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Petrovskis I, Skrastina D, Jansons J, Dislers A, Bogans J, Spunde K, Neprjakhina A, Zakova J, Zajakina A, Sominskaya I. Toward a SARS-CoV-2 VLP Vaccine: HBc/G as a Carrier for SARS-CoV-2 Spike RBM and Nucleocapsid Protein-Derived Peptides. Vaccines (Basel) 2024; 12:267. [PMID: 38543900 PMCID: PMC10974900 DOI: 10.3390/vaccines12030267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 11/12/2024] Open
Abstract
Virus-like particles (VLPs) offer an attractive possibility for the development of vaccines. Recombinant core antigen (HBc) of Hepatitis B virus (HBV) was expressed in different systems, and the E. coli expression system was shown to be effective for the production of HBc VLPs. Here, we used HBc of the HBV genotype G (HBc/G) as a technologically promising VLP carrier for the presentation of spike RBM and nucleocapsid protein-derived peptides of the SARS-CoV-2 Delta variant for subsequent immunological evaluations of obtained fusion proteins. The major immunodominant region (MIR) of the HBc/G protein was modified through the insertion of a receptor binding motif (RBM) from the S protein or B-cell epitope-containing peptide from the N protein. The C-terminus of the two truncated HBc/G proteins was used for the insertion of a group of five cytotoxic T lymphocyte (CTL) epitopes from the N protein. After expression in E. coli, the MIR-derived proteins were found to be insoluble and were recovered through step-wise solubilization with urea, followed by refolding. Despite the lack of correct VLPs, the chimeric proteins induced high levels of antibodies in BALB/c mice. These antibodies specifically recognized either eukaryotically expressed hRBD or bacterially expressed N protein (2-220) of SARS-CoV-2. CTL-epitope-containing proteins were purified as VLPs. The production of cytokines was analyzed through flow cytometry after stimulation of T-cells with target CTL peptides. Only a protein with a deleted polyarginine (PA) domain was able to induce the specific activation of T-cells. At the same time, the T-cell response against the carrier HBc/G protein was detected for both proteins. The neutralization of SARS-CoV-2 pseudotyped murine retrovirus with anti-HBc/G-RBM sera was found to be low.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Irina Sominskaya
- Latvian Biomedical Research and Study Centre, Ratsupites 1, LV-1067 Riga, Latvia; (I.P.); (D.S.); (J.J.); (A.D.); (J.B.); (K.S.); (A.N.); (J.Z.); (A.Z.)
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2
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Muwanda F, Sendagire H, Mboowa G, Kateete DP, Achan B, Mupere E, Kafeero HM, Bagaya BS. A systematic review reveals that African children of 15-17 years demonstrate low hepatitis B vaccine seroprotection rates. Sci Rep 2023; 13:22182. [PMID: 38092870 PMCID: PMC10719251 DOI: 10.1038/s41598-023-49674-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
Childhood HBV immunization remains globally fundamental to the elimination of hepatitis B virus (HBV). However, monitoring proportions of HBV vaccine seroprotection and their determinants among African Pediatric recipients is crucial. This study sought to verify extent of immune protection accorded by the HBV vaccine in African children of up to 17 years of age by pooling the prevalence of seroprotection reported by primary studies conducted in the Northern, Western, and Southern African regions. We included 19 eligible articles out of the 197 initially downloaded, published from 1999 to 2021 from African Journals Online (AJOL), EMBASE, Scopus, and PubMed. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), University of York Centre for Reviews and Dissemination, under the registration number CRD42022361277. Significantly higher (p < 0.0001) proportion of HBV vaccine seroprotection (69.07%) was found among children under 15 years of age than children 15-17 years (32.368%), 95% CI [34.2454-39.0847%]. Whereas successful integration of the HBV vaccine on the extended programs on immunizations (EPI) has been a major achievement in the reduction of HBV infection in Africa, markedly reduced HBV vaccine seroprotection is persistently demonstrated among adolescent children 15-17 years of age. Future studies are required to clarify the need for booster dose vaccination in most at risk populations and age groups.
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Affiliation(s)
- Fahad Muwanda
- Department of Medical Microbiology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, P.O. Box 7689, Kampala, Uganda.
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Hakim Sendagire
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Gerald Mboowa
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
- The African Center of Excellence in Bioinformatics and Data-Intensive Sciences, Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Beatrice Achan
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Hussein Mukasa Kafeero
- Department of Medical Microbiology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, P.O. Box 7689, Kampala, Uganda
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Bernard Ssentalo Bagaya
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Hill PC, Cobelens F, Martinez L, Behr MA, Churchyard G, Evans T, Fiore-Gartland AJ, Garcia-Basteiro AL, Hanekom W, Rangaka MX, Vekemans J, White RG. An Aspiration to Radically Shorten Phase 3 Tuberculosis Vaccine Trials. J Infect Dis 2023; 228:1150-1153. [PMID: 37607272 DOI: 10.1093/infdis/jiad356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023] Open
Abstract
A new tuberculosis vaccine is a high priority. However, the classical development pathway is a major deterrent. Most tuberculosis cases arise within 2 years after Mycobacterium tuberculosis exposure, suggesting a 3-year trial period should be possible if sample size is large to maximize the number of early exposures. Increased sample size could be facilitated by working alongside optimized routine services for case ascertainment, with strategies for enhanced case detection and safety monitoring. Shortening enrolment could be achieved by simplifying screening criteria and procedures and strengthening site capacity. Together, these measures could enable radically shortened phase 3 tuberculosis vaccine trials.
