state. This Hepatitis B e antigen rate variation was found to be largely attributable to changes during the course of infection in the preCore and Core genes and their regulatory elements.
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Affiliation(s)
- Abby Harrison
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, South Parks Road, Oxford OX1 3SY, UK
- Fiji School of Medicine, Suva, Fiji; E-Mails: (J.P.); (J.M.)
- Authors to whom correspondence should be addressed; E-Mail: ; Tel.: +44-(0)-1865-281532; Fax: +44-(0)-1865-281890 (A.H.); E-Mail: ; Tel.: +1-814-863-9178; Fax: +1-814-865-9131 (B.S.)
| | - Philippe Lemey
- Department of Microbiology and Immunology, Rega Institute, K.U. Leuven 3000, Belgium; E-Mail:
| | - Matthew Hurles
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK; E-Mail:
| | - Chris Moyes
- The Hepatitis Foundation of New Zealand, Ohope, Whakatane 3121, New Zealand; E-Mail:
| | - Susanne Horn
- Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany; E-Mail:
| | - Jan Pryor
- Fiji School of Medicine, Suva, Fiji; E-Mails: (J.P.); (J.M.)
| | - Joji Malani
- Fiji School of Medicine, Suva, Fiji; E-Mails: (J.P.); (J.M.)
| | - Mathias Supuri
- School of Medicine and Health Sciences, University of Papua New Guinea, P.O. Box 5623, Boroko, Port Moresby, NCD, Papua New Guinea; E-Mails: (M.S.); (A.M.)
| | - Andrew Masta
- School of Medicine and Health Sciences, University of Papua New Guinea, P.O. Box 5623, Boroko, Port Moresby, NCD, Papua New Guinea; E-Mails: (M.S.); (A.M.)
| | - Burentau Teriboriki
- Nawerwere Hospital, Kiribati Ministry of Health, Tawara, Kiribati; E-Mails: (B.T.); (T.T.)
| | - Tebuka Toatu
- Nawerwere Hospital, Kiribati Ministry of Health, Tawara, Kiribati; E-Mails: (B.T.); (T.T.)
| | - David Penny
- Allan Wilson Centre for Molecular Ecology and Evolution, Massey University, Palmerston North 4442, New Zealand; E-Mail:
| | - Andrew Rambaut
- Ashworth Laboratories, Institute of Evolutionary Biology, King’s Buildings, Edinburgh, EH8 3JT, UK; E-Mail:
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Beth Shapiro
- Department of Biology, The Pennsylvania State University, University Park, PA 16802, USA
- Authors to whom correspondence should be addressed; E-Mail: ; Tel.: +44-(0)-1865-281532; Fax: +44-(0)-1865-281890 (A.H.); E-Mail: ; Tel.: +1-814-863-9178; Fax: +1-814-865-9131 (B.S.)
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Kfutwah AK, Tejiokem MC, Njouom R. A low proportion of HBeAg among HBsAg-positive pregnant women with known HIV status could suggest low perinatal transmission of HBV in Cameroon. Virol J 2012; 9:62. [PMID: 22401702 PMCID: PMC3315739 DOI: 10.1186/1743-422x-9-62] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 03/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transmission of hepatitis B virus (HBV) from HBV-positive mothers to their infants is common and usually occurs when the mother is hepatitis B e antigen (HBeAg) positive and/or has a high HBV DNA load. In this study, we determined the prevalence of hepatitis B surface antigen (HBsAg) and HBeAg among pregnant women with known HIV status. FINDINGS A total of 650 pregnant women with a mean age of 26.2 years including 301 HIV-positives and 349 HIV-negatives were screened for HBsAg (Monolisa AgHBs Plus Biorad, France). Among the HBsAg-positives, HBeAg and anti-HBe were tested (Monolisa Ag HBe Plus Biorad, France). Overall, 51 (7.85%) were positive for HBsAg. The prevalence of HBsAg was not statistically different between HIV-positive and HIV-negative pregnant women [28/301 (9.3%) vs 23/349 (6.59%); p = 0.2]. None of the 45 HBsAg-positive samples was reactive for HBeAg. CONCLUSIONS Our study indicates a high prevalence of HBsAg with very low proportion of HBeAg in Cameroonian pregnant women. Since perinatal transmission of HBV is mostly effective when the mother is also HBeAg-positive, our data could suggest that perinatal transmissions play a minor role in HBV prevalence in Cameroon. In line with previous African studies, these findings further suggests that horizontal transmission could be the most common mechanism of HBV infections in Cameroon.
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Affiliation(s)
- Anfumbom Kw Kfutwah
- Virology Service, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, BP 1274 Yaounde, Cameroon.
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Emergence of HBV resistance to lamivudine (3TC) in HIV/HBV co-infected patients in The Gambia, West Africa. BMC Res Notes 2011; 4:561. [PMID: 22195774 PMCID: PMC3292846 DOI: 10.1186/1756-0500-4-561] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 12/23/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Lamivudine (3TC) is a potent inhibitor of both Hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV) replication and is part of first-line highly active antiretroviral therapy (HAART) in the Gambia. Unfortunately, the effectiveness of 3TC against HBV is limited by the emergence of resistant strains. AIM The aim of this retrospective study was to characterise 3TC-resistant mutations in HBV from co-infected patients receiving HAART, by generating HBV polymerase sequence data and viral loads from HBV genotype E infected patients, both at initiation and during a course of 3TC therapy. METHOD Samples from 21 HBV chronic carriers co-infected with HIV-1 (n = 18), HIV-2 (n = 2) and HIV-dual (n = 1) receiving HAART for a period of 6-52 months were analysed for the emergence of 3TC-resistance mutations. FINDINGS Sixteen out of 21 HBV/HIV co-infected patients responded well to HAART treatment maintaining suppression of HBV viraemia to low (≤ 104 copies/mL) (n = 5) or undetectable levels (< 260 copies/ml) (n = 11). Out of the 5 non-responders, 3 had developed 3TC-resistant HBV strains showing mutations in the YMDD motif at position 204 of the RT domain of the HBV polymerase. One patient showed the M204V+ L180M+ V173L+ triple mutation associated with a vaccine escape phenotype, which could be of public health concern in a country with a national HBV vaccination programme. All except one patient was infected with HBV genotype E. CONCLUSIONS Our findings confirm the risk of 3TC mutations in HAART patients following monotherapy. This is a novel study on 3TC resistance in HBV genotype E patients and encourage the use of tenofovir (in association with 3TC), which has not shown unequivocally documented HBV resistance to date, as part of first-line therapy in HIV/HBV co-infected patients in West Africa.HBV- hepatitis B infection; HIV- human immunodeficiency virus; HAART- antiretroviral therapy.
