Intra-familial prevalence of hepatitis B virologic markers in HBsAg positive family members in Nahavand, Iran

Exploring risk factors and transmission dynamics of Hepatitis B infection among Indian families: Implications and perspective

INTRODUCTION

Hepatitis B virus (HBV) is global health problem. Family members of HBV infected people are considered as high-risk groups due to frequent household transmission of HBV among contacts of HBsAg carriers. The present study aimed to investigate the intrafamilial transmission of HBV among family members of HBV-infected persons and to identify the risk factors for viral transmission in these setting.

METHODS

361 index cases and their 1083 family contacts were tested for markers of Hepatitis B, viz. HBsAg and HBcAb using commercial ELISA. The demographic details and risk factors for acquiring HBV infection among the family members were recorded using a structured questionnaire.

RESULTS

The median (IQR) age of index cases and family members was 37 (27 - 48) and 26 (14 - 38) years, respectively. Among the screened family members, 9.23% (n = 100) members were positive for HBsAg and 32.75% (n = 355) were positive for HBcAb. At least one member of the family was affected in 229/361 (63.43%) index cases. Significantly lower percent of household contacts (9.23%, n = 100)were vaccinated against HBV.HBV transmission risk was significantly higher in families with more than four members(p < 0.0001). Multinomial logistics regression analysis for familial risk factors for transmission of HBV such asclose contact with carrier (aOR overt: 1.172, aOR occult: 1.173), sharing of bed/bedding (aOR overt: 1.258, aOR occult:1.264), personal hygiene items (aOR overt:1.260, aOR occult: 1.451), and eating in common utensils (aOR overt: 2.182, aOR occult: 1.307)were significantly associated with the transmission of HBV (p < 0.05).

DISCUSSION

Close contact with carrier, sharing of bed/bedding or personal hygiene items and eating in common utensils were significantly associated with the transmission of HBV. Increasing awareness about Hepatitis B infection and vaccination of family members in close contact with carrier is essential to prevent Hepatitis B transmission.

Horizontal Modes of Transmission of Hepatitis B Virus (HBV): A Systematic Review and Meta-Analysis

Background

Horizontal transmission of hepatitis B virus (HBV) is a significant transmission route in households, among contact sport athletes and institutionalized individuals. Children often are infected by non-sexual close contacts with an increased tendency to become chronic carriers. Hence, the awareness about various high-risk behaviours leading to horizontal transmission in the community is essential. A systematic review and meta-analysis was carried out to assess quantitatively the pooled prevalence of horizontally transmitted HBV infection globally.

Methods

The study was started after ruling out registered or ongoing systematic reviews related to this topic in the PROSPERO database. The study protocol was documented in PROSPERO with a registration number CRD42021235165. We searched electronic databases for published articles in English between 1981 and April 2021 reporting horizontal modes of hepatitis B transmission among unvaccinated contacts. Meta-analysis was carried out in STATA version 13.0 (College Station, Texas 77,845 USA). The forest plots were constructed using metaprop package in STATA.

Results

Forty-one studies were systematically reviewed and 15 studies were qualified for the meta-analysis, including 1619 hepatitis B cases and 4869 contacts. The overall pooled prevalence of horizontally transmitted HBV infection among the contacts was 38% (95% CI 30%-46%). The pooled prevalence among 3,912 household contacts from nine qualified studies was estimated as 44% (95% CI 35%-54%). The pooled prevalence rates among institutionalized individuals and contact sport athletes were 30% (95% CI 23%-37%) and 18% (95% CI 5%-32%), respectively.

Conclusion

The likelihood of horizontal transmission of HBV is greater among household contacts of chronic carriers of HBV and institutionalized individuals.

