Prevalence and risk factors of hepatitis B virus infection in Bahrain, 2000 through 2010

Risk Factors for Hepatitis B Virus Infection in North Ethiopia: A Case-Control Study

Background

Hepatitis B virus infection (HBV) is an important clinical and public health problem that contributes to liver-related public health morbidity and mortality. Although childhood vaccination was introduced in 1980, hospital admissions, morbidity and mortality rates from HBV infection increased in Ethiopia. Risk factors for HBV infection and associated complications generally vary from case to case. No epidemiological studies have identified the risk factors for HBV infection in northern Ethiopia. Therefore, this study aimed to identify risk factors for HBV infection in specialist and teaching hospitals in Ayder.

Methods

From March 2019 to May 2019, an unmatched hospital-based case-control study has been carried out on a total of 213 patients [71 cases and 142 controls] in northern Ethiopia. Cases were selected sequentially and two consecutive controls were selected for each case by a simple random method. The data were collected using pretested questionnaires structured by the interviewer as part of a face-to-face interview. Data were entered in Epi Data version 3.1, exported and analyzed with SPSS version 22. Binary and multivariable logistic regression analyses were used. Statistical significance was given as P <0.05.

Results

Multivariate logistic regression analysis revealed that patients with familial exposure to hepatitis (AOR 3.7, 95% CI: 1.5-9.01), prior traditional medical procedure (AOR 1.2, 95% CI: 1.08-3.4), any history of dental procedures (AOR 3.8, 95% CI: 1.8-9.01) were associated risk factors to hepatitis B virus infection, and awareness of sexually transmitted hepatitis B virus infection (AOR 0.084, 95% CI: 0.01-0.6) is less likely to be infected with hepatitis B virus infection.

Conclusion

This study (findings) demonstrated that contact with a case of hepatitis in the family, history of dentist visits, prior traditional medical procedure, and lack of awareness of its transmission through sexual contact have been identified as independent risk factors for the development of hepatitis B virus infection.

Prevalence of Hepatitis B Virus infection in the Gulf Cooperation Council: a systematic review and meta-analysis

Background

Hepatitis B virus (HBV) infection is a global public-health problem. Since the introduction of an effective vaccine, the epidemiology of HBV infection is changing. We aimed to estimate the prevalence of HBV infection in the Gulf Cooperation Council (GCC) region and delineate any variation in member-countries, special sub-groups, and over time.

Methods

This is a systematic review and meta-analysis to review studies of HBV prevalence in the GCC region. Databases were searched and all studies from inception to July 31st, 2021, were considered for inclusion. The pooled HBV prevalence was analyzed using the random-effect model after assessment for heterogeneity. True prevalence was adjusted using the Rogan-Gladen estimator. Pre-defined subgroup analysis was performed, and publication bias was assessed.

Results

Overall, 99 studies (n = 1,944,200 participants) met the inclusion criteria. The overall HBV apparent prevalence was 3.05% (95% CI 2.60, 3.52) and the true prevalence was 1.67% (95% CI 1.66, 1.68). The apparent prevalence varied between subgroups. Over time, the apparent prevalence of HBV infection has declined from 9.38% (95% CI 7.26, 11.74) before 1990 to 1.56% (95% CI 1.07, 2.12) during the period 2010 to 2020.

Conclusion

Over the last four decades the overall prevalence of HBV infection in the GCC region has decreased from high- to low-endemicity level. However, due to poor methodology of the included studies, further high-quality community-based studies are needed to obtain more precise estimate of HBV infection in this region.

Prevalence of Hepatitis B Infection Among Pregnant Women in Oman

Objective

The primary objective of our study was to estimate the prevalence of hepatitis B infection among pregnant women in Oman. The secondary objectives were to test for other hepatitis B virus (HBV) serological markers and to determine hepatitis B viral load.

Methods

In this cross-sectional study conducted from June 2019 to December 2020, we randomly selected 2210 Omani women who attended antenatal clinics across the country. Pregnant women were tested for HBV surface antigen (HBsAg) using a commercial enzyme immunoassay; those who tested positive were further analyzed for other HBV serological markers: HBV core total antibody (anti-HBc), HBV core antibody IgM (immunoglobulin M) (anti-HBc IgM), hepatitis B virus e antigen (HBeAg) and hepatitis B virus e antibody (anti-HBe). They were also tested for hepatitis B viral load.

Results

This study included 2210 women with a mean age of 39 years. Ninety-five percent of the women who were invited to participate consented and were included in the study. Thirty-three (1.49%) tested positive for HBsAg. All participants tested negative for HBeAg and anti-HBc IgM and positive for anti-HBc and anti-HBe, and 30 (90.9%) women had their hepatitis B viral load measured. Three (10.0%) had undetectable viral loads, 23 (76.7%) had low viral loads of < 2000 (IU/ml), 2 had moderate viral loads between 2000 and 200,000 (IU/ml) and one had a high viral load of 486,000 (IU/ml).

