Update on global epidemiology of viral hepatitis and preventive strategies

HCV and HBV genotypes: vital in the progression of HCV/ HBV co-infection

BACKGROUND

Viral hepatitis is the major contributor to liver cirrhosis and hepatocellular carcinoma (HCC). Studies indicated that the co-infection of hepatitis C and hepatitis B virus also prompts liver damage progression. Therefore, in the present study, the prevalence of HCV-HBV co-infection and the impact of HCV-HBV co-infection on the progression of liver damage was evaluated amongst the HCV-infected patients in Pakistan.

METHODS

In this study 2500 HCV-positive patients were recruited from Pakistan. The presence and prevalence of HCV and HBV was confirmed through ELISA and nested PCR. To determine the liver damage due to viral infection levels of ALT, ALP, and total bilirubin were also determined. Diagnostic history of patients was thoroughly documented through serological tests and liver biopsy reports. Viral genotypes and viral loads were determined through multiplex polymerase chain reaction (PCR) and time PCR, respectively.

RESULTS

The study outcomes showed that 12.5% of the HCV-infected patients were co-infected with HBV. Co-infection development was more common in females than in males, and females were at a higher risk of developing the infection (p-value = < 0.0001, OR = 2.437). Despite the variation among different age groups, there was no significant difference in co-infection prevalence. HCV genotype 3a was found to be most prevalent while in HBV genotype D was found to be prevalent among the patients. The HCV patients frequently developed co-infection with HBV genotype D. It was also determined that viral load for HBV genotype D was higher compared to non-D genotypes while for HCV viral load was higher in non-3a genotypes.

CONCLUSIONS

This study evaluated the prevalence of HCV and HBV co-infection among HCV-positive patients, revealing that 12.5% patients were co-infected with HBV. Co-infection was more common in females, who had a higher risk of developing it. The study also revealed that HBV genotype D was the most prevalent in co-infected patients, with no significant age-related differences in co-infection rates.

Assessment of human Herpes Virus-8 infection in Iranian cirrhotic patients on the waiting list for liver transplantation: A cross-sectional analysis

Background

Human Herpes Virus 8 (HHV-8) is involved in autoimmunity. However, its association with advanced liver disease has not been fully explained. Herein, the prevalence of HHV-8 viremia was assessed in Iranian liver transplant candidates with a confirmed diagnosis of cirrhosis.

Methods

This cross-sectional study was conducted on 230 patients with cryptogenic cirrhosis, virus-related cirrhosis, and autoimmune hepatitis, as well as 140 healthy blood donors from April 2022 to September 2023. The HHV-8 IgG antibody concentration and viral load were evaluated via ELISA and RT‒PCR, respectively.

Results

Anti-HHV-8 IgG antibodies were detected in 25 cirrhotic patients (10.8 %) and four healthy individuals (2.6 %) (p = 0.022). The majority of the seropositive patients had cryptogenic cirrhosis (20.4 %), followed by autoimmune hepatitis (13.1 %) and virus-related cirrhosis (4.7 %). The seropositivity of HHV-8 IgG antibody was significantly different among the etiologies of liver cirrhosis (p = 0.011). However, HHV-8 genomic DNA was not detected in the sera of the patients or healthy blood donors.

Conclusion

The role of HHV-8 infection in the development of posttransplant diseases, together with the higher seroprevalence of HHV-8 antibodies in cirrhotic patients than in healthy individuals, highlights the importance of both primary and latent infections in liver transplantation. Therefore, serological and molecular screening of HHV-8 is highly suggested for liver transplant candidates and organ donors. The possibility of antibody-mediated epitope mimicry in cryptogenic and autoimmune groups with moderate HHV-8 antibody positivity and negative viral loads may account for the development of advanced liver diseases.