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Affiliation(s)
- Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Frank Cobelens
- Department of Global Health, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Marcel A Behr
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Gavin Churchyard
- The Aurum Institute, Parktown, South Africa
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Andrew J Fiore-Gartland
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto de Salud Global, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | - Willem Hanekom
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Molebogeng X Rangaka
- MRC Clinical Trials Unit, University College London, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
- Centre for Infectious Diseases Research Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Richard G White
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Fofana DB, Somboro AM, Maiga M, Kampo MI, Diakité B, Cissoko Y, McFall SM, Hawkins CA, Maiga AI, Sylla M, Gozlan J, El-Sayed MH, Morand-Joubert L, Murphy RL, Diakité M, Holl JL. Hepatitis B Virus in West African Children: Systematic Review and Meta-Analysis of HIV and Other Factors Associated with Hepatitis B Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4142. [PMID: 36901164 PMCID: PMC10002029 DOI: 10.3390/ijerph20054142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
While Hepatitis B virus (HBV) and the human immunodeficiency virus (HIV) are endemic in West Africa, the prevalence of HBV/HIV coinfection and their associated risk factors in children remains unclear. In this review, we sought to assess HBsAg seroprevalence among 0- to 16-year-olds with and without HIV in West African countries and the risk factors associated with HBV infection in this population. Research articles between 2000 and 2021 that reported the prevalence of HBV and associated risk factors in children in West Africa were retrieved from the literature using the Africa Journals Online (AJOL), PubMed, Google Scholar, and Web of Science databases as search tools. StatsDirect, a statistical software, was used to perform a meta-analysis of the retained studies. HBV prevalence and heterogeneity were then assessed with a 95% confidence interval (CI). Publication bias was evaluated using funnel plot asymmetry and Egger's test. Twenty-seven articles conducted across seven West African countries were included in this review. HBV prevalence among persons aged 0 to 16 years was 5%, based on the random analysis, given the great heterogeneity of the studies. By country, the highest prevalence was observed in Benin (10%), followed by Nigeria (7%), and Ivory Coast (5%), with Togo (1%) having the lowest. HBV prevalence in an HIV-infected population of children was (9%). Vaccinated children had lower HBV prevalence (2%) than unvaccinated children (6%). HBV prevalence with a defined risk factor such as HIV co-infection, maternal HBsAg positivity, undergoing surgery, scarification, or being unvaccinated ranged from 3-9%. The study highlights the need to reinforce vaccination of newborns, screening for HBV, and HBV prophylaxis among pregnant women in Africa, particularly in West Africa, to achieve the WHO goal of HBV elimination, particularly in children.
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Affiliation(s)
- Djeneba B. Fofana
- Faculty of Medicine, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako BP 1805, Mali
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), for Department of Virology, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Antoine Hospital, F-75012 Paris, France
| | - Anou M. Somboro
- Faculty of Medicine, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako BP 1805, Mali
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Mamoudou Maiga
- Faculty of Medicine, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako BP 1805, Mali
- Institute for Global Health, Northwestern University, Chicago, IL 60208, USA
| | | | - Brehima Diakité
- Faculty of Medicine, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako BP 1805, Mali
| | - Yacouba Cissoko
- Faculty of Medicine, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako BP 1805, Mali
| | - Sally M. McFall
- Institute for Global Health, Northwestern University, Chicago, IL 60208, USA
| | - Claudia A. Hawkins
- Institute for Global Health, Northwestern University, Chicago, IL 60208, USA
| | - Almoustapha I. Maiga
- Faculty of Medicine, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako BP 1805, Mali
| | - Mariam Sylla
- Faculty of Medicine, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako BP 1805, Mali
| | - Joël Gozlan
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), for Department of Virology, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Antoine Hospital, F-75012 Paris, France
| | - Manal H. El-Sayed
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Laurence Morand-Joubert
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), for Department of Virology, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint-Antoine Hospital, F-75012 Paris, France
| | - Robert L. Murphy
- Institute for Global Health, Northwestern University, Chicago, IL 60208, USA
| | - Mahamadou Diakité
- Faculty of Medicine, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako BP 1805, Mali
| | - Jane L. Holl
- Department of Neurology, University of Chicago, Chicago, IL 60637, USA
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O'Ferrall AM, MacElhinney-West A, Bell MS, Haslam MP, Walker G, Norton D, Burns SA, Ferrier G, Easom NJW. Geographically targeted chronic infection screening: lessons from a hepatitis B pilot study in the UK. Trans R Soc Trop Med Hyg 2023:6980844. [PMID: 36625250 DOI: 10.1093/trstmh/trac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/17/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
Chronic hepatitis B (CHB) most commonly occurs following infection in early childhood. Prevalence varies markedly around the globe. Country of birth is therefore a strong predictor of CHB risk in adults. We used country of birth census data to predict CHB risk and carry out geographically targeted screening in East Yorkshire, UK. Despite engaging individuals born in high-prevalence countries with testing, we observed lower than expected prevalence in targeted highest-risk areas, which may indicate barriers to testing for people with undiagnosed CHB. Improved strategies for engagement with high-risk groups will be key for viral hepatitis elimination.
