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Wilson A, Anderson C, Mindlin M, Sawyer C, Verlander NQ, Hiironen I, Forde J, Paranthaman K, Chandra NL. Characteristics of women presenting with hepatitis B at antenatal care services in London, 2008-2018. J Public Health (Oxf) 2023; 45:584-592. [PMID: 37061977 DOI: 10.1093/pubmed/fdad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/17/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND To support interventions to prevent mother-to-child transmission of hepatitis B and fill gaps in surveillance, the Enhanced Surveillance of Antenatal Hepatitis B (ESAHB) programme was implemented in London from 2008 to 2018 to collect demographic information on women who tested positive for hepatitis B during antenatal screening. We describe the epidemiology of hepatitis B in pregnancy, as reported to ESAHB. METHODS The characteristics of pregnant women living with hepatitis B were described and rates were calculated by year, local authority and residence deprivation decile (1 being most deprived). Poisson regression tested the association between pregnant women living with hepatitis B and deprivation decile. RESULTS Between 2008 and 2018, 8879 women living with hepatitis B in London (0.35 per 1000 women) reported 11 193 pregnancies. Annual hepatitis B rates remained stable, but there was strong evidence for an inverse association between rate and deprivation decile (P < 0.001). The majority of women in the cohort presented late to antenatal care, were born outside the UK in a hepatitis B endemic area or required an interpreter for consultations. CONCLUSIONS ESAHB provided important data to inform service quality improvements for women living with hepatitis B. This analysis highlights the link between deprivation and hepatitis B.
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Affiliation(s)
- A Wilson
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - C Anderson
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - M Mindlin
- South London Health Protection Team, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - C Sawyer
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - N Q Verlander
- Statistics, Modelling and Economics Department, Data, Analytics and Surveillance Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - I Hiironen
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - J Forde
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - K Paranthaman
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - N L Chandra
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
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Clark-Wright J, Hudson P, McCloskey C, Carroll S. Burden of selected infectious diseases covered by UK childhood vaccinations: systematic literature review. Future Microbiol 2020; 15:1679-1688. [PMID: 33207948 DOI: 10.2217/fmb-2020-0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim: An overview of recent epidemiology and disease burden, independent of patient age, of diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and Hemophilus influenzae invasive disease in the UK. Materials & methods: A systematic review was undertaken. Outcomes included incidence, prevalence, risk factors and cost burden. Results: 39 publications were included. Hepatitis B prevalence is high among certain risk groups. A small pertussis risk remains in pregnancy and for infants, which led to the introduction of maternal vaccination. H. influenzae invasive disease cases are limited to rare serotypes. Polio, tetanus and diphtheria are well controlled. Conclusion: The evaluated diseases are currently well controlled, thanks to a comprehensive vaccination program, with a generally low clinical and cost burden.
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Ahmad AE, Bakari AG, Musa BOP, Mustapha SK, Jamoh BY, Abdullahi IN, Tahir MI, Olatunji AO, Maishanu SH, Suleiman AB, Tolulope A, Hawkins C, Sagay AS, Zoakah A, Olayinka AT. Pattern of prevalent Hepatitis B virus genotypes in Zaria, Nigeria. Niger Postgrad Med J 2019; 26:80-86. [PMID: 31187746 PMCID: PMC6626198 DOI: 10.4103/npmj.npmj_59_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Hepatitis B virus (HBV) is hyperendemic in Nigeria. Available literature reveal genotype E as being predominant in West Africa. This study aimed at identifying the current pattern and prevalent genotypes of HBV in Zaria, Nigeria. Materials and Methods: Four millilitre of blood was collected in ethylenediaminetetraacetic acid-container from each of 165 HBV surface antigen-positive participants recruited purposively from the gastroenterology clinic from May to August, 2017. Plasma was separated and frozen at −20°C till analysis. Multiplex-nested polymerase chain reaction using type-specific primers was used to identify the various HBV genotypes. Results: Median (and interquartile range ) age of the participants was 31.0 (25.5–39.0) years, with males constituting 107 (64.8%). Majority (83.6%) of the samples analysed were HBV-DNA-positive with 82.6% of the HBV-DNA-positive samples being mixed genotype infections. Irrespective of mode of occurrence, five HBV genotypes were identified with HBV/E (97.1%) being the most predominant, followed by HBV/B (82.6%), HBV/A (24.6%), then HBV/C (17.4%), while HBV/D (0.7%) was the least prevalent. Conclusion: In most (99.1%) of the mixed-infection were a combination of genotype E, the predominant genotype, with other genotypes predominantly genotype B. HBV genotypes E, B, A, C and D are the prevalent genotypes in Zaria, Nigeria, as they occur in single genotype and in mixed-genotypes pattern.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Claudia Hawkins