REASSURED evaluation of the Bioline HCV point-of-care testing for diagnosing hepatitis C virus infection in primary healthcare settings of Ghana: a study protocol

INTRODUCTION

Hepatitis C virus (HCV) infection is a silent epidemic that needs a comprehensive and contextualised approach to manage. Access to readily available, affordable and acceptable HCV point-of-care (POC) in vitro diagnostics (IVDs) is equally required to meet the global HCV goals. However, most guidelines for evaluating these IVDs such as the WHO prequalification process and country-specific standards disproportionately focus on diagnostic performance. The real-time connectivity, ease of specimen collection, affordability, sensitivity, specificity, user-friendliness, rapidity and robustness, equipment-free or simplicity and deliverability to end-users (REASSURED) criteria provide a holistic and user-oriented evaluation of the IVDs in the populations they are meant to be used. Therefore, as part of a multinational study in sub-Saharan Africa, we will conduct an evaluation of the Bioline HCV POC test for diagnosing HCV infection in primary healthcare settings of Ghana using the REASSURED criteria.

METHODS AND ANALYSIS

This field evaluation will be conducted in three phases. The first phase will use a cross-sectional field evaluation study design to evaluate the diagnostic performance of the Bioline HCV POC test. The second phase will use mixed methods to ascertain operational characteristics and users' perceptions. In the third phase, a cross-sectional survey will be used to estimate the costs of accessing HCV diagnostics services using three proposed HCV testing models to inform the affordability of the testing pathways and linkage to care in the primary healthcare clinics. This phase will run concurrently with the second phase of the study. Thematic content analysis and quantitative data analysis will be performed using ATLAS.ti V.23.0.6 and StataCorp LLC's Stata statistical software V.16.0, respectively.

ETHICS AND DISSEMINATION

The study protocol has been reviewed and fully approved by the Faculty of Health Sciences Research Ethics Committee, University of Pretoria (281/2023) and the Ghana Health Service Ethics Review Committee (GHS-ERC013/08/23). This diagnostic trial has also been registered in the Pan African Clinical Trial Registry (PACTR202410837698664). The findings of the study will be presented in relevant peer-reviewed journals, at local and international conferences, and to all stakeholders involved.

Seroprevalence of viral hepatitis B and C infections among healthcare workers in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Healthcare workers (HCWs) are at higher risk of contracting hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Currently, there is no estimate of pooled data on the prevalence of HBV and HCV infections among HCWs in the country. Thus, this review aimed to determine the pooled prevalence of hepatitis B and C infections among HCWs in Ethiopia.

MATERIALS AND METHODS

A comprehensive literature search was conducted using electronic databases, including PubMed, Cochrane Library, Science Direct, Hinari, and African Journals Online to identify pertinent articles from the inception to April 2024. The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024527940) and conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted independently by two authors and analyzed using STATA version 11 software. A random-effect model and Egger's test were computed to estimate the pooled prevalence and assess publication bias, respectively.

RESULTS

A total of 18 studies involving4,948 healthcare workers were included in this review to estimate the pooled prevalence of HBV and HCV infections among HCWs in Ethiopia. The overall prevalence of HBV was 5.93% (95% CI; 3.22-8.63). The sub-group analysis showed that the prevalence of HBV among medical waste handlers and health professionals was8.6% (95% CI; 3.01-14.13) and 4.98% (95% CI; 1.85-8.11), respectively. The combined prevalence of HCV was 1.12% (95% CI; -4.19-6.43). In the sub-group analysis, the prevalence of HCV among medical waste handlers and health professionals was1.44% (95% CI; -5.28-8.18) and 0.59% (95% CI; -8.09-9.27), respectively.

CONCLUSION

In this review, we found a higher (5.93%) and moderate (1.12%) prevalence of HBV and HCV infections, respectively among Ethiopian HCWs. Therefore, to reduce the infectious burden of HBV and HCV among HCWs; there is a need to strict adherence to infection prevention and control measures. In addition, adequate HBV vaccination coverage for HCWs is mandatory to reduce the burden of HBV infection in the country.