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Affiliation(s)
- Angus M O'Ferrall
- Infection Research Group, Hull University Teaching Hospitals - Address: Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Alison MacElhinney-West
- Viral Hepatitis Service, Hull University Teaching Hospitals - Address: Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Mark S Bell
- Viral Hepatitis Service, Hull University Teaching Hospitals - Address: Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Michael P Haslam
- Viral Hepatitis Service, Hull University Teaching Hospitals - Address: Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Gemma Walker
- Infection Research Group, Hull University Teaching Hospitals - Address: Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Donna Norton
- Infection Research Group, Hull University Teaching Hospitals - Address: Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Sean A Burns
- The University of Sheffield - Address: Sheffield, S10 2TN, UK
| | - Graham Ferrier
- Department of Geography, Geology and Environment, University of Hull - Address: Cottingham Road, Hull, HU6 7RX, UK
| | - Nicholas J W Easom
- Infection Research Group, Hull University Teaching Hospitals - Address: Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
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Ward JW, Wanlapakorn N, Poovorawan Y, Shouval D. Hepatitis B Vaccines. PLOTKIN'S VACCINES 2023:389-432.e21. [DOI: 10.1016/b978-0-323-79058-1.00027-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Abstract
Hepatocellular carcinoma (HCC) is one of the five leading causes of cancer death in human. Hepatitis B virus (HBV) is the most common etiologic agent of HCC in the world. Prevention is the best way to control cancer. There are three levels of liver cancer prevention, i.e., primary prevention by HBV vaccination targeting the general population starting from birth dose, secondary prevention by antiviral agent for high-risk subjects with chronic HBV infection, and tertiary prevention by antiviral agent to prevent recurrence for patients who have been successfully treated for liver cancer. Primary prevention by hepatitis B vaccination is most cost effective, the cancer preventive efficacy support it as the first successful example of cancer preventive vaccine in human. Addition of hepatitis B immunoglobulin immediately after birth and antiviral agent during the third trimester of pregnancy to block mother-to-infant transmission of HBV are existing or possible emerging strategies to enhance the prevention efficacy of HBV infection and its related liver cancer. Secondary prevention with current antiviral agents may reduce the risk or delay the onset of HCC development, but could not eradicate HBV infection and HCC. Better antiviral therapeutic agents are needed for better secondary prevention.
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Affiliation(s)
- Mei-Hwei Chang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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8
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Nayagam S, Shimakawa Y, Lemoine M. Mother-to-child transmission of hepatitis B: What more needs to be done to eliminate it around the world? J Viral Hepat 2020; 27:342-349. [PMID: 31698534 DOI: 10.1111/jvh.13231] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 12/11/2022]
Abstract
Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is a key component of the hepatitis B burden worldwide. Despite its efficacy to prevent HBV transmission, infant vaccination is not enough to control HBV MTCT. Additional efforts are urgently needed to evaluate and scale-up preventive strategies especially in endemic countries, which are most affected. This review highlights the efficacy and barriers of the currently validated measures for the prevention of HBV MTCT and proposes alternatives adapted to resource-limited settings to eventually achieve HBV elimination worldwide.
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Affiliation(s)
- Shevanthi Nayagam
- Section of Hepatology and Gastroenterology, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, St Mary's hospital, Imperial College London, UK.,MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Maud Lemoine
- Section of Hepatology and Gastroenterology, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, St Mary's hospital, Imperial College London, UK
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Tfifha M, Kacem S, Ben Rejeb M, Naija S, Boujaafar N, Abroug S, Trabelsi A. Evaluation of antibody persistence after a four-dose primary hepatitis B vaccination and anamnestic immune response in children under 6 years. J Med Microbiol 2019; 68:1686-1693. [PMID: 31592765 DOI: 10.1099/jmm.0.001086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction. Tunisia is an intermediate hepatitis B virus (HBV) endemic country. The vaccination against hepatitis B was introduced in 1995 including four doses with a first dose administrated at birth. Decreasing the level of antibodies against hepatitis B surface antigen (anti-HBs) over time can be alarming. This study was conducted to explore the anti-HBV immune response among children under 6 years old, vaccinated according to the national vaccination schedule, by evaluating the immunological response to primary vaccination and by exploring the anamnestic immune response to a booster dose.Methods. We conducted a cross-sectional prospective study from June 2016 to June 2017 (n=180), based on voluntary participation. Children were recruited from the public pediatric ward sectors in Sahloul University Hospital of Sousse in Central Tunisia. An anti-HB titre was determined based on electro-chemiluminescence micro-particle immunoassay (ECLIA), using Elecsys Anti-HBs II kit, Roche.Results. Mean age at the time of enrollment in the study was 33±14.8 months. The seroprotection rate was 77.2 %. The anti-HB titre differed significantly between the different age groups (P=0.002). The predicting variable for having no seroprotective antibody level was older age. Children with anti-HB levels <10 IU l- 1 were offered an additional dose of HBV vaccine. Anamnestic response 1 month after the challenge dose was observed in 100 % of subjects. The probability of developing a high antibody response, following the booster dose increased in conjunction with an increased pre-booster antibody level.Conclusion. The response to a booster dose suggests the persistence of immune memory in almost all vaccinated individuals. Although a booster dose increases substantially anti-HB titre, the clinical relevance of such an increase remains unknown.