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Ayuba Zoakah
- Department of Community Medicine, University of Jos, Jos, Nigeria
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A system dynamics modelling simulation based on a cohort of hepatitis B epidemic research in east China community. Epidemiol Infect 2019; 147:e86. [PMID: 30821223 PMCID: PMC6518579 DOI: 10.1017/s0950268819000220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Hepatitis B constitutes a severe public health challenge in China. The Community-based Collaborative Innovation hepatitis B (CCI-HBV) project is a national epidemiological study of hepatitis B and has been conducting a comprehensive intervention in southern Zhejiang since 2009.The comprehensive intervention in CCI-HBV areas includes the dynamic hepatitis B screening in local residents, the normalised treatment for hepatitis B infections and the upcoming full-aged hepatitis B vaccination. After two rounds of screening (each round taking for 4 years), the initial epidemiological baseline of hepatitis B in Qinggang was obtained, a coastal community in east China. By combining key data and system dynamics modelling, the regional hepatitis B epidemic in 20 years was predicted.There were 1041 HBsAg positive cases out of 12 228 people in Round 1 indicating HBV prevalence of 8.5%. Of the 13 146 people tested in Round 2, 1171 people were HBsAg positive, with a prevalence of 8.9%. By comparing the two rounds of screening, the HBV incidence rate of 0.192 per 100 person-years was observed. By consulting electronic medical records, the HBV onset rate of 0.533 per 100 person-years was obtained. We generated a simulated model to replicate the real-world situation for the next two decades. To evaluate the effect of interventions on regional HBV prevalence, three comparative experiments were conducted.In this study, the regional hepatitis B epidemic in 20 years was predicted and compared with HBV prevalence under different interventions. Owing to the existing challenges in research methodology, this study combined HBV field research and simulation to provide a system dynamics model with close-to-real key data to improve prediction accuracy. The simulation also provided a prompt guidance for the field implementation.
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Furuncuoglu Y, Bolukbas FF, Bolukbas C, Torun P, Ozturk R. Changes in the prevalence of HBV infection in pregnant women in Turkey between 1995 and 2015: a 20-year evaluation. Postgrad Med J 2016; 92:510-3. [PMID: 26941270 DOI: 10.1136/postgradmedj-2015-133876] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/11/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine changes in hepatitis B virus (HBV) prevalence across three different time periods in pregnant women. METHODS This was a retrospective study of pregnant women attending four healthcare centres between January 1995 and May 2015. Data for serum hepatitis B surface antigen (HBsAg) and anti-HBs levels were collected from routine antenatal screening records. The 20-year study was divided into three periods: 1995-2001, 2002-2008 and 2009-2015. The results are presented by the women's age and gravidity as possible determinants of HBV infection. RESULTS 7605 pregnant women (56.0% primigravidae) (mean age 23.4±4.8 years) were tested for markers of HBV infection. 3010 pregnant women were screened between 1995 and 2001, 2995 between 2002 and 2008, and 1600 between 2009 and 2015. The overall prevalence of HBsAg and anti-HBs positivity in the 7605 pregnant women was 1.5% (n=114) and 11.5% (n=877), respectively. Regarding temporal change in the prevalence of HBV markers, HBsAg decreased significantly from 2.6% to 0.8% (p<0.01), while anti-HBs increased significantly from 9.5% to 17.5% (p<0.01), between the first and last study periods. Multigravidae and older women had higher HBsAg and anti-HBs positivity compared to primigravidae. CONCLUSIONS The data suggest that the prevalence of HBsAg positivity is gradually decreasing among pregnant women, while the level of HBsAg antibody seropositivity is lower than expected. HBV carrier rate increases with increasing age and gravidity. In addition to the national HBV immunisation programme, the prevention of perinatal transmission should also be prioritised to decrease the HBV pool of infection.