A Multicentre Cross-Sectional Study on Hepatitis B Vaccination Coverage and Associated Factors Among Personnel Working in Health Facilities in Kumasi, Ghana

Background: As part of efforts to reach the elimination target by 2030, the WHO and CDC recommend that all HCWs adhere to the three-dose Hepatitis B vaccination schedule to protect themselves against the infection. This study assessed Hepatitis B vaccination coverage and associated factors among personnel working in health facilities in Kumasi, Ashanti Region, Ghana. Materials and Methods: A cross-sectional study involving 530 HCWs was conducted in four hospitals in Kumasi from September to November 2023. An investigator-administered questionnaire was employed in gathering participant demographics and other information related to vaccination coverage. IBM SPSS Version 26.0 and GraphPad Prism 8.0 were used for analysing the data. Results: Even though the majority (70.6%) reported having taken at least one dose of the vaccine, only 43.6% were fully vaccinated (≥ 3 doses). More than a quarter (29.4%) had not taken any dose of the HBV vaccine. Close to a quarter (23.6%) had not screened or tested for HBV infection in their lifetime. The statistically significant variables influencing vaccination status were age, marital status, profession, and status in the hospital. Nearly one-half (44.9%) of the participants who have not taken the vaccine reported they do not have a reason for not taking it, and a high proportion (80.1%) were willing to take the vaccine when given for free. Conclusion: To combat the low Hepatitis B vaccination coverage among healthcare workers in Kumasi, Ghana, amidst the significant public health threat of HBV infection, comprehensive measures are necessary. These include implementing infection prevention control programmes, enhancing occupational health and safety, and conducting health promotion campaigns in healthcare facilities. Extending and intensifying Hepatitis B screening and vaccination initiatives to tertiary institutions and encouraging employers, supervisors, or team leaders to provide these services nationwide are also recommended.

Knowledge, attitude, and practices towards hepatitis infection and its associated factors among adults in Gondar town, northwest Ethiopia; a community-based study, 2021

BACKGROUND

Hepatitis virus infection remains a serious public health concern worldwide. Percutaneous, mucosal, or non-intact skin exposure to infectious blood, semen, and other body fluids are the major routes of infection in endemic areas, including Ethiopia, where little is known about the community's knowledge, attitudes, and practice toward hepatitis infection. Thus, this study aimed to determine the knowledge, attitude, and practices towards hepatitis infection among adults in Gondar town.

METHODS

A community-based cross-sectional study was conducted from July to August 2021 on a total of 390 participants. Proportional sample allocation was used in 3 randomly selected sub-cities. Then, study participants from randomly selected households were recruited by using a systematic random sampling technique. Socio-demographic data and questions regarding KAP were collected via a self-administered and interviewer-administered questionnaire. Statistical analysis was performed using SPSS version 20. Logistic regression analyses were used to identify the associated factors and a p-value < 0.05 was considered statistically significant.

RESULTS

The mean age of the study participants was 30 ± 8.43 years and more than half ½ (53.3%) ranged from 26 to 40 years old. In this study, 335 (85.9%) of study participants had poor knowledge about hepatitis infection. About 344 (88.2%) had a negative attitude toward hepatitis infections, and 344 (88.2%) of the participants had a poor practice to prevent hepatitis infections. Multivariate analysis affirmed that having vaccination for hepatitis infection was significantly associated with a positive attitude (AOR, with 95% CI: 2.135 (1.006-4.532) and good practice levels (AOR, with 95% CI: 22.623 (0.032-0.156).

CONCLUSIONS AND RECOMMENDATIONS

In this study majority of the participants have poor knowledge, attitudes, and practices toward hepatitis infection. Therefore, targeted community-based interventions are necessary. However, this study revealed that having vaccination for hepatitis infection was significantly associated with a positive attitude and good practice levels among the study participants.