Conclusion

Our study shows that the HBV prevalence in pregnant women is 1.49%, which is lower than what was reported earlier. Nevertheless, antenatal screening is still warranted, as there are vital interventions for the newborn and the mother.

Prevalence of hepatitis B virus and associated risk factors among adults patients at Dessie referral and Kemise general hospitals in northeastern Ethiopia

Background and Aims

Hepatitis is an inflammation of the liver that can reason a variety of health problems and can be fatal. According to the most recent estimates of the Global Burden of Disease study and WHO, viral hepatitis is accountable for around 1.34 million deaths yearly, which is comparable to the yearly number of deaths from HIV/AIDS (1.3 million), malaria (0.9 million), and tuberculosis (1.3 million). This study aimed to assess the prevalence of the Hepatitis B virus and associated risk factors among adults patients at Dessie Referral and Kemise General Hospitals.

Methods

The source for the data on Hepatitis B virus (HBV) was all adults aged≥18 years that were admitted and tested for HBV from September 2020 to February 2021 were included in the study. A total of 1283 adults were admitted out of which, 1080 adults have completed measurements and had been taken into consideration for this examination, and others had been excluded from the examination because of exclusion criteria. To meet our objective descriptive statistics, the χ 2 test and multiple logistic regression statistical models were used for data analysis.

Results

In this study, a total of 1080 adults were included out of which 631 (58.4%) female and 449 (41.6%) were male with a mean age of 34(SD ±±  12.56) years. The overall prevalence of HBV among adults was 27.4% (95% confidence interval [CI];24.8-30.2). The results of this study showed that age 25-34(odds ratio [OR] = 3.6, p-value = 0.005), 35-44 (OR = 6.67, p-value <0.001), ≥45 (OR = 3.85, p-value = 0.005), male (OR = 4.36, p-value < 0.001), history of hospitalization (OR = 0.644, p-value = 0.04), family history of HBV (OR = 1.96, p-value = 0.005), and jaundice (OR = 2.50, p-value = 0.005) were significant risk factors of HBV.

Conclusion

The prevalence of HBV in this study is 27.4%. The results of this study showed that age, male, history of hospitalization, family history of HBV, and jaundice were significant risk factors for Hepatitis B virus.

Evaluation of a universal hepatitis B vaccination program and antenatal screening for hepatitis B surface antigen: Results from a real-world study 2015-2016

BACKGROUND AND AIMS

Universal vaccination against hepatitis B virus (HBV) in infancy was implemented in Israel in 1992. This population-based study aimed to evaluate the coverage rate and cost-benefit of the HBV vaccination program among infants in Israel and the Hepatitis B surface antigen (HBsAg) status in their mothers.

METHODS

Using the database of a health maintenance organization with 2 million members, we retrospectively identified, all the infants born in 2015-2016 and their mothers. Maternal data collected included age, ethnicity, country of birth and HBsAg status during pregnancy. HBV vaccination coverage among infants was calculated. A cost-benefit analysis of the HBV vaccination program was conducted based on the actual costs of HBV infection treatments in all HBsAg positive mothers.

RESULTS

Our cohort included 72,792 mothers who gave birth to 77,572 live infants. A total of 71,107 (97.7%) mothers were screened for HBV during pregnancy, of them 124 (0.2%), who gave birth to 132 infants were HBsAg positive. HBV vaccination coverage rates were 94%, 93% and 89%, for the first, second and third dose, respectively. Birth dose coverage of 95% among infants born to HBsAg positive mothers was significantly higher compared to HBsAg negative or unscreened mothers (p < 0.001). The percentage of HBsAg positivity among mothers who were born in Israel, the Former Soviet Union or Ethiopia, were 0.1%, 0.8% and 5%, respectively (p < 0.001). Ethnic differences were not found between HBsAg positive and HBsAg negative mothers. Calculated benefit-to-cost ratios were 1.24:1 and 4.15:1, with and without antenatal HBsAg screening, respectively.

CONCLUSIONS

The Israeli vaccination program against HBV infection is epidemiologically and economically justified. High coverage rates among infants born to HBsAg positive mothers reflect very good adherence to the vaccination program and antenatal screening. Higher HBsAg positivity rates among immigrant mothers identify a high-risk population for HBV infection.

Risk Factors for Hepatitis B Virus Transmission in Oman

Objectives

Hepatitis B virus (HBV) is a major public health problem worldwide. The prevalence of HBV is dependent on the modes of transmission. Chronic hepatitis B (CHB) infection can progress to liver cirrhosis and hepatocellular carcinoma. Oman is regarded as an intermediate endemic region and has had a neonatal vaccine against HBV since 1990. However, little research has been conducted regarding risk factors for HBV transmission. Our study aimed to identify the prevalence of major risk factors for acquiring HBV in Oman.