Sharing of Personal Sanitary Kits as One Risk Factor of Horizontal Transmission of Hepatitis B among Children Resident at Orphanage

BACKGROUND: Hepatitis B is a disease that infects the liver and is caused by the infection of a hepatitis B virus (HBV), and is becoming a global health issue, especially in developing countries including Indonesia. Hepatitis B can be transmitted through several ways such as infected bodily fluids. Indeed, children who live together in an orphanage are prone to having a high chance of transmitting Hepatitis B to each other. AIM: The purpose of this study was to analyze the factors associated with the prevalence of infected Hepatitis B. METHODS: This research used casecontrol study methodology by taking 15 positive case samples and 33 controlled uninfected patients and was conducted in six orphanages in Kupang Municipality in NTT between July 2019 and November 2019. There were 310 orphanage residents participating in this research. RESULTS: The research denotes that variables of using a shared toothbrush, nail clipper, and shaver show a significant connection with their Hepatitis B status (p < 0.05). A further analysis also indicates that using a shared shaver and toothbrush for 12.6 times has a high risk of being infected by Hepatitis B compared to those who do not share their personal items. CONCLUSION: Vaccinations and meeting the basic needs of every child in orphanages are essential in order to minimize the risk of Hepatitis B transmission.

Intra-familial Transmission of Hepatitis B Virus Infection in Arak, Central Iran

BACKGROUND

The household transmission of hepatitis B virus (HBV) is a major health problem. High incidence of HBV infection is observed within the household contacts of HBV carriers. We aimed to evaluate serological markers of hepatitis B infection among family members of HBV carriers in Arak, central Iran.

METHODS

Data were collected from the 100 chronic HBV carriers (subjects with positive HBsAg for at least 6 months period) as index cases and 700 members of their family. Then, we checked serologic markers of hepatitis B [hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti- HBs)] using the ELISA test.

RESULTS

The prevalence rate of HBsAg, anti-HBs and anti-HBc among household members was 23.3%, 20.4% and 23% respectively. Isolated anti-HBc (positive anti-HBc with negative HBsAg and anti-HBs) found in 0.4% of family members. Mothers and children with 47.6% and 17.2% had the highest and lowest rates of HBV infection, respectively (P=0.00). There was a significant difference between mothers and spouses of index case (47.6% and 29.8%) regarding HBsAg positivity (P=0.03).

CONCLUSION

The low rate of HBV infection reported in children reveal the effective prevention of HBV transmission with the universal vaccination programs and also importance of pregnant women screening for HBV serological markers.

Intrafamilial spread of hepatitis B virus in Guilan Province-North of Iran

The aim of the present study was to determine the intrafamilial spread of HBV in the family members of patients with Hepatitis B in Guilan Province, North of Iran. In a descriptive-comparative study, 156 patients with Hepatitis B, 415 family members of the index cases and 599 age and gender matched people as a control group were enrolled. Blood samples were taken from the participants and were checked for HBs Ag, HBC Ab, HBs Ab, and HBV DNA. Totally 44 (10.6%) of family members and only 1 (0.2%) of control group were HBs Ag positive (P=0.0001, OR=70.92). The overall prevalence in members of the original family was 5.3% (1.2% of the mothers, 2.2% of the brothers, 1.9% of the sisters), in sexual partners it was 1.4%, in offsprings it was 2.4% and in other households it was 1.4%. The mean age of HBs Ag positive family members was 35.3 ± 12.9 years old. Among them 27 (61.4%) were female. Only 8 (18.2%) of all HBsAg-positive reported previous HBV vaccination but just one person had the vaccine titer checked. The present survey indicates that there is a significant difference in the prevalence of Hepatitis B in the general population and family members of Hepatitis B patients and this is an evidence for horizontal transmission of HBV in household contacts.

Lower intrafamilial transmission rate of hepatitis B in patients with hepatitis d coinfection: a data-mining approach

BACKGROUND

The presence of an infected family member significantly increases the risk of HBV transmission, but many socio-demographic and viral characteristics of family members affect the transmission rate.

OBJECTIVES

In this study, we have used data mining techniques to investigate the impact of different variables in intrafamilial transmission of HBV infection.

PATIENTS AND METHODS

demographic information, viral markers, and medical history of 330 patients with chronic hepatitis B and their offspring attending a referral center in Tehran were collected. Data-mining techniques were administered to detect patterns.

RESULTS

The overall transmission rate was 15.7% (5.4% and 27.3% for male and female index cases respectively). In female patients, HBe Ag positively affected the transmission rate (49% vs. 23.4%). There was a dominant change in transmission rate of female patients with negative results for Hbe Ag with HDV coinfection, where the transmission rate changed from 25% in patients with negative results for HDV Ab to 5% in those with positive results. In Hbe Ag negative male index cases, the transmission rate was 1.3% in cases with positive results for HDV Ab compared to 7% in those with negative findings. The overall transmission rate was statistically different between patients with positive and negative results for HDV Ab (P = 0.016).