Hepatitis B vaccine responders show higher frequencies of CD8+ effector memory and central memory T cells compared to non-responders

Hepatitis B (HB) infection is a major global health problem. There is limited knowledge about HB vaccination-induced immune memory responses. We compared the frequency of CD8+ memory T cell subsets between responders (RSs) and non-responders (NRs) to HB vaccination. Blood samples were collected from RSs and NRs. PBMCs were cultured in the presence of Hepatitis B surface antigens (HBsAg) and PHA for 48 h to restimulate CD8+ memory T cells and T cell memory subsets were detected by flow cytometry using memory cell markers. The frequency of TEM, TCM, and TCM hi was significantly higher in responders compared to non-responders (p = 0.024, 0.022, and 0.047, respectively). Additionally, we report a positive correlation between the frequency of TEM cells in RSs with age and anti-HBsAb level (p = 0.03 and rs = 0.5; p = 0.01 and rs = 0.06). Responders display a higher level of CD8+ T cell-mediated immunity. Therefore, we suggest a possible defect in the formation of immunological CD8+ memory T cells in NRs and it may reduce antibody production compared to the RSs, although more experiments are needed.

Long Lasting Insecticide-Treated Nets Utilization and Associated Factors Among Pregnant Women in Shebel Berenta District, Northwest Ethiopia

Background

Insecticide-treated bed nets are cost-effective vector control methods for malaria prevention. Malaria during pregnancy poses a significant health problem in Ethiopia. This study aimed to assess insecticide-treated nets utilization and associated factors among pregnant women in Shebel Berenta District, Northwest Ethiopia.

Objective

To assess insecticide-treated bed nets utilization and associated factors among pregnant women in Shebel Berenta District, Northwest Ethiopia, in 2023.

Methods

A community-based cross-sectional study was conducted from March 15 to April 30, 2023, on 505 randomly selected pregnant women. Data were collected using a pre-tested structured questionnaire and observational checklist, analyzed with EpiData 3.1 and SPSS 25. Significant factors associated with long-lasting insecticide-treated nets were identified (P < .05, 95% CI) and were reported as statistically significant factors associated with the utilization of insecticide-treated bed nets.

Results

The utilization of long-lasting insecticide-treated nets was 45.10% [95% CI: 40.5%-49.2%]. Mothers who had antenatal care follow-up (AOR = 3.359; 95%CI: 1.829, 6.166), mothers with illiterate educational status (AOR = 0.196; 95%CI: 0.064-0.603), and mothers who had received information (message) (AOR = 8.102; 95%CI: 3.942-16.653) were significantly associated with long lasting insecticide-treated net utilization.

Conclusion

Utilization of long lasting insecticide-treated nets by pregnant women was 45.1%, which was lower than the WHO standard. Attending antenatal care, receiving information (messages) about malaria and long lasting insecticide-treated net, and mother's being literate had a substantial impact on long lasting insecticide-treated net utilization. Therefore, efforts should be made to strengthen ANC service, health information and women's educational status to increase utilization of long lasting insecticide-treated nets.

Assessing the Efficacy of Novel Antiviral Therapies in Treating Hepatitis C

Hepatitis C virus (HCV) infection is a major global health burden, with an estimated 58 million people chronically infected worldwide, according to the World Health Organization (WHO). While many people remain asymptomatic during the early stages of infection, chronic hepatitis C can cause long-term liver damage, significantly increasing the morbidity and mortality associated with the disease. The primary objective of this technical report is to find the efficacy of novel antiviral therapies in treating hepatitis C in a tertiary care hospital in Lahore. This technical report was done in Shalamar Hospital, Lahore, from June 2023 to June 2024. Data for the report were collected retrospectively from 500 patients through a review of patient medical records from the hospital. Medical and electronic health records provided the patient demographics (age, gender, ethnicity), hepatitis C genotype, liver disease stage (fibrosis or cirrhosis staging), previous treatment history, and type of antiviral therapy administered (direct-acting antivirals (DAA)). Out of 500, there were 280 (56%) male and 220 (44%) female patients. The mean age of the patients was 41.23±5.67 years. Patients were divided among mild, advanced, and post-liver transplant as 320 (64%), 150 (30%), and 30 (6%), respectively. Among the DAA regimens, sofosbuvir-based therapies had the highest sustained virologic response (SVR) rate of 95%, followed by glecaprevir/pibrentasvir at 93%. Ledipasvir/sofosbuvir and other DAAs showed slightly lower SVR rates, at 89% and 87%, respectively, indicating high overall efficacy across different therapies. This report concluded that DAAs are highly effective in treating hepatitis C, with an overall SVR rate of 92% and good tolerability across most patient groups. However, patients with genotype III, advanced liver disease, or post-liver transplant status may require personalized treatment approaches due to slightly lower efficacy.