Methods

We conducted a retrospective chart review of all adult Omani patients diagnosed with CHB at two tertiary hospitals in Oman, Sultan Qaboos University Hospital and Armed Forces Hospital, between February 2009 and July 2013. The prevalence of major risk factors was identified by interviewing CHB patients using a standard questionnaire during their follow-up visits to the hepatology clinic at both hospitals. The risk factor frequency was stratified by age, gender, and educational level.

Results

A total of 274 patients were interviewed; 52.2% of the participants were males. The median age for men was 35.9 years and 35.1 years for women, with 75.5% aged 20–39 years old. The antenatal screening was the most common means of identifying HBV infection in females, and pre-blood donation screening was the most common in males. Intra-familial contact with HBV infected persons and behavioral risks such as body piercing (females) and barber shaving (males) were more common than nosocomial risk factors. Knowledge about HBV infection was scarce among our participants. More than half of the participants had a positive family history of HBV infection. There was a significant association between HBV infection and age groups, and educational levels (p < 0.050 and p < 0.001, respectively). Among those who were infected due to intra-familial contact or behavioral risk, there was a significant difference between the two sexes (p < 0.020) and between the three age groups (< 23, 23–28, >28) of HBV positive mothers (33.3%, 14.3%, and 6.6%, respectively; p < 0.050). There was also a statistically significant difference among different educational levels (p < 0.050).

Conclusions

Direct contact of infected individuals within a family and exposure to high-risk behaviors such as piercing and barber shaving are the main reported risk factors for HBV infection in Omani patients. Reducing the vertical and horizontal transmission of HBV in Oman could be improved by implementing routine antenatal screening of pregnant women and a greater focus on contact screening, respectively.

HBV S antigen evolution in the backdrop of HDV infection affects epitope processing and presentation

INTRODUCTION

HBV can evolve under selection pressure exerted by drugs and/or host immunity, resulting in accumulation of escape mutations that can affect the drug or the immune activity. Hepatitis delta virus (HDV) coinfection is also known to exert selection pressure on HBV, which leads to selective amplification of certain mutations, especially in genes that are required for HDV pathogenesis, such as HBsAg. However, little is known about the function of these mutations on HBV or HDV life cycle. The purpose of this study is to determine mutations selectively amplified in the backdrop of HDV, and how these mutations affect processing of CD4- and CD8-T cell epitopes.

METHODS

HBsAg was successfully amplified from 49/50 HBV mono- and 36/50 coinfected samples. The sequences were used to identify mutations specific to each study group, followed by an in silico analysis to determine the effect of these mutations on (1) proteasomal degradation, (2) MHC-I and MHC-II biding, and (3) processing of T-cell epitopes.

RESULTS

HBV-HDV coinfected sequences exhibited certain unique mutations in HBsAg genes. Some of these mutations affected the generation of proteasomal sites, binding of HBsAg epitopes to MHC-I and -II ligands, and subsequent generation of T- cell epitopes.

CONCLUSION

These observations suggest that HBV selectively amplifies certain mutations in the backdrop of HDV coinfection. Selective amplification of these mutations at certain strategic locations might not only enable HBV to counteract the inhibitory effects of HDV on HBV replication but also facilitate its survival by escaping the immune response.

Prevalence of hepatitis B e antigenemia in Bahraini hepatitis B patients: A retrospective, single-center study

Background and Aim

Hepatitis B e (HBe) antigen (HBeAg) is commonly encountered among hepatitis B patients and is indicative of active infection. There is a lack of data in the literature about the prevalence of HBeAg among hepatitis B patients in Bahrain and its impact on the disease. The aims of this study were to investigate the prevalence of HBeAg among a sample of hepatitis B patients in Bahrain and to analyze their associated laboratory profile, radiological characteristics, comorbidities, and complications.

Methods

This was a retrospective record-review study conducted on patients' records at Salmaniya Medical Complex hospital in Bahrain during the period of 2011-2016. All records of hepatitis B patients who had HBeAg tests performed were included in this study.

Results

Of 323 patients recruited, 18.9% had positive HBeAg. The prevalence of anti-HBe antibodies and hepatitis B core immunoglobulin G (HBc IgG) differed significantly between patients with positive and negative HBeAg (P < 0.001, P = 0.026, respectively). Alanine transferase and gamma-glutamyl transferase were significantly higher among patients with positive HBeAg (P = 0.017, P = 0.016, respectively). There was no significant difference with regard to the prevalence of hepatitis C virus, human immunodeficiency virus, hepatocellular carcinoma, or liver transplantation between HBe-positive and -negative patients (P ≥ 0.05).