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Affiliation(s)
- Miniar Tfifha
- Pediatric department, Sahloul University Hospital, 4054 Sousse, Tunisia
| | - Saoussen Kacem
- LR14SP02, Epidemiology and Immunogenetics of Human Viral Infections, Laboratory of Microbiology, Sahloul University Hospital, 4054 Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, Sahloul University Hospital, 4054 Sousse, Tunisia
| | - Said Naija
- LR14SP02, Epidemiology and Immunogenetics of Human Viral Infections, Laboratory of Microbiology, Sahloul University Hospital, 4054 Sousse, Tunisia
| | - Noureddine Boujaafar
- Laboratory of Microbiology, Sahloul University Hospital, 4054 Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Saoussen Abroug
- Pediatric department, Sahloul University Hospital, 4054 Sousse, Tunisia
| | - Abdelhalim Trabelsi
- LR14SP02, Epidemiology and Immunogenetics of Human Viral Infections, Laboratory of Microbiology, Sahloul University Hospital, 4054 Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
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10
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Moghadami M, Dadashpour N, Mokhtari AM, Ebrahimi M, Mirahmadizadeh A. The effectiveness of the national hepatitis B vaccination program 25 years after its introduction in Iran: a historical cohort study. Braz J Infect Dis 2019; 23:419-426. [PMID: 31678055 PMCID: PMC9428176 DOI: 10.1016/j.bjid.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Hepatitis B virus (HBV) is responsible for one of the most common human viral infections. An estimated 257 million people are living with chronic HBV infection worldwide, and mortality has reached 900,000 deaths in recent years. In 2001, the World Health Organization reported a prevalence of chronic hepatitis B infection in Iran between 2–7%. Objective To assess the effect of the national HBV mass vaccination program after 25 years. Methods A retrospective cohort study was conducted in vaccinated and unvaccinated people according to the year of birth. Blood samples were obtained from each enrolled person and data about demographic variables, and medical and vaccination history were collected using a standardized questionnaire. Persons were considered uninfected if they were negative for both HBsAg and anti-HBc. Also, Vaccine effectiveness was measured by calculating the risk of disease among vaccinated and unvaccinated persons and defining the percentage risk reduction of infection in the vaccinated group. Results A total of 2720 persons were interviewed. The rate of HBV breakthrough infection among the vaccinated group was significantly lower than in unvaccinated group. One hundred ninety-four cases with positive HBV markers of infection were identified. The risk ratio of HBV infection was 0.71, 95% CI: 0.54–0.94 (vaccinated/unvaccinated). The estimated vaccination effectiveness against Hepatitis B infection was 29% (95% CI: 6%–46%). Conclusions Iran has successfully combined hepatitis B vaccination into regular immunization programs. The WHO goal of reducing HBsAg prevalence to an equivalent of 1% by 2020 has been reached. With respect to vaccination effectiveness and low prevalence of the disease in the country, catch-up hepatitis B vaccination programs for adolescents can guarantee the immunity of the population.
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Affiliation(s)
- Mohsen Moghadami
- Shiraz University of Medical Sciences, Clinical Microbiology Research Center, Shiraz, Iran.
| | - Nazanin Dadashpour
- Shiraz University of Medical Sciences, School of Medicine, Department of Internal Medicine, Shiraz, Iran.
| | | | - Mostafa Ebrahimi
- Shiraz University of Medical Sciences, Department of Health, Shiraz, Iran.
| | - Alireza Mirahmadizadeh
- Shiraz University of Medical Sciences, Non-communicable diseases research center, Shiraz, Iran.
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11
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Kakisaka K, Sakai A, Yoshida Y, Miyasaka A, Takahashi F, Sumazaki R, Takikawa Y. Hepatitis B Surface Antibody Titers at One and Two Years after Hepatitis B Virus Vaccination in Healthy Young Japanese Adults. Intern Med 2019; 58:2349-2355. [PMID: 31118375 PMCID: PMC6746647 DOI: 10.2169/internalmedicine.2231-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective Since healthcare providers face an increased risk of hepatitis B virus (HBV) infection because of their work, vaccination plays a critical role in preventing HBV transmission. However, the duration for which acquired HBV surface antibodies (anti-HBs) persist remains unknown. To evaluate the primary immunologic response to HBV vaccination and its persistence in healthy Japanese adolescents. Methods In total, 690 young adults underwent HBV vaccination with a three-dose schedule. The primary response was determined by the anti-HBs titers at 1-2 months after the final dosage. Subjects with anti-HBs titers of <10, 10-100, and >100 mIU/mL were classified as "non-responders," "low-responders," and "sufficient responders," respectively. Anti-HB titers were re-measured at 1 or 2 years after vaccination. Results First, 95.8% and 72.8% of the subjects had anti-HBs titers of >10 and >100 mIU/mL, respectively, as a primary response. The anti-HBs titers measured at 1 and 2 years after vaccination were significantly correlated with those of the primary response (1 year: r=0.893, p<0.0001; 2 years: r=0.902, p<0.001). Most subjects with a titer of >100 mIU/mL at the primary response maintained an anti-HBs titer of >10 mIU/mL [1 year after vaccination, 208/209 (99.5%); 2 years after vaccination, 72/81 (90.1%)]. However, in subjects with a primary response of 10-100 mIU/mL the anti-HBs titer frequently declined; 17/38 (44.7%) and 9/10 (90.0%) subjects had a titer of <10 mIU/mL at 1 and 2 years, respectively. Conclusion The primary response was associated with the anti-HBs titers at 1 and 2 years after vaccination, and the anti-HBs titers of 54.2% of the low responders were not maintained for 2 years, even if they were vaccinated as healthy young adults.
