• Hepatitis B virus/genetics
• Hepatitis B virus/physiology
• Humans
• Virus Replication/genetics
• Viral Regulatory and Accessory Proteins/genetics
• Viral Regulatory and Accessory Proteins/metabolism
• Trans-Activators/genetics
• Trans-Activators/metabolism
• Animals
• Genotype
• Mice
• Polymorphism, Genetic
• Phenotype
• Hepatitis B/virology
• Hepatitis B/genetics
• Hepatocytes/virology
• Hepatocytes/metabolism

• National Institutes of Health (US)
• Japan Agency for Medical Research and Development

• HBV
• HIV
• HTLV
• patient
• prevalence

• Humans
• Male
• Female
• South Africa/epidemiology
• Hepatitis B/epidemiology
• Hepatitis B/blood
• HIV Infections/epidemiology
• Prevalence
• Adult
• Middle Aged
• Transfusion Reaction/epidemiology
• HTLV-I Infections/epidemiology
• Hepatitis B virus
• Adolescent
• HTLV-II Infections/epidemiology
• Blood Transfusion

• D43 TW010345 FIC NIH HHS

• (sub)genotypes
• hepatitis B virus
• hepatocellular carcinoma
• oncogenic pathways
• viral oncogenesis

• Humans
• Hepatitis B virus/genetics
• Proteomics
• Genotype
• Cell Line, Tumor
• Signal Transduction
• Africa South of the Sahara
• Proteome
• rhoC GTP-Binding Protein/metabolism
• rhoC GTP-Binding Protein/genetics
• Carcinoma, Hepatocellular/virology
• Carcinoma, Hepatocellular/metabolism
• Carcinoma, Hepatocellular/genetics
• Transfection
• Liver Neoplasms/virology
• Liver Neoplasms/metabolism
• Liver Neoplasms/genetics
• Hepatitis B/virology
• Hepatitis B/metabolism
• Hepatitis B/genetics

• https://cansa.org.za/, accessed on 1 January 2023 Cancer Association of South Africa

South Africa’s National Health Laboratory Service (NHLS), the only clinical laboratory service in the country’s public health sector, is an important resource for monitoring public health programmes.

We describe NHLS data quality, particularly patient demographics among infants, and the effect this has on linking multiple test results to a single patient.

Retrospective descriptive analysis of NHLS data from 1^st January 2017—1^st September 2020 was performed. A validated probabilistic record-linking algorithm linked multiple results to individual patients in lieu of a unique patient identifier. Paediatric HIV PCR data was used to illustrate the effect on monitoring and evaluating a public health programme. Descriptive statistics including medians, proportions and inter quartile ranges are reported, with Chi-square univariate tests for independence used to determine association between variables.

During the period analysed, 485 300 007 tests, 98 217 642 encounters and 35 771 846 patients met criteria for analysis. Overall, 15.80% (n = 15 515 380) of all encounters had a registered national identity (ID) number, 2.11% (n = 2 069 785) were registered without a given name, 63.15% (n = 62 020 107) were registered to women and 32.89% (n = 32 304 329) of all folder numbers were listed as either the patient’s date of birth or unknown. For infants tested at < 7 days of age (n = 2 565 329), 0.099% (n = 2 534) had an associated ID number and 48.87% (n = 1 253 620) were registered without a given name. Encounters with a given name were linked to a subsequent encounter 40.78% (n = 14 180 409 of 34 775 617) of the time, significantly more often than the 21.85% (n = 217 660 of 996 229) of encounters registered with a baby-derivative name (p-value < 0.001).

Unavailability and poor capturing of patient demographics, especially among infants and children, affects the ability to accurately monitor routine health programmes. A unique national patient identifier, other than the national ID number, is urgently required and must be available at birth if South Africa is to accurately monitor programmes such as the Prevention of Mother-to-Child Transmission of HIV.

The online version contains supplementary material available at 10.1186/s12889-022-13508-y.

• Data quality
• Early infant HIV diagnosis
• Monitoring and evaluation
• Public health programmes
• Unique patient identifier

Hepatitis B virus (HBV), a global public health threat, is targeted for elimination by 2030. As national HBV prevalence and incidence is lacking for South Africa, our study aimed to provide such data in the public health sector.

We analysed laboratory-confirmed HBV data from 2015 to 2019 to determine annual prevalence and incidence rates of HBV infection per 100,000 population, HBsAg and anti-HBc IgM test positivity rates, and HBsAg and anti-HBc IgM testing rates per 100,000 population. Time trend and statistical analyses were performed on HBsAg and anti-HBc IgM test positivity rates.