Conclusion

HBeAg is prevalent among hepatitis B patients in Bahrain and is associated with a significantly different laboratory profile.

Hepatitis B Virus Genotypes in the Kingdom of Bahrain: Prevalence, Gender Distribution and Impact on Hepatic Biomarkers

Background: Approximately 400 million people are infected with Hepatitis B virus (HBV) around the world, which makes it one of the world’s major infectious diseases. The prevalence of HBV genotypes and predictive factors for risk are poorly known in the Kingdom of Bahrain. Objectives: The aim of the present study was to investigate the prevalence of HBV genotypes, its correlation with demographic factor sand impacts on hepatic biomarkers. Materials and Methods: Venous blood samples were collected from 82 HBV positive patients (48 males, 34 females). The extraction of HBV DNA, PCR amplification, and genotyping were done to classify different genotypes (A, A/D, B, B/D, C, D, D/E, E). HBV genotypes association with gender, nationality, mode of transmission, and liver cirrhosis complication was determined by descriptive statistic and univariate analysis of variance (ANOVA). For liver function test, unpaired t-test and ANOVA were performed. Results: The predominant genotype among patients under study was genotype D (61%), followed by genotype A (10%), and lowest frequency was found for undetermined genotype (1%). In general, there was no significant association between the different genotypes and some demographical factors, serological investigations, and liver function test. The prevalence of HBV genotypes was higher in male patients as compared to female patients and higher in non-Bahraini than in Bahraini. Patients with the dominant genotype D showed higher than the normal maximum range for alanine aminotransferase (ALT) (mean = 45.89) and Gamma-glutamyl transferase (GGT) (mean = 63.36). Conclusions: The most common HBV genotype in Bahrain was genotype D, followed by genotype A. Further studies involving the sources of transmission and impact of hepatic biomarker in Bahrain are required to enhance the control measures of HBV infections.

Risk factors of catheter-related thrombosis in early-stage breast cancer patients: a single-center retrospective study

Purpose

Totally implantable venous access devices (TIVADs) are widely used in cancer patients. The main purpose of our study is to observe the incidence and identified risk factors of catheter-related thrombosis (CRT) in breast cancer patients with TIVAD.

Patients and methods

We performed a retrospective cohort study of consecutive breast cancer patients who received the ultrasound-guided TIVAD implantation for the administration of chemotherapy from 2013 to 2016. The primary outcome was CRT (both symptomatic and asymptomatic detected by ultrasound). Univariable and multivariable logistic regression analyses were used to identify the risk factors for breast cancer TIVAD-related CRT.

Results

A total of 209 breast cancer patients with a newly implanted TIVAD for chemotherapy were included in this study. The average time of port duration was 7 months. Of the enrolled 209 patients, 33 patients (15.8%) had CRT, 2 of the 33 cases were symptomatic (1 pulmonary embolism, 1 deep-venous thrombosis [DVT]), the other 31 cases were asymptomatic detected by routine ultrasound examination of the catheter-associated vein before TIVAD removal with all cycles of chemotherapy completed. In total, 19 (57.6%) of CRT patients underwent directly TIVAD removal without any further treatments, 14 patients received anticoagulation treatments for 3–30 days followed by TIVAD removal. No DVT event was observed within at least 1.5 years of follow-up. In the multiple-variable analysis, tumor size >2 cm (OR 2.735, 95% CI 1.042–7.177; P=0.032), positive HbsAg (OR 2.803 95% CI 1.027–7.856; P=0.047) and low-density lipoprotein (LDL) >3.6 mmol/L (OR 2.360, 95% CI 1.059–5.351; P=0.040) were the significant independent risk factors of breast cancer TIVAD-related CRT.

Conclusion

CRT is a common complication in breast cancer patients with TIVAD for chemotherapy. Tumor size, HbsAg status and LDL level were independent predictors of breast cancer for TIVAD-related CRT. Removal of the port without anticoagulation treatments might be a feasible choice for asymptomatic TIVAD-related CRT.

Moving towards hepatitis B elimination in Gulf Health Council states: From commitment to action

INTRODUCTION

In 2016, the World Health Assembly adopted the hepatitis B (HB) elimination strategy that aims at ending HB by 2030. In this descriptive review we provide the progress made and challenges to achieving hepatitis B elimination by 2030 in Gulf Health Cooperated (GHC) states.

METHODS

Data record from relevant online databases and reliable resources were reviewed until the end of 2017. The analysis was based on the core indicators of the WHO monitoring and evaluation framework for viral hepatitis B and the targets of the global health sector strategy by 2016‒2021.