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Affiliation(s)
- Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Aiko Sakai
- Department of Child Health, Faculty of Medicine, Tsukuba University, Japan
| | - Yuichi Yoshida
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Akio Miyasaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Fumiaki Takahashi
- Division of Medical Engineering, Department of Information Science, Iwate Medical University, Japan
| | - Ryo Sumazaki
- Department of Child Health, Faculty of Medicine, Tsukuba University, Japan
| | - Yasuhiro Takikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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12
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Sagnelli C, Sagnelli E. Towards the worldwide eradication of hepatitis B virus infection: A combination of prophylactic and therapeutic factors. World J Clin Infect Dis 2019; 9:11-22. [DOI: 10.5495/wjcid.v9.i2.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
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13
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Leoni MC, Ustianowski A, Farooq H, Arends JE. HIV, HCV and HBV: A Review of Parallels and Differences. Infect Dis Ther 2018; 7:407-419. [PMID: 30182282 PMCID: PMC6249183 DOI: 10.1007/s40121-018-0210-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Indexed: 02/06/2023] Open
Abstract
Elimination of the three blood-borne viruses-human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV)-as public health issues may be plausible in the near future. Spectacular advances have been made with the introduction of highly effective antiviral agents into clinical practice, and prevention strategies are available for all three infections. Effective disease control, laid out by WHO global strategies, is currently feasible for all three viruses. However, for worldwide elimination of these viruses, effective vaccines are required that are currently only available for HBV. In this review differences and parallels among HIV, HCV and HBV will be discussed with a focus on virologic and therapeutic issues, and prospects for the future of HBV will be presented.
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Affiliation(s)
- Maria C Leoni
- Department of Internal Medicine, Section Infectious Diseases, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
- Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Andrew Ustianowski
- Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK
- School of Medical Sciences, University of Manchester, Manchester, UK
| | - Hamzah Farooq
- Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK
| | - Joop E Arends
- Department of Internal Medicine, Section Infectious Diseases, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
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14
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Apiung T, Ndanu TA, Mingle JA, Sagoe KW. Hepatitis B virus surface antigen and antibody markers in children at a major paediatric hospital after the pentavalent DTP-HBV-Hib vaccination. Ghana Med J 2018; 51:13-19. [PMID: 28959067 DOI: 10.4314/gmj.v51i1.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The knowledge about outcomes of infant vaccination against HBV infections using the DPT-HepB-Hib vaccine in Ghana is limited. This study therefore investigated the levels of immunity to HBV among children who received the DPT-HepB-Hib vaccine and HBsAg carriage in non-responders. Correlates for non-response or poor response were also investigated. METHODS Cross-sectional study. A major paediatric hospital in Accra. Four hundred and twenty four children between the ages of 5 to 32 months who had completed the full vaccination schedule for the DPT-HepB-Hib vaccine. RESULTS Of the 424 children, 358 (84.4%) developed anti-HBs while 340 (80.2%) developed ≥10 mIU/ml anti-HBs (sero-protection) and 3 had HBsAg. A binary logistic regression analysis showed that younger children were associated with sero-conversion (p=.022) and sero-protection (p=.021). For anti-HBs titres ≥100 mIU/ml age was a weaker but significant contributor (p=.041), as compared to the number of vaccines from different manufacturers the child used (p=.028). The mean age of those who used a single type of vaccine was higher (14.75 ± 6.056 months; n=268) than those who used vaccines from two or more manufacturers (11.96 ± 4.645 months; n=156), p= <.001 (CI: -3.897 - 1.688), an indication that efforts to procure vaccine from same source when it was initially introduced are waning. CONCLUSIONS There is still a residual possibility of infection with HBV in spite of infant vaccination. In the light of possible loss of anamnestic response over time, there is the need to consider a birth dose for HBV vaccination for all neonates or booster dose for infants who may not have received the vaccine at birth. Using vaccines from a single manufacturer is recommended. FUNDING None declared.