CONCLUSIONS

There is a minor but consistent pattern change in the presence of HDV infection which reduces familial transmission of HBV, especially in female patients with negative results for HBe Ag.

Knowledge and attitude of medical science students toward hepatitis B and C infections

The present survey aimed to determine the knowledge level and attitude of medical students in Guilan University toward Hepatitis B and C viruses' infections. In a cross-sectional survey, the knowledge and attitude of 424 medical science undergraduate students of nursing, midwifery, operating room technician, laboratory, anesthesiology and radiology in Guilan University of Medical Sciences toward Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections were investigated using a standardized questionnaire. The mean (SD) knowledge level of the medical students toward HBV and HCV were 17 ± 5 from 28 and 10.58 ± 6.7 from 29 questions respectively. Females, nursing students, forth year students, those who worked in hospital and those who had needle stick injuries (NSI) history showed significantly higher knowledge scores toward HBV (P< 0.05). Married students, anesthesiology students, those who were in their fourth year of study, and those who worked in hospital had significantly higher mean knowledge scores toward HCV (P< 0.05). Also students' attitude toward HBV and HCV was positively correlated with their mean knowledge level (r=0.14, p=0.004), (r=0.18, p=0.0001). Education on the nature, symptoms, transmission, prevention and treatment of HBV and HCV infections may increase the willingness of health care workers to care for infected persons.

Intra-familial Transmission of Hepatitis B virus Infection in Zahedan

BACKGROUND

The household transmission of hepatitis B virus (HBV) is a major health problem. The prevalence rate of this infection is reported about 11% to 57% among family members of HBsAg carriers.

OBJECTIVES

This study was conducted to evaluate serological determinants of chronic hepatitis B infection, especially HBsAg positivity, among family members of asymptomatic HBsAg positive carriers in Zahedan (Southeast of Iran).

PATIENTS AND METHODS

In a cross-sectional study, data were collected from the total number of 454 HBsAg positive cases and 1817 members of their family by trained interviewers and a validated questionnaire. In addition, blood samples were obtained and titrated to detect serologic markers of hepatitis B. All subjects were recruited following informed consent to the study.

RESULTS

In total, 454 chronic HBsAg carriers (66% male) with mean age of 36 ± 10 years and 1817 of their family members were included in the study. The prevalence rate of HBsAg and HBcAb positivity among household members were 19.3% (n = 351) and 51% (n = 573), respectively. The frequency of HBV markers was different by age groups. The highest prevalence rate of HBsAg (34.9%) and HBcAb (31.9%) positivity were found in the age group of 21-30 years old. Importantly, the mothers of index cases had the highest prevalence of HBsAg positivity compared to their spouses who had the lowest proportion (53.2% vs. 8.4%, P < 0.001).

CONCLUSIONS

In family members, HBsAg positivity was four times greater than the general indigenous population. Considering the importance of close contacts for transmission, it was more prevalent in mothers of index cases compared to their spouses, suggesting more efficient mother-to-child than sexually transmission of HBV. It was also more prevalent in those having a history of hepatitis B in their maternal family compared to those with paternal one, probably due to more efficient transmission from infected mothers to children. The lower prevalence of HBsAg positivity in lower age groups could be attributed to vaccination of Iranian infants since 1993 and the screening of HBsAg positive mothers during the last two decades.

Characterization of hepatitis B virus genome variability in Iranian patients with chronic infection, a nationwide study