RESULTS

The states introduced HB vaccination, including birth-dose for those under 5 years old, with global coverage of more than 95%, in order to prevent mother-to-child transmission of HBV. The prevalence of HB antigens declined in children under age 5 to less than 1%. However, the rate of vaccination among the most-at-risk populations remains suboptimal. All states have implemented safe blood transfusions and injection safety policies as well as universal laboratory-based surveillance for acute HB. However, surveillance for chronic HB and sequelae as well as estimation methods of morbidity and mortality to evaluate impact are not established. Similarly, harm reduction for people who inject drugs and testing and treatment policies and protocols for people with chronic HB are suboptimal.

CONCLUSIONS

Additional steps are required to strengthen immunisation among the most-at-risk populations, maintain high quality surveillance, use antiviral therapy to treat chronic HBV and stop unsafe injection practices for drug users. Establishing country-specific national hepatitis responses based on country priorities as well as the capacity of the home health sectors to address these needs are paramount. Achieving elimination targets will require a radical alteration in the current hepatitis response and this goal should be elevated to a higher priority in the public health arena.

Log-Linear Modelling of Effect of Age and Gender on the Spread of Hepatitis B Virus Infection in Lagos State, Nigeria

BACKGROUND:

The effect of age and gender on the transmission of any infectious disease can be of great important because the age at which the host contact the disease may be a determinant on the rate at which the disease will spread.

AIM:

The purpose of this research is to model the significant effect of age and gender on the spread of hepatitis B virus using data collected from Lagos State, Nigeria.

MATERIAL AND METHODS:

The data that was used for this research is a ten years data covering the period of 2006 to 2015, which was collected from Nigeria Institute of Medical Research (NIMR). A log-linear modelling approach was employed using R programming language software. Akaike Information Criterion (AIC) method of model selection was used in selecting the best model.

RESULTS:

It was discovered from the analysis that both factors (age and gender) have a significant effect on the spread of hepatitis B infection. This means that the age at which an individual is tested positive to hepatitis B virus will affect the spread of the disease. In choosing the best model among the four models that were developed, model AY: GY (age & year: gender and year) was found to be the best model.

CONCLUSION:

Age and gender were found to act as a risk influencer that could have a great effect on the transmission of hepatitis B virus infections in Lagos state, Nigeria.

Hepatitis B virus sero-prevalence amongst pregnant women in the Gambia

BACKGROUND

Infection with Hepatitis B virus (HBV) is a serious public health problem worldwide, with over 360 million carriers. Sixty million of these are resident in Sub-saharan Africa. Hepatitis B infection is the cause of Hepatocellular carcinoma (HCC), which is the second commonest cause of death from cancers among women in The Gambia. Vertical transmission is the commonest route of spread of Hepatitis B Virus in many endemic areas. The main aim of the study was to determine the sero-prevalence of Hepatitis B surface antigen (HBsAg) among pregnant women attending antenatal clinic at the Edward Francis Small Teaching Hospital, Banjul, The Gambia.

METHODS

Four hundred and twenty six pregnant women were recruited from our antenatal clinics and tested for HBsAg. Serum Hepatitis B surface antigen (HBsAg) was tested using commercial rapid diagnostic Elisa kits at the point of care.

RESULTS

A prevalence rate of 9.20% among all pregnant women studied was found. Women who were likely to have been vaccinated had a prevalence rate of 2.30% whiles those unlikely to have been vaccinated had a prevalence of 13.71%. There was a statistically significant difference between those likely to have been vaccinated and those unlikely to have been vaccinated.

CONCLUSION

The prevalence of hepatitis B infection is very high among pregnant women at EFSTH as in the high endemic zone that is more than 8%. However the prevalence rate is lower than the national average of 15%. The prevalence is of moderate endemicity among the women who likely received vaccination during childhood. More interventions during pregnancy need to be undertaken if more successes are to be registered.

Understanding Risk Behaviors of Vietnamese Adults with Chronic Hepatitis B in an Urban Setting

Cigarette smoking and alcohol consumption can be considered as risk factors that increase the progression of chronic liver disease. Meanwhile, unprotected sex is one of the main causes of hepatitis B infection. This study aimed to explore drinking, smoking, and risky sexual behaviors among people with chronic hepatitis B virus (HBV) in a Vietnamese urban setting, as well as investigating potential associated factors. A cross-sectional study was performed in October 2018 in Viet-Tiep Hospital, Hai Phong, Vietnam. A total of 298 patients who had been diagnosed with chronic hepatitis B reported their smoking status, alcohol use, and sexual risk behavior in the last 12 months. A multivariate logistic regression model was used to identify the associated factors. It was identified that 82.5% of participants never used alcohol. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) positive result among male patients was 7.4% (0% in female patients). In addition, 14.5% of participants were current smokers and the mean number of cigarettes per day was 7.4 (SD = 3.4). It was found that 35.4% of male patients had sex with two or more sex partners. Furthermore, 66.7% and 74.1% of participants used condoms when having sex with casual partners/one-night stands and sex workers, respectively. There was a positive correlation between monthly drinking and currently smoking. White-collar workers were less likely to have multiple sex partners within the last 12 months. Our study highlights the need for integrating counseling sessions and educational programs with treatment services.