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Butler LM, Were WA, Balinandi S, Downing R, Dollard S, Neilands TB, Gupta S, Rutherford GW, Mermin J. Human herpesvirus 8 infection in children and adults in a population-based study in rural Uganda. J Infect Dis 2011; 203:625-34. [PMID: 21273188 DOI: 10.1093/infdis/jiq092] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human herpesvirus 8 (HHV-8) infection is endemic in sub-Saharan Africa. We examined sociodemographic, behavioral, and biological factors associated with HHV-8 infection in children and adults to determine HHV-8 seroprevalence and potential routes of transmission. METHODS Participants were 1383 children and 1477 adults from a population-based sample in a rural community in Uganda. Serum samples were tested for HHV-8 antibodies with use of an enzyme immunoassay against K8.1. RESULTS HHV-8 seroprevalence increased from 16% among children aged 1.5-2 years to 32% among children aged 10-13 years (P <.001) and from 37% among participants aged 14-19 years to 49% among adults aged ≥ 50 years (P <.05). HHV-8 seropositivity in children was independently associated with residing with a seropositive parent (P < .001) and residing with ≥ 1 other seropositive child aged <14 years (P < .001). History of sharing food and/or sauce plates was marginally associated with HHV-8 infection in children (P = .05). Among 1404 participants aged ≥ 15 years , there was no association between correlates of sexual behavior (eg, number of lifetime sex partners and HIV infection) and HHV-8 seropositivity (P > .10). CONCLUSIONS Our data suggest that HHV-8 is acquired primarily through horizontal transmission in childhood from intrafamilial contacts and that transmission continues into adulthood potentially through nonsexual routes.
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Affiliation(s)
- Lisa M Butler
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, San Francisco, CA 94105, USA.
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Jobarteh M, Malfroy M, Peterson I, Jeng A, Sarge-Njie R, Alabi A, Peterson K, Cotten M, Hall A, Rowland-Jones S, Whittle H, Tedder R, Jaye A, Mendy M. Seroprevalence of hepatitis B and C virus in HIV-1 and HIV-2 infected Gambians. Virol J 2010; 7:230. [PMID: 20843322 PMCID: PMC2949835 DOI: 10.1186/1743-422x-7-230] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 09/15/2010] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of HIV/hepatitis co-infection in sub-Saharan Africa is not well documented, while both HIV and HBV are endemic in this area. Objective The aim of this study is to determine the seroprevalence of HBV and HCV virus in HIV-infected subjects in the Gambia. Methods Plasma samples from HIV infected patients (190 individuals with clinically defined AIDS and 382 individuals without AIDS) were tested retrospectively for the presence of HBV sero-markers and for serum HBV DNA, screened for HCV infection by testing for anti-HCV antibody and HCV RNA. Results HBsAg prevalence in HIV-positive individuals is 12.2%. HIV/HBV co-infected individuals with CD4 count of <200 cells uL-1 have a higher HBV DNA viral load than patients with higher CD4 count (log 4.0 vs. log 2.0 DNA copies/ml, p < 0.05). Males (OR = 1.8, 95% CI: 1.0, 3.2) were more likely to be HBsAg positive than female. HCV seroprevalence was 0.9% in HIV-positive individuals. Conclusion The prevalence of HBsAg carriage in HIV- infected Gambians is similar to that obtained in the general population. However co-infected individuals with reduced CD4 levels, indicative of AIDS had higher prevalence of HBeAg retention and elevated HBV DNA levels compared to non-AIDS patients with higher CD4 count.
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Affiliation(s)
- Modou Jobarteh
- Medical Research Council, Fajara, P O Box 273, Banjul, The Gambia
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Implementing a birth dose of hepatitis B vaccine for home deliveries in Africa--too soon? Vaccine 2010; 28:6408-10. [PMID: 20673825 DOI: 10.1016/j.vaccine.2010.07.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 07/07/2010] [Accepted: 07/13/2010] [Indexed: 01/05/2023]
Abstract
Despite the recommendation of the World Health Organization (WHO) to provide the first hepatitis B vaccine dose at birth (within 24h), there are epidemiological, economic and logistical reasons why this may not be the best approach for home births in Africa. The WHO policy presupposes that the epidemiology of hepatitis B infection in Africa is similar to the rest of the world and that the organizational, infrastructural and financial support is adequate. While babies born in health facilities may be relatively easy to immunize at birth, health systems and infrastructures in many resource-poor countries in Africa would be severely challenged, if required to reach home deliveries within 24h of birth.
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A population-based study of how children are exposed to saliva in KwaZulu-Natal Province, South Africa: implications for the spread of saliva-borne pathogens to children. Trop Med Int Health 2010; 15:442-53. [PMID: 20149165 DOI: 10.1111/j.1365-3156.2010.02474.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In sub-Saharan Africa, many viral infections, including Epstein-Barr virus, cytomegalovirus, Kaposi's sarcoma-associated herpesvirus and hepatitis B are acquired in childhood. While saliva is an important transmission conduit for these viruses, little is known about how saliva is passed to African children. We endeavoured to identify the range and determinants of acts by which African children are exposed to saliva. METHODS To identify the range of acts by which African children are exposed to saliva, we conducted focus groups, semi-structured interviews and participant observations in an urban and a rural community in South Africa. To measure the prevalence and determinants of the identified acts, we administered a questionnaire to a population-based sample of caregivers. RESULTS We identified 12 caregiving practices that expose a child's oral-respiratory mucosa, cutaneous surfaces or anal-rectal mucosa to saliva. Several acts were heretofore not described in the contemporary literature (e.g., caregiver inserting finger lubricated with saliva into child's rectum to relieve constipation). Among 896 participants in the population-based survey, many of the acts were commonly practised by all respondent types (mothers, fathers, grandmothers and siblings). The most common were premastication of food, sharing sweets and premastication of medicinal plants that are spit onto a child's body. CONCLUSIONS African children are exposed to saliva through a variety of acts, practised by a variety of caregivers, with no single predominant practice. This diversity poses challenges for epidemiologic work seeking to identify specific saliva-passing practices that transmit viruses. Most acts could be replaced by other actions and are theoretically preventable.