The national prevalence rate of HBV infection per 100,000 population increased from 56.14 in 2015 to 67.76 in 2019. Over the five years, the prevalence rate was higher in males than females, highest amongst individuals 25 to 49 years old and highest in Gauteng province. The HBsAg test positivity rate dropped from 9.77% in 2015 to 8.09% in 2019. Over the five years, the HBsAg test positivity rate was higher in males than females, amongst individuals 25 to 49 years old and amongst individuals of Limpopo province. Amongst HBsAg positive children under 5 years old, the majority (65.7%) were less than a year old. HBsAg testing rates per 100,000 population were higher in females under 45 years of age and in males 45 years and above. The national incidence rate of acute HBV infection per 100,000 population dropped from 3.17 in 2015 to 1.69 in 2019. Over the five-year period, incidence rates were similar between males and females, highest amongst individuals 20 to 39 years old and highest in Mpumalanga province. Amongst individuals 20 to 24 years old, there was a substantial decline in the incidence and anti-HBc IgM test positivity rates over time. Anti-HBc IgM testing rates per 100,000 population were higher in females under 40 years of age and in males 40 years and above.

Critical to hepatitis B elimination is strengthened infant vaccination coverage and interruption of vertical transmission. Transmission of HBV infection in adults may be reduced through heightened awareness of transmission routes and prevention measures.

The online version contains supplementary material available at 10.1186/s12889-021-12391-3.

• Acute
• Anti-HBc IgM
• HBsAg
• Hepatitis B
• Incidence
• Prevalence
• Test positivity rates

Hepatitis B virus (HBV) (sub)genotypes A1, D3 and E circulate in sub-Saharan Africa, the region with one of the highest incidences of HBV-associated hepatocellular carcinoma globally. Although genotype E was identified more than 20 years ago, and is the most widespread genotype in Africa, it has not been extensively studied. The current knowledge status and gaps in its origin and evolution, natural history of infection, disease progression, response to antiviral therapy and vaccination are discussed. Genotype E is an African genotype, with unique molecular characteristics that is found mainly in Western and Central Africa and rarely outside Africa except in individuals of African descent. The low prevalence of this genotype in the African descendant populations in the New World, phylogeographic analyses, the low genetic diversity and evidence of remnants of genotype E in ancient HBV samples suggests the relatively recent re-introduction into the population. There is scarcity of information on the clinical and virological characteristics of genotype E-infected patients, disease progression and outcomes and efficacy of anti-HBV drugs. Individuals infected with genotype E have been characterised with high hepatitis B e antigen-positivity and high viral load with a lower end of treatment response to interferon-alpha. A minority of genotype E-infected participants have been included in studies in which treatment response was monitored. Of concern is that current guidelines do not consider patients infected with genotype E. Thus, there is an urgent need for further large-scale investigations into genotype E, the neglected genotype of HBV.

• Hepatitis B virus
• Genotype E
• Evolution
• Clinical significance
• Antiviral therapy
• Vaccination

The paucity of animal models that simulate the replication of the hepatitis B virus (HBV) is an impediment to advancing new anti-viral treatments. The work reported here employed recombinant adeno-associated viruses (AAVs) to model HBV subgenotype A1 and subgenotype D3 replication in vitro and in vivo. Infection with subgenotype A1 is endemic to parts of sub-Saharan Africa, and it is associated with a high risk of hepatocellular carcinoma. Recombinant AAV serotype 2 (AAV2) and 8 (AAV8) vectors bearing greater-than-genome-length sequences of HBV DNA from subgenotype A1 and D3, were produced. Transduced liver-derived cultured cells produced HBV surface antigen and core antigen. Administration of AAV8 carrying HBV subgenotype A1 genome (AAV8-A1) to mice resulted in the sustained production of HBV replication markers over a six-month period, without elevated inflammatory cytokines, expression of interferon response genes or alanine transaminase activity. Markers of replication were generally higher in animals treated with subgenotype D3 genome-bearing AAVs than in those receiving the subgenotype A1-genome-bearing vectors. To validate the use of the AAV8-A1 murine model for anti-HBV drug development, the efficacy of anti-HBV artificial primary-microRNAs was assessed. Significant silencing of HBV markers was observed over a 6-month period after administering AAVs. These data indicate that AAVs conveniently and safely recapitulate the replication of different HBV subgenotypes, and the vectors may be used to assess antivirals’ potency.

• HBV mouse models
• adeno-associated virus
• anti-viral gene therapy
• hepatitis B virus

• donors
• hepatitis
• infectious disease testing
• transfusion-transmitted disease

• HBV
• HCC
• continent
• risk

• R21 CA215883 NCI NIH HHS

Healthcare workers (HCWs) are at risk of bloodborne infections from sharp instrument injuries and skin and mucous membrane exposures to contaminated blood and body fluids (BBF). While these have clinical and occupational health implications, little is known about BBF exposure and its reporting pattern in South African primary healthcare (PHC). The aim of this study was to determine the rate of BBF exposure, the extent of reporting and the reasons for not reporting among HCWs in PHC facilities in Johannesburg, South Africa.