Management of individuals with chronic hepatitis B virus infection and persistent normal or mildly elevated aminotransferase levels

No consensus exists with respect to positive hepatitis B virus (HBV) DNA results and persistent normal or mildly elevated alanine aminotransferase (ALT). The aim of this study is to investigate the appropriate management and prognosis of these populations with chronic hepatitis B (CHB). A total of 235 subjects with positive HBV DNA results and persistent normal or mildly elevated ALT were enrolled in this study. Liver biopsy and liver stiffness measurements (LSM) were performed in all participants at baseline. Antiviral therapy was initiated in patients with significant hepatic inflammation (G ≥ 2) and/or fibrosis (S ≥ 2). The patients were divided into entecavir and adefovir groups based on HBV DNA load (>2000 IU/mL vs <2000 IU/mL). The liver biopsies were repeated at 72 weeks for the patients received antiviral therapy. We found that 112 subjects were hepatitis B e antigen (HBeAg) positive, and 123 subjects were negative. The corresponding median ALTs were 46 (39.5-52.5) and 48 (41.5-57.0) U/mL, respectively. G ≥ 2 and/or S ≥ 2 diseases were present in 48.8% (82/168) of the HBeAg-positive and 51.2% (86/168) of HBeAg-negative patients, respectively. In addition, 96 HBeAg-positive and 72 HBeAg-negative patients were divided into entecavir and adefovir groups. Meanwhile, liver biopsies had greater diagnostic accuracy for determining cirrhosis than LSM (0.711 vs 1.0, P < 0.0001). At the end of the study period, undetectable HBV DNA levels and normal ALT levels were observed in CHB-infected patients. Furthermore, the patients showed histologic improvement at 72 weeks compared with baseline measurements (G, 1.72 ± 1.00 vs 0.73 ± 0.88, P = 0.0002; S, 1.484 ± 0.90 vs 0.99 ± 1.13, P < 0.0001). Collectively, liver biopsy enhanced diagnostic accuracy for CHB-infected individuals with persistent normal or mildly elevated aminotransferase levels. Moreover, antiviral therapy can improve or regress the hepatic fibrosis and cirrhosis.

Prevalence and influencing factors of hepatitis B among a rural residential population in Zhejiang Province, China: a cross-sectional study

OBJECTIVES

To reveal the prevalence and associated influencing factors of hepatitis B among a rural residential population in Zhejiang, China, in order to help develop specific control strategies.

METHODS

We conducted a cross-sectional study among a rural residential population in Zhejiang, China. Stratified multistage cluster sampling was utilised in five districts; a structured questionnaire was used to collect the information such as age, gender, education, occupation, living status, and other health related information of the participants by trained local staff; and the hepatitis B virus (HBV) infection status of the participants was determined by the chemiluminescence immunoassay test. Univariate and multivariate analyses were applied to evaluate the influencing factors of HBV infection. The odds ratio of each related factor was assessed with or without adjustment separately.

RESULTS

The mean age of the 16 601 participants (7881 males and 8720 females) who completed the survey was 40.28±19.47 years. The positive rate of hepatitis B surface antigen (HBsAg) was 4.04% (95% CI 3.74% to 4.35%), and 3.85% when standardised by age and gender. Univariate analysis showed that age, educational level, occupation, living status, history of hepatitis B examinations, history of blood transfusion, vaccination, family history, coastal living, and district were the potential influencing factors. Multivariate logistic regression indicated that occupation, living status, history of hepatitis B examinations, vaccination and district were the influencing factors. Undertaking a service-based tertiary industry job (OR_a 1.19, 95% CI 0.94 to 1.51) and non-single living (OR_a 2.84, 95% CI 2.17 to 3.70) might be risk factors, while vaccination (OR_a 0.43, 95% CI 0.34 to 0.53) and history of hepatitis B examinations (OR_a 0.71, 95% CI 0.48 to 1.03) were potential protective factors.

CONCLUSIONS

The prevalence of hepatitis B is at an intermediate epidemic level in a rural residential population in Zhejiang, China. Raising vaccination coverage, especially in adults, is a suitable strategy for the prevention and control of hepatitis B.

Long-term effectiveness of plasma-derived hepatitis B vaccine 22-28 years after immunization in a hepatitis B virus endemic rural area: is an adult booster dose needed?