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Mendy ME, Welzel T, Lesi OA, Hainaut P, Hall AJ, Kuniholm MH, McConkey S, Goedert JJ, Kaye S, Rowland-Jones S, Whittle H, Kirk GD. Hepatitis B viral load and risk for liver cirrhosis and hepatocellular carcinoma in The Gambia, West Africa. J Viral Hepat 2010; 17:115-22. [PMID: 19874478 PMCID: PMC2817443 DOI: 10.1111/j.1365-2893.2009.01168.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The main objectives of this study were to define the occurrence and levels of hepatitis B virus (HBV) DNA in asymptomatic HBV carriers, cirrhosis patients and hepatocellular carcinoma (HCC) cases from The Gambia, and to evaluate the risk for cirrhosis or HCC associated with HBV viremia. We used sensitive real-time quantitative PCR assays to measure HBV DNA in samples from a case-control study consisting of 60 asymptomatic HBV carriers, 53 cirrhotic patients and 129 HCC cases. Logistic regression was used to estimate the risks of cirrhosis and HCC associated with HBV-DNA levels and HBV e antigenemia (HBeAg) detection (a surrogate marker for viral replication). Detectable HBV viremia and HBeAg positivity were both significantly associated with cirrhosis (increasing risk by fourfold and 11-fold respectively) and with HCC (increasing risk by sixfold and threefold respectively). HBV-DNA levels were significantly higher in both HCC cases and cirrhotic patients compared to asymptomatic carriers (P < 0.01 for both). High-level HBV DNA (>10,000 copies/mL) was strongly associated with both HCC and cirrhosis (17- and 39-fold increased risk). Lower level HBV viremia (200-10,000 copies/mL) conferred a significant risk of HCC, although the association with cirrhosis was not significant. In conclusion, we find that high HBV-DNA levels are strongly associated with the serious sequelae of HBV infection, independent of HBeAg status. While risk for cirrhosis and for HCC notably increases at HBV-DNA levels >or=10,000 copies/mL, low-level viremia was also associated with significant risk for HCC.
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Affiliation(s)
- M E Mendy
- Viral Diseases Programe, Medical Research CouncilBanjul, The Gambia
| | - T Welzel
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteRockville, MD, USA
| | - O A Lesi
- Lagos University Teaching HospitalLagos, Nigeria
| | - P Hainaut
- International Agency for Research on CancerLyon, France
| | - A J Hall
- London School of Hygiene and Tropical MedicineLondon; England
| | - M H Kuniholm
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthBaltimore, MD, USA
| | - S McConkey
- Royal College of Surgeons in IrelandDublin, Ireland
| | - J J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteRockville, MD, USA
| | - S Kaye
- Imperial CollegeLondon, UK
| | - S Rowland-Jones
- Viral Diseases Programe, Medical Research CouncilBanjul, The Gambia
| | - H Whittle
- Viral Diseases Programe, Medical Research CouncilBanjul, The Gambia
| | - G D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthBaltimore, MD, USA
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Plymoth A, Viviani S, Hainaut P. Control of hepatocellular carcinoma through hepatitis B vaccination in areas of high endemicity: perspectives for global liver cancer prevention. Cancer Lett 2009; 286:15-21. [PMID: 19836128 DOI: 10.1016/j.canlet.2009.08.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There are approximately 360 millions chronic carriers of Hepatitis B virus worldwide. Patterns of HB carriage are variable from one region to the other. Regions with rates of carriage over 8% are commonly considered as "high endemicity" regions. HB carriers have a very significant lifetime risk of developing chronic liver diseases such as cirrhosis and/or liver cancer (hepatocellular carcinoma, HCC). An efficient HB vaccine is available since the early eighties and has been used since for universal infant vaccination in regions of high endemicity. Observations from Taiwan, where universal infant vaccination was introduced from 1984, show a remarkable, long-lasting protection against carriage and reduction of HCC rates in adolescent and young adults born after the initiation of the programme. Two population-based trials have been set up in the mid-eighties to evaluate lifelong protective effects of infant HB vaccine against liver cancer, in The Gambia (West Africa) and in the area of Qidong, China. In other high-endemicity regions of Asia and Africa, universal infants vaccination has consistently showed a long-lasting high protection against chronic carriage and this is expected to lead to a dramatic decrease of chronic liver disease and liver cancer within the next decades. Here we briefly review the lessons of vaccination programmes and trials in high-endemicity regions, based on data gathered during 15-20years of implementation.
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Affiliation(s)
- Amelie Plymoth
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
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Mandeville KL, Krabshuis J, Ladep NG, Mulder CJJ, Quigley EMM, Khan SA. Gastroenterology in developing countries: issues and advances. World J Gastroenterol 2009; 15:2839-54. [PMID: 19533805 PMCID: PMC2699001 DOI: 10.3748/wjg.15.2839] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 04/21/2009] [Accepted: 04/28/2009] [Indexed: 02/06/2023] Open
Abstract
Developing countries shoulder a considerable burden of gastroenterological disease. Infectious diseases in particular cause enormous morbidity and mortality. Diseases which afflict both western and developing countries are often seen in more florid forms in poorer countries. Innovative techniques continuously improve and update gastroenterological practice. However, advances in diagnosis and treatment which are commonplace in the West, have yet to reach many developing countries. Clinical guidelines, based on these advances and collated in resource-rich environments, lose their relevance outside these settings. In this two-part review, we first highlight the global burden of gastroenterological disease in three major areas: diarrhoeal diseases, hepatitis B, and Helicobacter pylori. Recent progress in their management is explored, with consideration of future solutions. The second part of the review focuses on the delivery of clinical services in developing countries. Inadequate numbers of healthcare workers hamper efforts to combat gastroenterological disease. Reasons for this shortage are examined, along with possibilities for increased specialist training. Endoscopy services, the mainstay of gastroenterology in the West, are in their infancy in many developing countries. The challenges faced by those setting up a service are illustrated by the example of a Nigerian endoscopy unit. Finally, we highlight the limited scope of many clinical guidelines produced in western countries. Guidelines which take account of resource limitations in the form of "cascades" are advocated in order to make these guidelines truly global. Recognition of the different working conditions facing practitioners worldwide is an important step towards narrowing the gap between gastroenterology in rich and poor countries.
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Affiliation(s)
- V. Susan Springthorpe
- a Department of Microbiology and Immunology, Faculty of Medicine , University of Ottawa , 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
| | - Syed A. Sattar
- a Department of Microbiology and Immunology, Faculty of Medicine , University of Ottawa , 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada
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Mendy M, D'Mello F, Kanellos T, Oliver S, Whittle H, Howard CR. Envelope protein variability among HBV-Infected asymptomatic carriers and immunized children with breakthrough infections. J Med Virol 2008; 80:1537-46. [PMID: 18649345 DOI: 10.1002/jmv.21221] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A detailed study of hepatitis B virus (HBV) surface variants and their role in breakthrough infections has been conducted in The Gambia, West Africa. Samples from 1856 vaccinated subjects were tested for hepatitis B surface antigen (HBsAg). Evidence of infection was found in 11% (22/192) of subjects with breakthrough infections and 18 (81.8%) were also positive for HBV DNA following PCR analysis. A cohort of 58 unvaccinated carriers which also included 11 patients with hepatocellular carcinoma was also investigated in order to establish the prevalence of surface variants in the unvaccinated population. Analysis of the S gene from HBV PCR-positive subjects (n = 64) revealed little variation in the S gene of these subjects. Twenty-four S protein sequences (37.5%) were identical and a further 22 sequences differed by only a single amino acid. The K141E variant found in previous work was not detected and little variation was observed in the immunodominant "a" determinant; a single change was found in one vaccinated patient (Q129H) and nine changes detected among six unvaccinated carriers. This study showed that breakthrough HBV infection in vaccinated Gambians is mainly caused by the wild type genoytype E strain and that immune escape mutants are uncommon. However, HBV mutants may play a role in establishing infection later in life when anti-HBs antibodies have begun to decline. Further investigation is required to determine the cause of these breakthrough infections and whether they contribute to the establishment of the carrier state.