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Affiliation(s)
- Thomas Apiung
- Clinical Virology Laboratory, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Thomas A Ndanu
- School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Julius Aa Mingle
- Clinical Virology Laboratory, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Kwamena Wc Sagoe
- Clinical Virology Laboratory, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
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15
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Shams AZ, Haug U. Strategies for prevention of gastrointestinal cancers in developing countries: a systematic review. J Glob Health 2018; 7:020405. [PMID: 29250323 PMCID: PMC5718709 DOI: 10.7189/jogh.07.020405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Gastrointestinal cancers account for one third of total cancer incidence and mortality in developing countries. To date, there is no systematic synthesis of evidence regarding strategies to prevent gastrointestinal cancers in developing countries. We aimed to provide a systematic overview of studies evaluating strategies for prevention or early detection of the three most common gastrointestinal cancers (gastric, liver and colorectal cancer) in developing countries. Methods We searched MEDLINE, Web of Science and WHO Global Index Medicus databases for relevant articles published until October 2016 using combinations of the search terms “gastrointestinal”, “digestive system”, “gastric”, “liver”, “colorectal”, “cancer”, “prevention”, “early detection” and “developing country” (including names). Results Overall, 73 articles met the inclusion criteria, providing information on short– and long–term outcomes (up to 30 years) from various intervention studies (∼45% randomized). Trials on hepatitis B vaccination consistently showed vaccine efficacy over time and indicated long–term preventive effects on liver cancer incidence that start to become measurable at the population level. Studies on anti–H. pylori treatment suggested a reduction in gastric cancer incidence reaching statistical significance after long–term follow–up, while evidence regarding a preventive effect in persons with precancerous lesions is still inconclusive. The studies regarding colorectal cancer focused on early detection, ∼90% of which were restricted to intermediate endpoints. Conclusion In conclusion, there were a number of studies on gastric and liver cancer prevention in developing countries showing promising results after long–term follow–up. Important next steps include pooled meta–analyses as far as possible given the heterogeneity between studies as well as implementation research.
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Affiliation(s)
- Ahmad Zia Shams
- Epidemiological Cancer Registry Baden-Wuerttemberg, German Cancer Research Centre, Heidelberg, Germany.,Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
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16
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Allen LN, Pullar J, Wickramasinghe KK, Williams J, Roberts N, Mikkelsen B, Varghese C, Townsend N. Evaluation of research on interventions aligned to WHO 'Best Buys' for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015. BMJ Glob Health 2018. [PMID: 29527342 PMCID: PMC5841523 DOI: 10.1136/bmjgh-2017-000535] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed ‘best buys’. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs). Aim To systematically review research on interventions aligned to WHO ‘best buys’ for NCDs in LLMICs. Methods We searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence. Results We identified 2672 records, of which 36 were included (608 940 participants). No studies on ‘best buys’ were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related ‘best buys’, presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the ‘best buy’ interventions did not have any good evidence for effectiveness in LLMICs. Conclusions We found studies on only 11 of the 24 interventions aligned with the WHO ‘best buys’ from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate ‘best buys’ in their national context, based on national priorities, and starting with interventions with the strongest evidence base.
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Affiliation(s)
- Luke N Allen
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jessica Pullar
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kremlin Khamarj Wickramasinghe
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julianne Williams
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nia Roberts
- Health Library, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bente Mikkelsen
- Global Coordination Mechanism for Noncommunicable Diseases, WHO, Geneva, Switzerland
| | - Cherian Varghese
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, WHO, Geneva, Switzerland
| | - Nick Townsend
- Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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18
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Zhao H, Zhou YH. Revaccination against hepatitis B in late teenagers who received vaccination during infancy: Yes or no? Hum Vaccin Immunother 2017; 14:456-463. [PMID: 29083945 PMCID: PMC5806661 DOI: 10.1080/21645515.2017.1397243] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The significance of vaccination against hepatitis B during infancy is recognized worldwide, however, whether booster or revaccination after a period of time following the primary vaccination is required remains controversial. Recently, cross-sectional epidemiological surveys found that HBsAg prevalence in subjects born after the implementation of mass vaccination was increased with age, which was attributed to waning of anti-HBs over time. However, comprehensive analysis of the closely related cross-sectional surveys showed that the age-specific increased HBsAg prevalence was more likely associated with the carry-over of the infection occurred in early life, likely due to imperfect coverage of hepatitis B vaccination at the beginning of its introduction. Latest studies showed that booster response could be observed in the majority of individuals vaccinated 30 years ago. Moreover, confirmed breakthrough HBV infection with severe consequences in successfully vaccinated individuals is extremely rare. Thus far no compelling evidence has been acquired to support booster vaccination in adolescence. The uncertainty regarding the duration of protection of hepatitis B vaccination, especially beyond 30 years after the primary vaccination, merits a systematically designed study to follow the same cohort of participants longitudinally, which differs from the cross-sectional studies reported previously, can hopefully offer more direct evidence to help us to determine whether revaccination of hepatitis B vaccine is necessary.