Longan County is considered a highly endemic area for hepatitis B virus (HBV). The plasma-derived vaccine has been used in newborns in this area since 1987. A cross-sectional survey was conducted to evaluate the long-term effectiveness of this vaccine. In total, 1634 participants born during 1987-1993 and who had received a series of plasma-derived HB vaccinations at ages 0, 1, and 6 months were enrolled. Serological HBV markers were detected and compared with previous survey data. Overall the prevalence of hepatitis B surface antigen (HBsAg) in all participants was 3·79%; 3·47% of subjects who had received the first dose within 24 h were HBsAg positive, and 8·41% of subjects who had received a delayed first dose were also HBsAg positive. There were 1527 subjects identified who had received the first dose within 24 h and whose HBsAg and anti-HBc prevalence increased yearly after immunization, while the anti-HBs-positive rate and vaccine effectiveness declined. The geometric mean concentration of antibody in the anti-HB-positive participants was 55·13 mIU/ml and this declined after immunization. Fewer than 2·0% of participants had anti-HB levels ⩾1000 mIU/ml. The data show that the protective efficacy of the plasma-derived vaccinations declined and administration of HB vaccine within 24 h of birth was very important. To reduce the risk of HBV infection in this highly endemic area, a booster dose might be necessary if anti-HBs levels fall below 10 mIU/ml after age 18 years. Furthermore, studies on the immune memory induced by plasma-derived HB vaccine are needed.

Demographic changes of hepatitis B virus infection in Iran for the last two decades

AIM

The objective of this study was to evaluate the impact of the hepatitis B virus (HBV) vaccination program, 24 years after its implementation, by analyzing patients with hepatitis B surface antigen (HBsAg) infection based on gender and age group.

BACKGROUND

Since the launch of the first universal vaccination program against HBV in Iran in 1993, the epidemiological pattern of HBV prevalence may have changed in our country.

METHODS

All data for this cross-sectional study were collected from medical records of HBsAg positive patients, who were referred to the Golhak and Armin private laboratories and also to the Gastrointestinal Department of Tehran's Taleghani Hospital and Day Hospital in Iran over a period of 5 years (2011-2016). In total, 8,606 HBsAg positive subjects were assessed according to gender and age group.

RESULTS

The rates of HBsAg carriage were 0.8%, 7.8%, 49.3%, 27.9% and 14.1% among subjects under 14 years old, 15-24 years, 25-44 years, 45-59 years and those older than 60 years, respectively. According to the age subgroup analyses; the highest (26.2%) and lowest (0.6%) rate of HBsAg positivity was seen in the 31-40 age group and younger than 10 year old children, respectively.

CONCLUSION

Global vaccination against hepatitis B has significantly reduced carrier rates among children and teenagers under 20 years old in this country. Nevertheless, HBsAg carriers still remain highly prevalent among 25-35-year age group. Therefore, the decline is limited to the younger population born after 1993, and it remains high in the middle-aged individuals.

Trends in the Incidence Rates of Chronic Hepatitis B in Poland in the Years 2005 - 2013

BACKGROUND

The prevalence of newly-diagnosed cases of chronic hepatitis is decisive for the overall incidence rate of hepatitis B observed in Poland.

OBJECTIVES

We aimed to determine the chronic hepatitis B incidence trends in Poland, taking into consideration the ages, genders, and environments of the patients.

METHODS

The study is based on aggregated data from Polish descriptive epidemiological studies for the period of 2005 to 2013 (i.e., hepatitis B incidence numbers and ratios, including mixed HBV and HCV infections) as published in the annual bulletins Choroby zakazne i zatrucia w Polsce (Infectious diseases and poisonings in Poland] drawn up by the laboratory for the monitoring and analysis of epidemiological status of the department of epidemiology at the national institute of public health - national institute of hygiene (NIPH-NIH). Poland, a central European country situated in the humid continental climate zone, is classified as a highly developed country. In the analyzed period, the Polish population consisted of about 38 million people, more than 19 million of whom were women, and more than 18 million of whom were men. Among European countries, Poland has the smallest number of national and ethnic minorities. For the purposes of epidemiological supervision, a special definition of acute hepatitis B was adopted in Poland in 2005, which facilitated separate registration of acute and chronic cases.

RESULTS

A significantly increasing chronic hepatitis B incidence trend was observed in the population of Poland, with considerable increases in incidence rates for both men and women alike. The incidence rates for inhabitants of both urban and rural areas also showed an increasing tendency. Chronic hepatitis B occurred more frequently in men and in urban areas. For each of the five-year age groups encompassing patients between 20 and 54 years of age, the increase in the incidence rate proved to be significant.

CONCLUSIONS

The registered increase in the incidence rate of chronic hepatitis B in Poland is a consequence of the new registration of cases of chronic hepatitis B acquired in the past. The problem of chronic hepatitis B can be solved by improving epidemiological supervision, enhancing the detection of frequently asymptomatic infections, and by providing easier access to optimized therapies.

Frequency of Hepatitis B and C Viruses, and HIV Among Drug Addicts in the Eastern Anatolia, Turkey

Background:

Hepatitis B, hepatitis C and HIV infections constitute serious healthcare problems worldwide.