Hepatitis B virus (HBV) isolates from Iranian patients around the country were characterized. Eighty-one complete genomes from HBV isolates were sequenced and analyzed. The studied population was grouped into three categories including inactive carriers, patients with chronic hepatitis, and patients with liver cirrhosis. Molecular and phylogenetic analyses revealed that Iranian patients were infected with HBV genotype D and subgenotype D1. The most common subtype was ayw2, followed by ayw3 and ayw4. Several deletions and insertions that had no correlation with disease outcome were observed in the HBV genomes. The most frequent mutation in the major hydrophilic region (MHR) of HBV surface antigen (HBsAg) was sP120S. Almost half of the patients studied carried precore (PC) mutant variants and one-third of the studied population was infected with variants carrying basal core promoter (BCP) mutations. PC and BCP mutations were observed in older patients, especially in those with chronic liver disease. Sixty-seven patients (82.7%) were HBeAg negative, and the prevalence of precore mutant isolates (G1896A) was higher in this group than in HBeAg-positive patients. Lamivudine drug resistance mutations were detected after 1 year of treatment in about 30% of lamivudine-treated patients. In conclusion, these results demonstrate that HBV subgenotype D1 is the only subgenotype circulating in Iran, and there is no evidence of any exotic genotype in the region. The HBV PC (G1896A) mutation may play an important role in the clinical outcome of the disease by increasing the risk of progressive liver disease among Iranian patients infected with HBV.

Multiple intra-familial transmission patterns of hepatitis B virus genotype D in north-eastern Egypt

The transmission rate of intra-familial hepatitis B virus (HBV) and mode of transmission were investigated in north eastern Egypt. HBV infection was investigated serologically and confirmed by molecular evolutionary analysis in family members (N = 230) of 55 chronic hepatitis B carriers (index cases). Hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) prevalence was 12.2% and 23% among family members, respectively. HBsAg carriers were prevalent in the age groups; <10 (16.2%) and 21-30 years (23.3%). The prevalence of HBsAg was significantly higher in the family members of females (19.2%) than males (8.6%) index cases (P = 0.031). HBsAg and anti-HBc seropositive rates were higher significantly in the offspring of females (23%, 29.8%) than those of the males index cases (4.3%, 9.8%) (P = 0.001, 0.003), as well as higher in the offspring of an infected mother (26.5, 31.8%) than those of an infected father (4.7%, 10.5%) (P = 0.0006, 0.009). No significant difference was found in HBsAg seropositive rates between vaccinated (10.6%) and unvaccinated family members (14.8%). Phylogenetic analysis of the preS2 and S regions of HBV genome showed that the HBV isolates were of subgenotype D1 in nine index cases and 14 family members. HBV familial transmission was confirmed in five of six families with three transmission patterns; maternal, paternal, and sexual. It is concluded that multiple intra-familial transmission routes of HBV genotype D were determined; including maternal, paternal and horizontal. Universal HBV vaccination should be modified by including the first dose at birth with (HBIG) administration to the newborn of mothers infected with HBV.

Successful management of critical illness polyneuropathy and myopathy in renal transplant recipients

Critical illness polyneuropathy and myopathy commonly occur in patients with multiorgan failure and sepsis. Distal muscle weakness and loss of deep tendon reflexes are usually found, with sparing of the cranial nerve musculature. Many risk factors have been identified, specifically hypoxia, hypotension, hyperpyrexia, and age. Other independent risk factors include female sex, severity of illness, duration of organ dysfunction, renal failure and renal replacement therapy, hyperosmolality, parenteral nutrition, low serum albumin level, duration of intensive care unit stay, vasopressor and catecholamine support, and central neurologic failure. Hyperglycemia also has been identified as an independent risk factor, with important potential affect in terms of prevention. Herein, we report the development of critical illness polyneuropathy and myopathy in 7 of 22 renal transplant recipients who underwent successful ventilator weaning during treatment for bronchopneumonia. This is the first report of critical illness polyneuropathy and myopathy among renal transplant recipients. Clinical suspicion and electrophysiologic studies are tools for early diagnosis. Proper management, including correction of risk factors (especially diabetes) and long-term rehabilitation measures might be beneficial.

Successful exclusion of blood-borne viral disease in blood donors

BACKGROUND

All blood transfusion services have various rules to insure that blood products are kept safe for transfusion. Donor selection is crucial in providing safe blood. We propose in our study to determine the influence of donor selection on blood safety.

METHODS

In this case-control study, donors who were referred to the Qazvin Blood Transfusion Organization during 2007-2009 were selected. Based on a special questionnaire, all blood donors were examined by physicians and every donor was categorized as one of two types of rejected donors (high risk and low risk) or as accepted donors. Data were analyzed by SPSS version 13.0, using chi-square and Fisher's exact tests, where P<0.05 was considered significant.