Prevalence of occult hepatitis C virus infection (OCI) among hemodialysis patients; a cross-sectional study from Lorestan Province, Western Iran

Patients with chronic kidney disorders, such as hemodialysis, are at a higher risk of infection with hepatitis viruses than the other population due to high nosocomial transmission by the dialysis units. The incidence of occult HCV infection (OCI) among chronic hemodialysis (CHD) remains controversial and the real burden of HCV in this population may be affected by the rate of OCI. This study aimed to evaluate the prevalence of OCI among patients with CHD from Lorestan province, Western Iran. In this cross-sectional study, whole blood samples were collected from 122 patients with CHD. Subsequently, anti-HCV antibody and HCV-RNA were assessed in serum/peripheral blood mononuclear cells (PBMCs) using Enzyme-Linked Immunosorbent Assay and Real-Time PCR technique, respectively. Out of the 122 patients, 61.15% were male and 38.8% were female. Regarding HCV results, out of the 122 studied patients, 4 cases (3.3%) were positive for anti-HCV IgM Ab and 3 patients (2.47%) for anti-HCV IgG Ab in their serum. Moreover, none of the 122 patients were positive for HCV-RNA in serum samples, while in PBMC samples, two patients (1.6%) tested positive for HCV-RNA, of which one patient was anti-HCV IgG Ab positive. Furthermore, the prevalence of OCI was correlated with the history of blood transfusion and serum level of transaminases (P = 0.012). The results of the current study suggest that there is a potential risk of occult HCV infection among patients undergoing hemodialysis. Therefore, it is necessary to use appropriate molecular techniques for early diagnosis and treatment of these patients.

Molecular characterisation of hepatitis A in the Western Cape province, South Africa in 2023

In 2023, passive laboratory-based surveillance showed an increase in hepatitis A virus (HAV) infection. We investigated hepatitis A incidence using the notifiable medical condition surveillance system (NMCSS) data and molecularly characterised positive blood samples from the Western Cape province for 2023. All HAV IgM seropositive cases from the NMCSS from 1 January to 31 October 2023 in South Africa were investigated. HAV RNA from blood samples that had tested positive for HAV IgM from Western Cape was amplified in the VP1/P2B junction and sequenced (3500Xl Genetic Analyser). Sequences were assembled, aligned (Sequencher) and analysed (Aliview 1.27 and MEGA11). Statistical analysis was performed using Excel and the CuSum2 Threshold to determine suspected outbreaks. In 2023, the incidence of HAV IgM was 6.28/100,000 in South Africa, with the highest incidence in Western Cape province (15.86/100,000). Children aged 5 to 14 years were affected the most in the Western Cape. The positive cases in the Western Cape were above the CuSum2 threshold from January to May 2023, with the highest incidence observed in the City of Cape Town Metropolitan (14.8/100,000). Genotyping was successfully performed on 92.7% (139/150) of serum samples, for which the IB sub-genotype was detected. Three primary mutations R63K, R71S and M104I were observed in more than 49% of the samples. Most of the samples sequenced belonged to patients residing in areas close to each other within the City of Cape Town Southern, Western, and Mitchells Plain sub-districts. The CuSum2 threshold method allowed the identification of suspected HAV outbreaks in the districts within the Western Cape in 2023 while genotyping identified clusters of sub-genotype IB. Genotyping could assist with determining the common source of infection during an outbreak, especially if coupled with epidemiological and geographical data. Further active surveillance can assist in investigating the HAV risk factors for targeted public health responses.