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Affiliation(s)
- Yavuz Furuncuoglu
- Department of Internal Medicine, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - F Fusun Bolukbas
- Gastroenterology Division, Department of Internal Medicine, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Cengiz Bolukbas
- Gastroenterology Division, Department of Internal Medicine, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Perihan Torun
- Department of Public Health, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Recep Ozturk
- Department of Infectious Diseases, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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Protective immune barrier against hepatitis B is needed in individuals born before infant HBV vaccination program in China. Sci Rep 2015; 5:18334. [PMID: 26655735 PMCID: PMC4677310 DOI: 10.1038/srep18334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 11/16/2015] [Indexed: 12/15/2022] Open
Abstract
The hepatitis B prevalence rate in adults is still at a high to intermediate level in China. Our purpose was to explore the incidence rate and protective immune barrier against hepatitis B in adults in China. A sample of 317961 participants was multi-screened for hepatitis B surface antigens (HBsAg) in a large-scale cohort of the National Hepatitis B Demonstration Project. A total of 5401 persons were newly-infected, representing an incidence rate of 0.81 (95% CI: 0.77–0.85) per 100 person-years after adjusted by gender and age. History of acquired immune deficiency syndrome, birth prior to 1992, coastal residence, family history of HBV, and migrant worker status were significantly associated with higher incidence, while HBV vaccination and greater exercise with lower incidence. The hepatitis B surface antibody (HBsAb) positive rate was negatively correlated with the incidence rate of hepatitis B (r = −0.826). Linear fitting yielded an incidence rate of 1.23 plus 0.02 multiplied by HBsAb positive rate. The study firstly identified the HBsAg incidence rate, which was reduced to 0.1 per 100 person-years after vaccination coverage of about 64%. The protective immune barrier against hepatitis B needs to be established in individuals born prior to the advent of infant HBV vaccination.
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Sweeney L, Owiti JA, Beharry A, Bhui K, Gomes J, Foster GR, Greenhalgh T. Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: qualitative study of at-risk immigrant communities and healthcare professionals. BMC Health Serv Res 2015; 15:97. [PMID: 25890125 PMCID: PMC4372168 DOI: 10.1186/s12913-015-0746-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/17/2015] [Indexed: 01/03/2023] Open
Abstract
Background Effective strategies are needed to provide screening and treatment for hepatitis B and C to immigrant groups in the UK at high risk of chronic infection. This study aimed to build an understanding of the knowledge, beliefs and attitudes towards these conditions and their management in a range of high-risk minority ethnic communities and health professionals, in order to inform the design of a screening and treatment programme in primary care. Methods Qualitative data collection consisted of three sequential phases- (i) semi-structured interviews with key informants (n = 17), (ii) focus groups with people from Chinese, Pakistani, Roma, Somali, and French- and English-speaking African communities (n = 95), and (iii) semi-structured interviews with general practitioners (n = 6). Datasets from each phase were analysed using the Framework method. Results Key informants and general practitioners perceived that there was limited knowledge and understanding about hepatitis B and C within high-risk immigrant communities, and that chronic viral hepatitis did not typically feature in community discourses about serious illness. Many focus group participants were confused about the differences between types of viral hepatitis, held misconceptions regarding transmission, and were unaware of the asymptomatic nature of chronic infection. Most welcomed the idea of a screening programme, but key informants and focus group participants also identified numerous practical barriers to engagement with primary care-based screening and treatment; including language and communication difficulties, limited time (due to long working hours), and (for some) low levels of trust and confidence in general practice-based care. General practitioners expressed concerns about the workload implications and sustainability of screening and treating immigrant patients for chronic viral hepatitis in primary care. Conclusions Strategies to reduce the burden of chronic viral hepatitis in immigrant communities will need to consider how levels of understanding about hepatitis B and C within these communities, and barriers to accessing healthcare, may affect capacity to engage with screening and treatment. Services may need to work with community groups and language support services to provide information and wider encouragement for screening. Primary care services will need ongoing consultation regarding their support needs to deliver hepatitis screening and treatment programmes.