In a cross-sectional study involving 444 participants, an 18-item, self-administered questionnaire was used to collect information on socio-demographic characteristics, HCWs’ exposures to BBF in the last year, whether the exposure was reported and the reasons for not reporting. Analysis included descriptive statistics and chi-square test.

Most participants were nurses (87.4%) and female (88.1%). About a quarter of participants (112) reported having at least one BBF exposure in the last year. Overall, there were 355 exposures, resulting in 0.8 BBF exposure per HCW per year. Of these exposures, 291 (82.0%) were not reported. Common reasons for not reporting include lack of time (42.72%), perception that the source patient was at low risk for human immunodeficiency virus (24.7%) and concerns about confidentiality (22.5%). Blood and body fluids exposures involving nurses (p < 0.001), sharp instrument (p < 0.001) and HCWs aged < 50 years (p = 0.02) were significantly more likely to be reported.

This study found a high rate of underreporting of BBF exposures among HCWs in PHC facilities in Johannesburg, suggesting an urgent need for interventions to improve reporting.

• blood
• body fluids
• healthcare workers
• injury reporting
• occupational exposure
• sharps exposure.

• occult
• overt
• suppression
• virological breakthrough

• Ghana
• Hepatitis B
• children
• vaccination

• hepatitis B antiviral therapy
• hepatitis B in pregnancy
• hepatitis B virus (HBV) infection
• sub-Saharan Africa (SSA)
• vertical HBV transmission

• Africa South of the Sahara
• Antiviral Agents/therapeutic use
• Capacity Building
• Female
• Hepatitis B/diagnosis
• Hepatitis B/prevention & control
• Hepatitis B/transmission
• Humans
• Immunization Programs
• Infant
• Infant, Newborn
• Infectious Disease Transmission, Vertical/prevention & control
• Pregnancy
• Pregnancy Complications, Infectious/drug therapy
• Prenatal Care
• Seroepidemiologic Studies
• Vaccination

• K23 HD090993 NICHD NIH HHS

The aim of the study was to determine the knowledge and practices of dental and oral hygiene (OH) students related to the transmission and prevention of the hepatitis B virus (HBV).

A cross-sectional analytical design was used and all dental and OH students registered at a university in Pretoria in 2017 were asked to participate. Students were classified as either clinical (senior students who were treating patients) or nonclinical (junior students who had not yet started treating patients) depending on their year of study. A pretested, self-administered questionnaire consisting of 16 closed-ended and 4 open-ended questions relating to the students’ knowledge and practice concerning HBV infection was used. Data were analyzed using SPSS version 23. All data were confidential and anonymity was ensured.

A total of 292 (78%) students agreed to participate, and of these, 70% were female. The average age was 21.78 years (±2.7) and almost two-thirds (61%) were classified as clinical students. A significant number of nonclinical students reported that the HBV could be transmitted through saliva (P < 0.01), through shaking hands (P < 0.01) and from sharing a toothbrush (P = 0.02) with an infected person. Clinical students correctly reported that HBV could be spread during the birth process from mother to child (P = 0.03). A significant number of nonclinical students stated that they would use antibiotics to prevent the spread of HBV infection (P < 0.01). The majority of respondents (94%) stated that vaccinations should be taken to prevent infection with HBV and >90% of students reported having completed the vaccination schedule.

Although both the knowledge on the virus and the modes of transmission were very good, more than half did not know that HBV infection can be transmitted through piercing and more than half of the nonclinical students wrongly reported that antibiotics can be used to prevent infection after exposure. The vast majority were vaccinated against HBV.

• Dental and oral hygiene
• hepatitis B virus
• infection
• knowledge
• practice
• students

Globally, approximately two billion people are infected with the Hepatitis B virus with attributable death estimated at about half a million people annually across the globe. Chronic hepatitis B infection is also an important public health problem in Ghana. The main mode of transmission in endemic regions is the perinatal route. Mother-to-child transmission can be reduced by antiviral therapy especially in the last trimester and adherence to the national immunization schedule. The World Health Organization recommends to add the birth dose vaccine to the current expanded program on immunization (EPI) in all countries but especially for endemic regions. The evidence for the efficacy of the birth dose HBV vaccine is overwhelming and there is an urgent need for its introduction into the current EPI schedule in Ghana.

• birth dose vaccine
• hepatitis B infection
• mother-to-child transmission