Factors affecting the prevention of unwanted pregnancies among young adolescents in secondary schools in the Eastern Province of Rwanda: An explorative qualitative study

INTRODUCTION

The escalating number of teenage pregnancies, especially in the Eastern province of Rwanda, continues to raise concerns regarding the sexual and reproductive health of adolescents in the country. Recent statistics indicate that 5% of adolescent girls between the ages of 15 and 19 have given birth and 4% are currently pregnant with their first child. This highlights the critical need for comprehensive sexual and reproductive health education tailored for adolescents. However, there is limited evidence on factors affecting adolescents' efforts to prevent unwanted pregnancies and sexually transmitted infections in the Eastern Province of Rwanda, and the support systems available to adolescents in secondary schools, including the role of parents in promoting their sexual and reproductive health to minimize the risky sexual practices.

METHODS

An explorative qualitative study utilizing focus group discussions was conducted to garner the perspectives of 118 adolescents enrolled in six twelve-year-basic-education schools from three districts of the Eastern Province of Rwanda. Thematic analysis was employed to identify themes related to the impact of various factors on adolescents' sexual and reproductive health as they navigate through the physical and emotional changes from puberty to adolescence.

RESULTS

Adolescents are aware of the potential consequences of engaging in unprotected sexual intercourse which include the risk of unplanned pregnancy, sexually transmitted infections, HIV/AIDS, and emotional distress. Female participants emphasized that young girls who do not receive adequate support upon becoming pregnant prematurely may encounter depression, discontinue their education, face the harsh reality of extreme poverty, and struggle significantly in assuming the responsibilities of parenthood as young single mothers. Adolescents highlighted the lack of parental guidance concerning sexual and reproductive matters as a significant obstacle in their pursuit of a healthy and safe sexual and reproductive health during adolescence.

CONCLUSION

Inadequate parental engagement still hinders adolescents in navigating the physical bodily, mental, and emotional changes during adolescence. This affects their capacity to make well-informed decisions to prevent adverse consequences such as unintended pregnancies, substance misuse, sexually transmitted infections, and HIV/AIDS resulting from unsafe sexual practices. Since this study was qualitative, quantitative data necessary for a precise evaluation of the extent of the problem related to the absence of parental involvement in educating adolescents on sexual and reproductive health needs further research.

Detection of hepatitis viruses in suspected cases of Viral Haemorrhagic Fevers in Nigeria

There have been several Viral Hemorrhagic Fever (VHF) outbreaks in Nigeria which remains a public health concern. Despite the increasing number of suspected cases of VHF due to heightened surveillance activities and growing awareness, only a few cases are laboratory-confirmed to be VHF. Routinely, these samples are only tested for Lassa virus and Yellow fever virus with occasional testing for Dengue virus when indicated. The aetiology of the disease in these VHF suspected cases in Nigeria which are negative for Lassa, Yellow fever and Dengue viruses remains a puzzle. Since the clinical features exhibited by suspected VHF cases are like other endemic illnesses such as Hepatitis, there is a need to investigate the diversity and co-infections of hepatitis viruses as differentials and possible co-morbidity in suspected cases of VHFs in Nigeria. A total of three hundred and fifty (350) blood samples of 212 (60.6%) males and 138 (39.4%) females, aged <1-70 years with a mean age of 25 ±14.5, suspected of VHFs and tested negative for Lassa, Yellow fever and Dengue viruses were investigated for Hepatitis A, B, C and E viruses at the Centre for Human and Zoonotic Virology (CHAZVY), College of Medicine, University of Lagos (CMUL) using serologic and molecular techniques. The serologic analysis of these VHF suspected cases samples revealed that 126 (36%) were positive for at least one hepatitis virus. Individual prevalence for each of the hepatitis virus screened for showed that 37 (10.6%), 18 (5.1%) and 71 (20.3%) were positive for HBV, HCV and HEV respectively. All the samples were negative for HAV. A co-infection rate of 11.9% was also observed, with HCV/HEV co-infections being the most prevalent and the Northern region having the greatest burden of infection. The evidence of hepatitis virus infections in suspected cases of VHF was documented. Thus, their associations as co-morbidities and/or mortalities in this category of individuals require further investigations in endemic countries such as Nigeria. Therefore, the possible inclusion of screening for hepatitis viruses and other aetiologic agents that could mimic infections in suspected cases of VHFs in Nigeria should be thoroughly evaluated to guide informed policy on the diagnosis and management of these cases.