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Affiliation(s)
- Maimuna Mendy
- Medical Research Council, Atlantic Boulevard, Fajara, Banjul, The Gambia
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Mendy ME, McConkey SJ, Sande van der MAB, Crozier S, Kaye S, Jeffries D, Hall AJ, Whittle HC. Changes in viral load and HBsAg and HBeAg status with age in HBV chronic carriers in The Gambia. Virol J 2008; 5:49. [PMID: 18416832 PMCID: PMC2358882 DOI: 10.1186/1743-422x-5-49] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 04/16/2008] [Indexed: 01/17/2023] Open
Abstract
Background Little is known about changes in hepatitis B viral load (HBV DNA) in relation to age in Africa. The aim of this study is to determine the natural course of HBV chronic infection, particularly in relation to sequential changes in serum HBV DNA levels and hepatitis B surface (HBsAg) antigen/hepatitis e antigen (HBeAg) status by age. Methods The study was conducted on 190 HBV chronic carriers, aged 1–19 years who were followed for 19 years. 160, 99 and 123 were traced at 5, 9 and 19 years later. All available samples were tested for HBsAg and HBeAg, whilst 170, 61, 63 and 81 were tested for HBV DNA at the baseline, and at 5, 9 and 19 years following recruitment. Results In general HBeAg which correlated with high levels of HBV DNA was lost at a much faster rate than HBsAg. 86% of the carriers who were recruited at the age of 1–4 yrs lost HBeAg by the age of 19 years compared to 30% who lost HBsAg. HBeAg negative carriers had serum HBV DNA levels of < 105 copies per mL, HBV DNA positivity declined from 100% in 1–4 yrs old carriers at recruitment to 62.5%,60% and 88% at 5, 9 and 19 years respectively following recruitment. Conclusion After 19 years of follow up, the majority of HBV surface antigen carriers had lost HBeAg positivity and had low levels of viral replication. However small proportions (10–20%) retained HBeAg and continue to have high levels of viral replication.
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Affiliation(s)
- Maimuna E Mendy
- Medical Research Council Laboratories, Atlantic Boulevard, PO Box 273, Banjul, The Gambia.
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31
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Hennig BJ, Fielding K, Broxholme J, Diatta M, Mendy M, Moore C, Pollard AJ, Rayco-Solon P, Sirugo G, van der Sande MA, Waight P, Whittle HC, Zaman SM, Hill AV, Hall AJ. Host genetic factors and vaccine-induced immunity to hepatitis B virus infection. PLoS One 2008; 3:e1898. [PMID: 18365030 PMCID: PMC2268746 DOI: 10.1371/journal.pone.0001898] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 02/26/2008] [Indexed: 02/07/2023] Open
Abstract
Background Vaccination against hepatitis B virus infection (HBV) is safe and effective; however, vaccine-induced antibody level wanes over time. Peak vaccine-induced anti-HBs level is directly related to antibody decay, as well as risk of infection and persistent carriage despite vaccination. We investigated the role of host genetic factors in long-term immunity against HBV infection based on peak anti-HBs level and seroconversion to anti-HBc. Methods We analyzed 715 SNP across 133 candidate genes in 662 infant vaccinees from The Gambia, assessing peak vaccine-induced anti-HBs level and core antibody (anti-HBc) status, whilst adjusting for covariates. A replication study comprised 43 SNPs in a further 393 individuals. Results In our initial screen we found variation in IFNG, MAPK8, and IL10RA to affect peak anti-HBs level (GMTratio of <0.6 or >1.5 and P≤0.001) and lesser associations in other genes. Odds of core-conversion was associated with variation in CD163. A coding change in ITGAL (R719V) with likely functional relevance showed evidence of association with increased peak anti-HBs level in both screens (1st screen: s595_22 GMTratio 1.71, P = 0.013; 2nd screen: s595_22 GMTratio 2.15, P = 0.011). Conclusion This is to our knowledge the largest study to date assessing genetic determinants of HBV vaccine-induced immunity. We report on associations with anti-HBs level, which is directly related to durability of antibody level and predictive of vaccine efficacy long-term. A coding change in ITGAL, which plays a central role in immune cell interaction, was shown to exert beneficial effects on induction of peak antibody level in response to HBV vaccination. Variation in this gene does not appear to have been studied in relation to immune responses to viral or vaccine challenges previously. Our findings suggest that genetic variation in loci other than the HLA region affect immunity induced by HBV vaccination.
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Affiliation(s)
- Branwen J Hennig
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
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Kew M. Epidemiology of HBV infection and HBV-related hepatocellular carcinoma in Africa: natural history and clinical outcome. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1751-2824.2006.00018.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Hepatitis B virus (HBV) infection is widely distributed in both human and ape populations throughout the world and is a major cause of human morbidity and mortality. HBV variants are currently classified into the human genotypes A to H and species-associated chimpanzee and gibbon/orangutan groups. To examine the role of recombination in the evolution of HBV, large-scale data retrieval and automated phylogenetic analysis (TreeOrder scanning) were carried out on all available published complete genome sequences of HBV. We detected a total of 24 phylogenetically independent potential recombinants (different genotype combinations or distinct breakpoints), eight of which were previously undescribed. Instances of intergenotype recombination were observed in all human and ape HBV variants, including evidence for a novel gibbon/genotype C recombinant among HBV variants from Vietnam. By recording sequence positions in trees generated from sequential fragments across the genome, violations of phylogeny between trees also provided evidence for frequent intragenotype recombination between members of genotypes A, D, F/H, and gibbon variants but not in B, C, or the Asian B/C recombinant group. In many cases, favored positions for both inter- and intragenotype recombination matched positions of phylogenetic reorganization between the human and ape genotypes, such as the end of the surface gene and the core gene, where sequence relationships between genotypes changed in the TreeOrder scan. These findings provide evidence for the occurrence of past, extensive recombination events in the evolutionary history of the currently classified genotypes of HBV and potentially in changes in its global epidemiology and associations with human disease.