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Affiliation(s)
- Hong Zhao
- a Department of Infectious Diseases , The Second Hospital of Nanjing, The Second Affiliated Hospital of Southeast University , Nanjing , Jiangsu , China
| | - Yi-Hua Zhou
- b Departments of Laboratory Medicine and Infectious Diseases , Nanjing Drum Tower Hospital and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School , Nanjing , Jiangsu , China
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19
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Sagnelli E, Stroffolini T, Sagnelli C, Morisco F, Coppola N, Smedile A, Pisaturo M, Colloredo G, Babudieri S, Licata A, Brancaccio G, Andriulli A, Almasio PL, Gaeta GB. Influence of universal HBV vaccination on chronic HBV infection in Italy: Results of a cross-sectional multicenter study. J Med Virol 2017; 89:2138-2143. [PMID: 28608566 DOI: 10.1002/jmv.24873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/25/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM The universal hepatitis B vaccination for infants and 12-year-old adolescents (the latter limited to the first 12 years of application) was launched in Italy in 1991. Twenty-three years later we evaluated the impact of the vaccination campaign on the burden of HBsAg-positive chronic liver diseases (CLD). MATERIAL AND METHODS A total of 513 HBsAg-positive chronic carriers referring to 16 Italian liver units were investigated and compared with HBsAg carriers enrolled in previous surveys. RESULTS The proportion of inactive carriers decreased from 20.0% in 2001 to 3.3% in 2014, while that of cirrhotic patients increased from 22.6% to 33.2%. Regarding the age class 0-33 (fully covered by HBV vaccination in 2014), the rate of inactive carriers decreased from the 21.7% in 2001 to 5.9% in 2014, that of chronic hepatitis from 17.5% to 5.2% and that of cirrhosis cases from 26.4% to 4.1%. Instead, in the over-60 age group the rate of inactive carriers increased from 22.8% to 41.2% and that of chronic hepatitis from 16.8% to 46%; the rate of patients with cirrhosis ranged from 5% to 8% in different studies. CONCLUSION Twenty-three years after the introduction universal HBV vaccination in Italy, the clinical presentation of CLD had shown a shift toward older ages and more severe diseases.
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Affiliation(s)
- Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy
| | - Tommaso Stroffolini
- Department of Tropical and Infectious Diseases, Policlinico Umberto Primo, Rome, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Naples "Federico II", via Sergio Pansini, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy
| | - Antonina Smedile
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Guido Colloredo
- Department of Internal Medicine, San Pietro Hospital, Ponte San Pietro, Italy
| | - Sergio Babudieri
- Clinic of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Anna Licata
- Gastroenterology and Hepatology Unit, Di.Bi.MI.S. University of Palermo, Palermo, Italy
| | - Giuseppina Brancaccio
- Infectious Diseases, Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Caserta, Italy
| | - Angelo Andriulli
- Gastroenterology Unit, Fondazione "Casa Sollievo della Sofferenza" IRCCS Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Piero L Almasio
- Gastroenterology and Hepatology Unit, Di.Bi.MI.S. University of Palermo, Palermo, Italy
| | - Giovani B Gaeta
- Infectious Diseases, Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Caserta, Italy
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20
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Shang J, Wen Q, Wang CC, Liu K, Bai L, Tang H. Safety and efficacy of telbivudine for chronic hepatitis B during the entire pregnancy: Long-term follow-up. J Viral Hepat 2017; 24 Suppl 1:43-48. [PMID: 29082646 DOI: 10.1111/jvh.12785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 09/14/2017] [Indexed: 02/05/2023]
Abstract
The management of hepatitis B virus (HBV) infection in pregnancy is a unique issue. Telbivudine (LdT) is recommended to block HBV mother-to-child transmission (MTCT) in the third trimester. However, the safety of LdT treatment during the entire pregnancy for the long-term growth of infants is unclear. The aim of this study was to evaluate the efficacy and long-term safety of LdT for the entire pregnancy period. This retrospective cohort study included 40 pregnant women and 43 children from 2011 to 2017. The antiviral effects and maternal abnormalities were evaluated. In addition, adverse events regarding infants at delivery and HBV vaccination outcomes were recorded. The status of physical development in the children during follow-up was also evaluated. Among pregnant women, the rates of HBV DNA flare were 5.00% during pregnancy and 7.50% postpartum, and the HBeAg seroconversion rates were 7.50% during pregnancy and 7.50% postpartum. No severe maternal abnormalities were observed. Regarding the infants, no one was positive for HBsAg, and only one infant was negative for anti-HBs in children over 7 months of age. Furthermore, no birth defects or severe adverse events were observed at delivery, and 97.67% normal height and 93.02% normal weight in children were observed on follow-up until 5 years of age. In conclusion, LdT use for the entire pregnancy is both effective for treating pregnant women and blocking HBV MTCT. Moreover, LdT is safe for women and infants. Most importantly, the long-term follow-up indicated that LdT is safe and does not affect the growth of children.