Objectives:

There are a limited number of studies regarding the prevalence of hepatitis B, hepatitis C and HIV infections among the drug addicts in Turkey; hence, the current study aimed to determine the frequency of these infections among 235 drug addicts treated in a drug addiction treatment centre/Elazig, Turkey.

Patients and Methods:

HBsAg, anti-HBs, anti-HCV and anti-HIV tests in 235 drug addicts were studied by ELISA technique. Urine samples obtained from drug addicts were analyzed for cannabis, opiate and cocaine metabolites.

Results:

All the 235 drug users were males, and their mean age was 30.69 ± 9.494 years; 112 (47.7%) of them were in the age group ranging 20 - 29 years (P < 0.05). Of 235 drug addicts, 113 (48.1%) and 115 (48.9%) were only cannabis and opiate users, respectively. In urine samples of seven (3%) drug addicts both cannabis and opiate metabolites were detected. Cocaine was detected in none of the urine samples. The frequencies of HBsAg, anti-HBs and anti-HCV among drug addicts were 2.6%, 38.3%, and 9.4%, respectively. None of the drug addicts was positive for HIV. Anti-HCV was more prevalent in opiate users than in cannabis users: 15.7% vs. 1.8% (P < 0.001).

Conclusions:

The obtained results showed that HCV infection was an alarming problem among opiate users in the eastern part of Turkey. It is suggested to rapidly diagnose the infected persons; thus preventive measures and appropriate control may limit further transmission of these infections.

Effects of Risk Factors on Anti-HBs Development in Hepatitis B Vaccinated and Nonvaccinated Populations

Hepatitis B infection is still a major global health problem even though safe and effective vaccines have been available for more than 30 years. Although development of protective antibody to hepatitis B surface antigen (anti-HBs) is a common phenomenon after vaccination as well as natural infection, sometimes it does not appear even after complete vaccination. In the present study, whether the impairment of the development of anti-HBs in naturally infected and/or vaccinated populations is associated with immunomodulating risk factors (i.e., age, gender, smoking, and diabetes) and/or other risk factors (i.e., socioeconomic status, dental, and saloon exposure) was investigated through a cross-sectional study. Among 204 nonvaccinated patients, 132 (64.7%) tested positive for anti-HBc, indicating that they had been exposed to hepatitis B virus (HBV) at least once in their lifetime. Exposure to HBV (anti-HBc positive) was significantly higher among low-income people, dental exposed, and saloon users. Among anti-HBc positive patients, only 44 (33.3%) developed natural immunity with anti-HBs. Impairment in anti-HBs formation was found to be significantly high among cigarette smokers. However, no significant association of anti-HBs development was observed with age, gender, socioeconomic status, diabetes, dental exposure, and using saloon. Consistently, the frequency of developing protective anti-HBs (≥10 IU/L) among a vaccinated population was almost nine times less among smokers. These data suggest that anti-HBs development, either naturally or after vaccination, is significantly lower among smokers. It emphasizes the need to check the anti-HBs status in smokers after vaccination, and a booster vaccination should be administered if the anti-HBs antibody titer decreases below the protective level.

Cerebral venous sinus thrombosis may be associated with hepatitis B virus infection: a preliminary finding

OBJECTIVE

To assess the clinical significance of hepatitis B virus (HBV) infection in patients with cerebral venous sinus thrombosis (CVST).

METHODS

Twenty-two patients with CVST confirmed by magnetic resonance venography (MRV) or digital subtraction angiography (DSA) and 743 controls with ischemic stroke confirmed by magnetic resonance imaging (MRI) were analyzed retrospectively.

RESULTS

Among all researches, HBV surface antigen (HBsAg)-positive rate was high. Six of the 22 (27.3%) confirmed cases had HBsAg. However, HBsAg-positive rate in patients with ischemic stroke was only 45 of the 743 cases (6.1%), closed to the average prevalence in China (∼ 8.6%), but much lower than the positive rate in CVST patients (27.3 vs 6.1%, P  =  0.002). Odd ratio (OR) value between HBsAg-positive CVST patients (27.3%) and HBsAg-positive ischemic stroke patients (6.1%) was 5.78. The OR value between HBsAg-positive CVST patients (27.3%) and average prevalence of HBV infection in China (8.6%) was nearly 3.99. It meant that HBV infection might be a risk factor for CVST. However, there existed no statistically significant difference in HBV surface antibody (HBsAb), HBV e antigen (HBeAg), HBV e antibody (HBeAb), and HBV central antibody (HBcAb)-positive rate. The HBV surface antigen (HBsAg)-positive CVST patients did not show worse liver function. Most of them were inactive HBV carriers.

CONCLUSION

Hepatitis B virus infection may be a risk factor for CVST.