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Affiliation(s)
- Peter Simmonds
- Centre for Infectious Diseases, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, United Kingdom.
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Mendy M, Kirk GD, van der Sande M, Jeng-Barry A, Lesi OA, Hainaut P, Sam O, McConkey S, Whittle H. Hepatitis B surface antigenaemia and alpha-foetoprotein detection from dried blood spots: applications to field-based studies and to clinical care in hepatitis B virus endemic areas. J Viral Hepat 2005; 12:642-7. [PMID: 16255766 DOI: 10.1111/j.1365-2893.2005.00641.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In many resource-limited regions with endemic hepatitis B virus (HBV), there is limited infrastructure to collect, process, transport, and store blood samples for identification of persons with chronic HBV infection or with hepatocellular carcinoma (HCC). We describe the application of a simple technique using commercially available kits for detection of HBV surface antigen (HBsAg) and alpha-foetoprotein (AFP) in dried blood spots (DBS) collected on filter paper. Study participants included subjects with and without chronic HBV infection and subjects with HCC or cirrhosis. Three to five blood drops were dried on filter paper. Dried blood (equivalent to 20 muL) was eluted and tested for HBsAg by Determine(TM) HBsAg and for AFP by counter-current immuno-electrophoresis and radio-immunoassay (RIA). The primary analysis focused on comparison of DBS results to serum testing results as the gold standard. The sensitivity of DBS for detecting chronic HBV infection was 96% (98-98) with specificity of 100% (CI 99-100). Sensitivity of DBS in detecting AFP compared with serum RIA was 73% (60-86) with specificity of 90% (81-98). Both HBsAg and AFP recovery were unaffected when DBS were left at room temperature (30-33 degrees C) and under humid conditions for up to 28 days prior to elution. We conclude that DBS can be reliably used as an economical and logical alternative for detection of HBsAg in chronically infected patients and for AFP-based diagnosis of HCC in clinical situations which preclude adequate collection and processing of blood samples. Both research-oriented field studies and routine clinical care may benefit from application of these techniques in resource-limited settings.
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Affiliation(s)
- M Mendy
- Medical Research Council Fajara, Banjul, The Gambia, West Africa.
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Pinder M, Reece WHH, Plebanski M, Akinwunmi P, Flanagan KL, Lee EAM, Doherty T, Milligan P, Jaye A, Tornieporth N, Ballou R, McAdam KPMJ, Cohen J, Hill AVS. Cellular immunity induced by the recombinant Plasmodium falciparum malaria vaccine, RTS,S/AS02, in semi-immune adults in The Gambia. Clin Exp Immunol 2004; 135:286-93. [PMID: 14738458 PMCID: PMC1808944 DOI: 10.1111/j.1365-2249.2004.02371.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Vaccination of malaria-naive humans with recombinant RTS,S/AS02, which includes the C-terminus of the circumsporozoite protein (CS), has been shown to induce strong T cell responses to both the whole protein antigen and to peptides from CS. Here we show that strong T cell responses were also observed in a semi-immune population in The Gambia, West Africa. In a Phase I study, 20 adult male volunteers, lifelong residents in a malaria-endemic region, were given three doses of RTS,S/AS02 at 0, 1 and 6 months. Responses to RTS,S, hepatitis B surface antigen and peptides from CS were tested using lymphocyte proliferation, interferon (IFN)-gamma production in microcultures, and IFN-gamma ex vivo and cultured ELISPOT, before and after vaccination. Cytotoxic responses were tested only after vaccination and none were detected. Before vaccination, the majority of the volunteers (15/20) had detectable responses in at least one of the tests. After vaccination, responses increased in all assays except cytotoxicity. The increase was most marked for proliferation; all donors responded to RTS,S after the third dose and all except one donor responded to at least one peptide after the second or third dose. There was a lack of close association of peptide responses detected by the different assays, although in microcultures IFN-gamma responses were found only when proliferative responses were high, and responses by cultured ELISPOT and proliferation were found together more frequently after vaccination. We have therefore identified several peptide-specific T cell responses induced by RTS,S/AS02 which provides a mechanism to investigate potentially protective immune responses in the field.
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Affiliation(s)
- M Pinder
- Medical Research Council Laboratories, Banjul, The Gambia.
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Cobelens FGJ, van Schothorst HJ, Wertheim-Van Dillen PME, Ligthelm RJ, Paul-Steenstra IS, van Thiel PPAM. Epidemiology of Hepatitis B Infection among Expatriates in Nigeria. Clin Infect Dis 2004; 38:370-6. [PMID: 14727207 DOI: 10.1086/380968] [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] [Received: 07/07/2003] [Accepted: 09/23/2003] [Indexed: 11/03/2022] Open
Abstract
Adult expatriates in countries where hepatitis B virus (HBV) is highly endemic have an increased risk of HBV infection, but little is known about risks to their children or about patterns of spread. The epidemiology of HBV infection was studied among 124 unvaccinated Dutch missionaries and family members who lived in a rural area of Nigeria. Antibodies to hepatitis B core antigen were found in 5 (9.8%) of 51 adults (incidence rate, 1.7 per 1000 person-months at risk [PMAR]) and 9 (12.3%) of 73 children (incidence rate, 2.8 per 1000 PMAR). Vertical transmission of HBV was a likely source of infection in 1 child and was a possible source of infection in 2 others. The prevalence of HBV infection showed strong family clustering (P<.0001), was associated with a history of temporary adoption of Nigerian children (P=.004), and increased with both the number of adoptive children (P=.009) and the total time that these children had stayed in the family (P=.036). Horizontal transmission from adoptive Nigerian children probably played an important role in the spread of HBV infection in this expatriate community.