RESULTS

Single donors, the self-employed, the unemployed and students were banned from donation due to high-risk criteria (P<0.0001, 0.003). Female donors were banned from donation due to low-risk criteria. Hepatitis B was more prevalent among cases rejected for donation due to high-risk criteria than among healthy controls (P=0.014); but not so for hepatitis C (P=0.058). Hepatitis B was not significantly more prevalent among those cases rejected for donation due to low-risk criteria, than among healthy cases.

CONCLUSION

Those having a history of unsafe sexual conduct and intravenous drug abusers and their spouses are at risk for hepatitis C. Cases rejected for donation due to low-risk criteria were banned from donation to maintain the donors' health, while other cases with low-risk criteria were banned to guarantee the blood recipients' health.

The prevalence of hepatitis B antigen-positivity in the general population of Mashhad, Iran

BACKGROUND

Hepatitis B virus (HBV) infection is a significant health problem throughout the world.

OBJECTIVES

We aimed to evaluate the prevalence of hepatitis B antigen (HBsAg) seropositivity in the general population of Mashhad, northeast of Iran.

PATIENTS AND METHODS

One thousand six hundred fifty-two healthy individuals aged 1 to 90 (Mean; 29.1 ± 18.5) from all 12 municipalities of Mashad were selected randomly by multistage cluster sampling. Informed consent was obtained, and demographics and medical histories were collected. Twice-reactive samples were considered HBsAg-positive by ELISA. Chi-square test and logistic regression were applied to analyze the factors related to HBsAg positivity using SPSS 16.0.

RESULTS

The overall prevalence of HBsAg positivity was 1.39% (95% CI, 0.91% to 2.12%); 2.0% and 0.89% among men and women, respectively (p = 0.054). Infection was more prevalent in older (p = 0.019) and married persons (p = 0.001), Afghanis (p = 0.046), and those with a history of traditional cupping (p = 0.005). There was no association between HBV infection and gender; literacy; income; employment; family size; or history of blood transfusion, dental procedure, surgery, hospitalization, or tattooing. By logistic regression analysis, age was the only variable that had a significant association with infection (p = 0.026).

CONCLUSION

It seems that the prevalence of HBV infection in Mashhad is slightly lower than that of the nation.

Prevalence of chronic hepatitis B infection in Iran: a review article

Hepatitis B virus infection is a major public health problem worldwide. Islamic Republic of Iran is a country in which hepatitis B prevalence is intermediate. The aim of this study is to assess prevalence of chronic hepatitis B infection in Iran according to demographic characteristics. All cross-sectional studies concerning prevalence of chronic hepatitis B infection in Iran were included irrespective of date and language. The outcome of interest was prevalence of chronic hepatitis B infection confirmed by blood specimen positive for HBsAg. The prevalence of chronic hepatitis B infection was estimated about 1.7% or lower in general population; 0.8% (95% CI: 0.6% to 0.9%) in blood donors and 3.2% (95% CI: 2.3% to 4.1%) in intravenous drug users and varied from zero to 1.5% in beta thalassemic patients. Since mass vaccination in 1993, prevalence of chronic hepatitis B infection has being reduced among children and adolescents. This reduction can be attributed to the effectiveness of the national immunization program and it may impact on reduction of prevalence of hepatitis B infection in general population.

Intra-familial spread of hepatitis B virus infection in eastern Turkey

Hepatitis B virus (HBV) infection is a worldwide health problem. The aim of the present study was not only to determine the prevalence of HBsAg in children of HBV-infected parents but also to identify all HBSAg-positive family members to protect as many children, in the present and future, as possible. The study was carried out with the participation of 2113 family members (1205 children, 453 mothers, and 455 fathers) at Sivas SSK Hospital, Turkey. They were screened for HBV markers using standard enzyme immunoassay between September 2001 and March 2005. The prevalence of any HBV markers and HBsAg among family members of index cases was 50.5% and 30.5% respectively. HBsAg carrier rate was higher among fathers (61%) than mothers (47%), (P<0.05). The children of mother index cases had higher rates of HBsAg compared with the children of father index cases (P<0.01). Our results suggest that intra-familial childhood horizontal transmission (especially mother-to-child) is important for HBV transmission in the Turkish community, and highlights the need for screening of adult siblings and mothers of adult HBsAg carriers in addition to their spouses and children.