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Affiliation(s)
- Lorna Sweeney
- Institute for Health and Human Development, University of East London, UH250, Stratford Campus, Water Lane, London, E15 4LZ, UK.
| | - John A Owiti
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Andrew Beharry
- Internal Medicine and Gastroenterology, San Fernando General Hospital, Independence Avenue, San Fernando, Trinidad and Tobago.
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Jessica Gomes
- The Liver Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Graham R Foster
- The Liver Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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Sewell J, Capocci S, Johnson J, Solamalai A, Hopkins S, Cropley I, Webster DP, Lipman M. Expanded blood borne virus testing in a tuberculosis clinic. A cost and yield analysis. J Infect 2014; 70:317-23. [PMID: 25452045 DOI: 10.1016/j.jinf.2014.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 08/11/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Testing for HIV is a standard of care for people with active tuberculosis (TB). People investigated for TB in the UK often originate from areas with a high prevalence of HIV and other blood borne viruses (BBV). However, assessment for these infections is patchy. We determined the yield and costs of different testing strategies for BBV in a UK TB clinic. METHODS Since 2009, it has been routine to test all TB clinic attendees. Demographic, clinical and virological data were retrospectively extracted from patient notes and hospital databases. RESULTS Over 3 years, 1036 people were assessed in the TB service. 410 had a final diagnosis of active TB. HIV testing of the latter population diagnosed 27 new HIV cases at a cost of £3017. When BBV testing was offered to all clinic attendees, a further 6 (total 33) new HIV, 5 Hepatitis B (HBV) and 2 Hepatitis C (HCV) diagnoses were made at a total cost of £22,170. CONCLUSIONS We have identified previously undiagnosed HIV, HBV and HCV in a TB clinic population. Our data suggest that despite increasing upfront expense, the associated yield argues strongly for BBV testing to be offered to all patients being investigated for possible TB, irrespective of their final diagnosis.
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Affiliation(s)
- J Sewell
- Department of Health and Population Sciences, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom.
| | - S Capocci
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom.
| | - J Johnson
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom.
| | - A Solamalai
- North Central London TB Service, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom.
| | - S Hopkins
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom.
| | - I Cropley
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom.
| | - D P Webster
- Department of Virology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom.
| | - M Lipman
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom; University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom.
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Hepatitis B prevalence in a multi-ethnic community in South England: a 3 year retrospective study. Public Health 2014; 128:764-5. [DOI: 10.1016/j.puhe.2014.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/16/2014] [Indexed: 11/22/2022]
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Use of laboratory-based surveillance data to estimate the number of people chronically infected with hepatitis B living in Scotland. Epidemiol Infect 2013; 142:2121-30. [PMID: 24480044 DOI: 10.1017/s0950268813003105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
It is paramount to understand the epidemiology of chronic hepatitis B to inform national policies on vaccination and screening/testing as well as cost-effectiveness studies. However, information on the national (Scottish) prevalence of chronic hepatitis B by ethnic group is lacking. To estimate the number of people with chronic hepatitis B in Scotland in 2009 by ethnicity, gender and age, the test data from virology laboratories in the four largest cities in Scotland were combined with estimates of the ethnic distribution of the Scottish population. Ethnicity in both the test data and the Scottish population was derived using a name-based ethnicity classification software (OnoMAP; Publicprofiler Ltd, UK). For 2009, we estimated 8720 [95% confidence interval (CI) 7490-10 230] people aged ⩾15 years were living with chronic hepatitis B infection in Scotland. This corresponds to 0·2% (95% CI 0·17-0·24) of the Scottish population aged ⩾15 years. Although East and South Asians make up a small proportion of the Scottish population, they make up 44% of the infected population. In addition, 75% of those infected were aged 15-44 years with almost 60% male. This study quantifies for the first time on a national level the burden of chronic hepatitis B infection by ethnicity, gender and age. It confirms the importance of promoting and targeting ethnic minority groups for hepatitis B testing.
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