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Affiliation(s)
- Frank G J Cobelens
- Division of Infectious Diseases, Tropical Medicine, and AIDS, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Kirk GD, Lesi OA, Mendy M, Akano AO, Sam O, Goedert JJ, Hainaut P, Hall AJ, Whittle H, Montesano R. The Gambia Liver Cancer Study: Infection with hepatitis B and C and the risk of hepatocellular carcinoma in West Africa. Hepatology 2004; 39:211-9. [PMID: 14752840 DOI: 10.1002/hep.20027] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common cancer in The Gambia. Hepatitis B virus (HBV) infection is endemic, with 15% to 20% of the population being chronic carriers, whereas hepatitis C virus (HCV) prevalence is low. We recruited 216 incident cases of HCC and 408 controls from three sites. HBV carriage was present in 61% (129/211) of HCC patients and 16% (64/402) of controls, whereas 19% (36/191) of HCC patients were HCV seropositive compared with 3% (11/382) of controls. HCC patients with HCV were notably older and were more likely to be female than those with HBV. Increased HCC risk was strongly associated with chronic HBV (odds ratio, 16.7; 95% CI, 9.7-28.7), HCV (16.7; 6.9-40.1), and dual infection (35.3; 3.9-323). We interpret the additive nature of risk with coinfection as representative of HBV and HCV acting primarily through shared steps in the multistage process of hepatocarcinogenesis. HCV infection was not observed among younger participants, suggesting a possible cohort effect. Reasons for the striking age and gender differences in HCC associated with HBV compared with HCV are unclear, but transmission patterns and age at exposure may be factors. In conclusion, in a standardized evaluation of well-characterized study participants from The Gambia, most cases of HCC are attributable to HBV (57%), but HCV adds a significant fraction (20%), especially among older patients and females. If HCV transmission is not perpetuated in future cohorts, focusing available resources on HB vaccination efforts could greatly ameliorate a major cause of cancer death in sub-Saharan Africa.
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Affiliation(s)
- Gregory D Kirk
- Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Whittle H, Jaffar S, Wansbrough M, Mendy M, Dumpis U, Collinson A, Hall A. Observational study of vaccine efficacy 14 years after trial of hepatitis B vaccination in Gambian children. BMJ 2002; 325:569. [PMID: 12228132 PMCID: PMC124550 DOI: 10.1136/bmj.325.7364.569] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the duration of protection from hepatitis B vaccine given in infancy and early childhood. DESIGN Cross sectional serological study of hepatitis B virus infection in children of various ages 14 years after the start of a trial of vaccination regimens. SETTING Two villages in the Gambia. PARTICIPANTS Children and adolescents given hepatitis B vaccine in infancy or early childhood: 232 were aged 1-5 years, 225 aged 5-9 years, 220 aged 10-14 years, and 175 aged 15-19 years. MAIN OUTCOME MEASURES Vaccine efficacy against infection and against chronic infection in the different age groups. RESULTS Vaccine efficacy against chronic carriage of hepatitis B virus was 94% (95% confidence interval 89% to 97%), which did not vary significantly between the age groups. Efficacy against infection was 80% (76% to 84%). This was significantly lower in the oldest age group (65%, 56 to 73). Of the uninfected participants in this age group, 36% had no detectable hepatitis B virus surface antibody. Time since vaccination and a low peak antibody response were the most powerful risk factors for breakthrough infection (P<0.001 in each case). Low peak antibody response was also a risk factor for chronic carriage (odds ratio 95, 19 to 466). CONCLUSIONS Children vaccinated in infancy are at increased risk of hepatitis B virus infection in the late teens. The risk of chronic carriage after sexual exposure needs further assessment to determine if booster vaccines are necessary.
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Affiliation(s)
- Hilton Whittle
- Medical Research Council Laboratories, PO Box 273, Banjul, Gambia.
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40
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Montesano R. Hepatitis B immunization and hepatocellular carcinoma: The Gambia Hepatitis Intervention Study. J Med Virol 2002; 67:444-6. [PMID: 12116042 DOI: 10.1002/jmv.10093] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The Gambia Hepatitis Intervention Study (GHIS) was initiated by the International Agency for Research on Cancer (IARC) in 1986. It consisted of a randomized trial in the Gambian population, aiming to evaluate the protection provided by HBV vaccination administered during the first year of life against primary infection, the development of chronic carriage, and primary liver cancer. The results, reported at 9 years from the introduction of the vaccine as conferring a high degree of protection (83% against primary infection and 95% against chronic carriage), are briefly discussed. It is expected that HBV vaccination will result in a reduction of mortality from hepatocellular carcinoma, the most frequent cancer in males in sub-Sahara Africa.
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Armstrong GL, Mast EE, Wojczynski M, Margolis HS. Childhood hepatitis B virus infections in the United States before hepatitis B immunization. Pediatrics 2001; 108:1123-8. [PMID: 11694691 DOI: 10.1542/peds.108.5.1123] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To estimate the number of hepatitis B virus (HBV) infections among US children younger than 10 years before implementation of routine childhood hepatitis B immunization. METHODS Incidence of HBV infection in children was modeled from existing prevalence data by means of regression analysis. Sources of data for the models included published and unpublished surveys that determined the prevalence of HBV infection in US-born children. The number of nonperinatal HBV infections in children younger than 10 years was estimated by applying these infection rates to 1991 population data according to maternal race, ethnicity, and birthplace. RESULTS Estimated annual rates of infection ranged from 24 per 100 000 in non-Asian children to 2580 per 100 000 in children of Southeast Asian immigrant mothers. These rates indicate that by the early 1990s, HBV was infecting 16 000 children who were younger than 10 years (8700 non-Asian children and 7300 Asian-American children) annually. The total estimate, not including perinatal infections, ranged from 12 000 (95% confidence interval: 5500-27 700) to 24 900 (95% confidence interval: 16 700-42 300) infections and depended on how the estimated rates were applied to the population data. CONCLUSION Thousands of US children were infected each year with HBV before routine infant hepatitis B immunization, placing them at high risk of death from cirrhosis or hepatocellular carcinoma later in life.
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Affiliation(s)
- G L Armstrong
- Hepatitis Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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42
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Akuta N, Chayama K, Suzuki F, Someya T, Kobayashi M, Tsubota A, Suzuki Y, Saitoh S, Arase Y, Ikeda K, Kumada H. Risk factors of hepatitis C virus-related liver cirrhosis in young adults: positive family history of liver disease and transporter associated with antigen processing 2(TAP2)*0201 Allele. J Med Virol 2001; 64:109-16. [PMID: 11360242 DOI: 10.1002/jmv.1025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to clinically characterize young patients with hepatitis-C-related cirrhosis. We compared 27 patients with liver cirrhosis (Group LC) who were anti-HCV positive, aged 40 years or less at the time of diagnosis, with 323 consecutive patients with HCV-related chronic hepatitis (Group CH) matched for age and gender. Furthermore, Group LC was divided into two arbitrary groups (29-35 years, n = 8 /36-40 years, n = 19), based on the age of patients at the time of diagnosis of liver cirrhosis. Patients' characteristics and family history were investigated, and the frequency of transporter associated with antigen processing 2 (TAP2) was determined. A family history of liver disease was present in 40.7% of Group LC but in 18.0% of Group CH (P < 0.05). The younger the age of diagnosis of cirrhosis in Group LC, the higher the frequency of a positive family history (29-35 years, 87.5%; 36-40 years, 21.1%, P < 0.05). The frequency of TAP2*0201 was significantly higher in young adult patients with HCV-related liver cirrhosis than in HCV carriers with normal ALT (P < 0.05), and tended to be higher than in uninfected normal subjects (P = 0.05). The cumulative survival rate of cirrhosis patients with family history of liver diseases was significantly lower than that of cirrhosis patients without such history (P < 0.05). Our findings suggest that a positive family history of liver disease and TAP2*0201 polymorphism may be risk factors for HCV-related liver cirrhosis in young adults.
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Affiliation(s)
- N Akuta
- Division of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan.
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43
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Dumpis U, Holmes EC, Mendy M, Hill A, Thursz M, Hall A, Whittle H, Karayiannis P. Transmission of hepatitis B virus infection in Gambian families revealed by phylogenetic analysis. J Hepatol 2001; 35:99-104. [PMID: 11495049 DOI: 10.1016/s0168-8278(01)00064-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS Transmission of hepatitis B virus (HBV) in Africa occurs horizontally, with most people becoming infected between the ages of 1 and 5 years. The index cases in such events have been assumed to come from within the family unit or from sources outside the immediate family, such as other families or inhabitants of the same compound or village. Here, we define these routes of transmission by phylogenetic tree analysis of sequences from the entire pre-core/core region of the virus, in Gambian chronic carriers. METHODS Amplification by polymerase chain reaction of serum extracted HBV-DNA was followed by direct sequencing of the target region. Following editing and alignment of these sequences, phylogenetic tree analysis was performed using the neighbour-joining and maximum-likelihood methods. RESULTS Despite the overall conserved nature of the sequences of the pre-core/core region from 142 chronic carriers, distinct clusters were easily defined at the family and village level, but not on a wider geographical separation. CONCLUSIONS Phylogenetic tree analysis of sequences obtained from family members provided strong evidence of intrafamilial transmission of HBV in at least two-thirds of the families studied from Gambia.
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Affiliation(s)
- U Dumpis
- Department of Medicine A, Imperial College School of Medicine, London, UK
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44
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Medley GF, Lindop NA, Edmunds WJ, Nokes DJ. Hepatitis-B virus endemicity: heterogeneity, catastrophic dynamics and control. Nat Med 2001; 7:619-24. [PMID: 11329065 DOI: 10.1038/87953] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hepatitis-B virus infection is globally ubiquitous, but its distribution is very heterogeneous, with prevalence of serological markers in various nations ranging from less than 1% to more than 90%. We propose an explanation for this diversity using a mathematical model of hepatitis-B virus transmission dynamics that shows, for the first time, 'catastrophic' behavior using realistic epidemiological processes and parameters. Our major conclusion is that the prevalence of infection is largely determined by a feedback mechanism that relates the rate of transmission, average age at infection and age-related probability of developing carriage following infection. Using the model we identify possible, highly non-linear, consequences of chemotherapy and immunization interventions, for which the starting prevalence of carriers is the most influential, predictive quantity. Taken together, our results demand a re-evaluation of public health policy towards hepatitis-B.
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Affiliation(s)
- G F Medley
- Ecology and Epidemiology Group, Department of Biological Sciences, University of Warwick, Coventry, UK.
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45
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Abstract
We studied hepatitis B virus (HBV) transmission among 7416 Thai children from 148 schools in Kamphaeng Phet province, a rural part of northern Thailand. Their age ranged from 2 to 16 years (median 9 years). Between May 1991 and June 1992, 61 of 2593 (2.4%) in the cohort of susceptible children acquired anti-HBc immunoglobulin. Forty-seven of the 148 schools had children who acquired anti-HBc. School seroconversion rates to anti-HBc varied from 0% to 23%. There was no correlation between percent of carriers in schools and percent of anti-HBc acquisition. Of the 61 children who acquired anti-HBc, eight (13%) became HBsAg carriers but only two were symptomatic, for a clinical to subclinical infection ration of 1 : 30. One of the two symptomatic children became an HBsAg carrier. Three (38%) of the eight who were persistently antigenemic developed antibody to hepatitis B virus e antigen. Males were 2.5 times (95% CI 1.4-4.3) more likely to acquire anti-HBc than females. Risk factors for acquisition of HBc in Thailand over a 9-month period were examined in a subset of 2412 susceptible children and later in a case-control study of 22 children who acquired anti-HBc and 59 age and sex-matched controls. Risks for acquiring anti-HBc were male gender and a history of bleeding gums. In comparing this study to an earlier pilot study among 9848 children from the same area in Thailand, the yearly antibody acquisition rate to anti-HBc among Thai children dropped from 5.7% in 1989 to 2.4% in 1992. A random sample of children in the pilot study showed that 16% were HBsAg positive and 27% had anti-HBc at the beginning of the study. 34% had markers for either anti-HBc or HBsAg. 12% were repeatedly positive for HBsAg a year later.
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Affiliation(s)
- C A Kozik
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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46
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Kato H, Nakata K, Hamasaki K, Hida D, Ishikawa H, Aritomi T, Nakao K, Kato Y, Yano M, Eguchi K. Long-term efficacy of immunization against hepatitis B virus in infants at high-risk analyzed by polymerase chain reaction. Vaccine 1999; 18:581-7. [PMID: 10547415 DOI: 10.1016/s0264-410x(99)00320-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Perinatal transmission of hepatitis B virus (HBV) is a common cause of chronic infection. In the present study, we evaluated the long-term efficacy of immunization against HBV in infants at high-risk, by using polymerase chain reaction (PCR). Two hundred and fifty-one infants received hepatitis B immunoglobulin at birth and a course of hepatitis B vaccine within 6 months of age between 1981 and 1993. Of 251 infants, 203 (81%) and 97 (39%) were followed until 1 and 4-6 years of age, respectively. HBV-DNA was detected by PCR in 74 (36%) of 203 children at 1 year of age, while the prevalence rate of children positive for HBV-DNA decreased to 14 (14%) of 97 children at 4-6 years of age, including 2 children who had the breakthrough variants of HBV. Our results indicate that most of HBV infections occur early, during the first year, and that immunization against HBV effectively protects infants at high-risk against viral transmission, at least up to 4-6 years of age.
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Affiliation(s)
- H Kato
- The First Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, Japan
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47
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Viviani S, Jack A, Hall AJ, Maine N, Mendy M, Montesano R, Whittle HC. Hepatitis B vaccination in infancy in The Gambia: protection against carriage at 9 years of age. Vaccine 1999; 17:2946-50. [PMID: 10462228 DOI: 10.1016/s0264-410x(99)00178-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To estimate the efficacy in The Gambia (West Africa) of infant hepatitis B vaccination against infection and carriage with the virus at the age of 9 years. The HBV status of 9-year old children vaccinated in infancy was compared to that of unvaccinated children of the same age. Eight percent of the vaccinated children had been infected by HBV compared to 50% of the unvaccinated control group; HBV carrier status was 0.6 and 10% respectively, resulting in a vaccine efficacy of 83% against infection and of 95% against chronic carriage. The results show that infant vaccination provides a high level of protection at the age of nine years against both HBV infection and chronic carrier status and no booster dose of vaccine is required in the first decade. These findings support the WHO recommendation for the introduction of HBV vaccination into the Expanded Programme on Immunization in Africa.
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Affiliation(s)
- S Viviani
- The Gambia Hepatitis Intervention Study, International Agency for Research on Cancer, Fajara, Banjul
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48
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Menendez C, Sanchez-Tapias JM, Kahigwa E, Mshinda H, Costa J, Vidal J, Acosta C, Lopez-Labrador X, Olmedo E, Navia M, Tanner M, Rodes J, Alonso PL. Prevalence and mother-to-infant transmission of hepatitis viruses B, C, and E in Southern Tanzania. J Med Virol 1999; 58:215-20. [PMID: 10447415 DOI: 10.1002/(sici)1096-9071(199907)58:3<215::aid-jmv5>3.0.co;2-k] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hepatitis B and C markers were tested in 980 pregnant women, in the infants born to infected mothers, and in a random sample of 42 and 50, respectively, children born to uninfected mothers in Tanzania. Sixty-two women (6.3%) were positive for HBsAg and 15 (24%) were HBeAg-seropositive. Anti-HCV was detected in 49 women (5%), 15 (31%) of whom had detectable viremia. HCV RNA serum levels were low and only genotype 4 was identified. Sixty-six women (6.7%) were positive for anti-HIV, six of whom were coinfected with HBV and one with HCV. Anti-HEV was negative in the 180 women tested. At 8 months of age, HBsAg was detected in 8% and 2% of children born to HBV-infected and noninfected mothers, respectively (P = 0.2). Corresponding figures at 18 months of age were 31% and 21% (P = 0.3). When tested at 2 months of age, HCV RNA was not detected in any of the 43 children born to anti-HCV-positive mothers nor in any of 50 children born to anti-HCV-negative mothers. At 18 months, only one child, born to an anti-HCV-positive mother, had detectable HCV RNA. None of the infants born to women with HIV coinfection were infected with hepatitis viruses. This study suggests that exposure to HEV does not occur in southern Tanzania. The prevalence of current HBV infection in pregnant women from rural Tanzania is lower than in other sub-Saharan areas. In early childhood, HBV infection appears to occur by horizontal rather than maternofilial mechanisms of transmission. The prevalence of HCV infection is similar to that in other African countries. The results of this study show for the first time in Africa that mother-to-infant transmission does not play a significant role in the acquisition of HCV infection.
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MESH Headings
- Adolescent
- Adult
- Child
- Child, Preschool
- DNA, Viral/blood
- Female
- Follow-Up Studies
- Hepatitis B/epidemiology
- Hepatitis B/prevention & control
- Hepatitis B/transmission
- Hepatitis B Surface Antigens/blood
- Hepatitis B e Antigens/blood
- Hepatitis C/epidemiology
- Hepatitis C/prevention & control
- Hepatitis C/transmission
- Hepatitis E/epidemiology
- Hepatitis E/prevention & control
- Hepatitis E/transmission
- Hepatitis, Viral, Human/epidemiology
- Hepatitis, Viral, Human/prevention & control
- Hepatitis, Viral, Human/transmission
- Humans
- Infant
- Infectious Disease Transmission, Vertical
- Middle Aged
- Pregnancy
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/virology
- Prevalence
- RNA, Viral/blood
- Tanzania/epidemiology
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Affiliation(s)
- C Menendez
- Unidad de Epidemiologia y Bioestadistica, Institut d'Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain.
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Bisharat N, Elias M, Raz R, Flatau E. Familial pattern of infection with hepatitis B virus among immigrating Ethiopian Jews in Israel. Eur J Epidemiol 1998; 14:89-91. [PMID: 9517878 DOI: 10.1023/a:1007475714341] [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: 02/06/2023]
Abstract
Seventy-eight families (506 members) of recently immigrating Ethiopian Jews to Israel, were tested for the presence of HBV serological markers to evaluate the intrafamilial horizontal transmission of the virus. Eighty-four members (16.6%) were carriers and 20.2% were HBeAg positive, the overall infection rate was 67.8%. In 40 families (51.3%) at least one family member was HBsAG positive, and in 19 families (24.4%) two or more family members were HBsAg positive. Thirty-six carriers (42.8%) were children under the age of 10, by one year of age 30% have contracted the virus, and by the age of 5 and 10 years 43.5% and 57.1% have had serological markers for past HBV infection, respectively. Our data correlate with other studies regarding the importance of horizontal spread of HBV among Sub-Saharan Africans.
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Affiliation(s)
- N Bisharat
- Infectious Disease Unit, Central Emek Hospital, Afula, Israel
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50
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Triki H, Said N, Ben Salah A, Arrouji A, Ben Ahmed F, Bouguerra A, Hmida S, Dhahri R, Dellagi K. Seroepidemiology of hepatitis B, C and delta viruses in Tunisia. Trans R Soc Trop Med Hyg 1997; 91:11-4. [PMID: 9093616 DOI: 10.1016/s0035-9203(97)90374-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Serum samples from 33,363 healthy people in Tunisia have been tested for serological markers of hepatitis B, C and delta viruses (HBV, HCV and HDV). Hepatitis B surface antigen (HBsAg) was detected in 6.5% of sera. The overall seroprevalence of HBV was 37.5%. Vertical and perinatal transmission of HBV in the first 3 months of life occurred in only 0.4% of 177 mother and child pairs. HBV seroprevalence was 10.7% in infants under 5 years old and increased with age rapidly till 25 years of age and then more slowly in adulthood, reaching 54% for people aged over 40 years. HBsAg seropositivity varied throughout the country, ranging from 3% to 13% with higher prevalences in the south and central-west regions. Overall seroprevalences for HDV and HCV were 17.7% and 0.4%, respectively. HDV superinfection occurred later than HBV and increased with age in parallel with HBV. Overall, HCV and HBV infections had different geographical distributions throughout the country. The study confirmed the high prevalence of HBV infection in Tunisia; it occurs mainly in children and teenagers, and vertical and perinatal transmission of HBV does not appear to be significant. HDV superinfection is quite common in Tunisia and occurs in almost 44% of individuals infected with HBV. In contrast, seroprevalence of HCV in the Tunisian general population was low (0.4%). These results indicate differences in the distribution of the viruses and/or different routes of transmission.
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Affiliation(s)
- H Triki
- Institut Pasteur, Tunis, Tunisia
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