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Affiliation(s)
- J Shang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Q Wen
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - C C Wang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - K Liu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - L Bai
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - H Tang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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21
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Zhou S, Li T, Allain JP, Zhou B, Zhang Y, Zhong M, Fu Y, Li C. Low occurrence of HBsAg but high frequency of transient occult HBV infection in vaccinated and HBIG-administered infants born to HBsAg positive mothers. J Med Virol 2017; 89:2130-2137. [PMID: 28543299 DOI: 10.1002/jmv.24861] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/01/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Shan Zhou
- Department of Transfusion Medicine; Southern Medical University; Guangzhou China
| | - Tingting Li
- Department of Transfusion Medicine; Southern Medical University; Guangzhou China
| | - Jean-Pierre Allain
- Department of Transfusion Medicine; Southern Medical University; Guangzhou China
- Department of Hematology; University of Cambridge; Cambridge United Kingdom
| | - Bin Zhou
- Department of Infectious Diseases; Nanfang Hospital; Southern Medical University; Guangzhou China
| | - Yuming Zhang
- Department of Paediatrics; Nanfang Hospital; Southern Medical University; Guangzhou China
| | - Mei Zhong
- Department of Obstetrics and Gynecology; Nanfang Hospital; Southern Medical University; Guangzhou China
| | | | - Chengyao Li
- Department of Transfusion Medicine; Southern Medical University; Guangzhou China
- School of Public Health and Tropical Medicine; Southern Medical University; Guangzhou China
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Breakwell L, Tevi-Benissan C, Childs L, Mihigo R, Tohme R. The status of hepatitis B control in the African region. Pan Afr Med J 2017; 27:17. [PMID: 29296152 PMCID: PMC5745934 DOI: 10.11604/pamj.supp.2017.27.3.11981] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/10/2017] [Indexed: 01/05/2023] Open
Abstract
The World Health Organization (WHO) African Region has approximately 100 million people with chronic hepatitis B virus (HBV) infection. This review describes the status of hepatitis B control in the Region. We present hepatitis B vaccine (HepB) coverage data and from available data in the published literature, the impact of HepB vaccination on hepatitis B surface antigen (HBsAg) prevalence, a marker of chronic infection, among children, HBsAg prevalence in pregnant women, and risk of perinatal transmission. Lastly, we describe challenges with HepB birth dose (HepB-BD) introduction reported in the Region, and propose strategies to increase coverage. In 2015, regional three dose HepB coverage was 76%, and 16(34%) of 47 countries reported ≥ 90% coverage. Overall, 11 countries introduced HepB-BD; only nine provide universal HepB-BD, and of these, five reported ≥ 80% coverage. From non-nationally representative serosurveys among children, HBsAg prevalence was lower among children born after HepB introduction compared to those born before HepB introduction. However, some studies still found HBsAg prevalence to be above 2%. From limited surveys among pregnant women, the median HBsAg prevalence varied by country, ranging from 1.9% (Madagascar) to 16.1% (Niger); hepatitis B e antigen (HBeAg) prevalence among HBsAg-positive women ranged from 3.3% (Zimbabwe) to 28.5% (Nigeria). Studies in three countries indicated that the risk of perinatal HBV transmission was associated with HBeAg expression or high HBV DNA viral load. Major challenges for timely HepB-BD administration were poor knowledge of or lack of national HepB-BD vaccination guidelines, high prevalence of home births, and unreliable vaccine supply. Overall, substantial progress has been made in the region. However, countries need to improve HepB3 coverage and some countries might need to consider introducing the HepB-BD to help achieve the regional hepatitis B control goal of < 2% HBsAg prevalence among children < 5 years old by 2020. To facilitate HepB-BD introduction and improve timely coverage, strategies are needed to reach both facility-based and home births. Strong political commitment, clear policy recommendations and staff training on HepB-BD administration are also required. Furthermore, high quality nationally representative serosurveys among children are needed to inform decision makers about progress towards the regional control goal.
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Affiliation(s)
- Lucy Breakwell
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carol Tevi-Benissan
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Lana Childs
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard Mihigo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Rania Tohme
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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23
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Will Infant Hepatitis B Vaccination Protect Into Adulthood?: Extended Canadian Experience After a 2-, 4- and 6-month Immunization Schedule. Pediatr Infect Dis J 2017; 36:609-615. [PMID: 28134742 DOI: 10.1097/inf.0000000000001543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) vaccination programs generally target infants to prevent chronic HBV infection and/or preadolescents to reduce transmission in adulthood. To assess whether infant HBV immunization can potentially accomplish both objectives, we measured residual immunity 10-16 years after vaccination in Canadian children. METHODS A prospective, parallel group, single center study enrolled adolescents given HBV vaccine at 2, 4 and 6 months of age. Exclusion criteria included prior HBV infection and additional vaccinations. At follow-up anti-HBs testing, participants were 10-11 or 15-16 years old; those with <12 mIU/mL anti-HBs by the assay used were challenged with HBV vaccine to assess immune memory-based responsiveness. RESULTS A total of 137 tested participants were 10-11 and 213 were 15-16 years old, respectively; none had evidence of prior HBV infection. At baseline, 78% of younger and 64% of older participants had <12 mIU/mL anti-HBs (P = 0.006) and were challenged with vaccine: 103/106 (97.2%) younger and 123/135 (91.1%) older participants developed ≥12 mIU/mL anti-HBs (P = 0.06), with geometric mean antibody concentration of 590 (95% confidence interval: 473-737) and 319 mIU/mL (95% confidence interval: 229-445; P = 0.004), respectively. Immune memory loss may have occurred in 3 younger (2.2%) and 12 older children (5.6%; P = 0.06) who were nonresponsive to first but not second vaccine challenge. CONCLUSIONS After HBV vaccination at 2, 4 and 6 months of age, most adolescents had little or no residual antibody but nearly all responded to HBV challenge, confirming immune memory persistence. However, anamnestic responses were weaker in 15- to 16-year olds and lost in some. Booster responses in 10- to 11-year olds were vigorous in comparison. Extended evaluation of protection is warranted.
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Shimakawa Y, Lemoine M, Njai HF, Bottomley C, Ndow G, Goldin RD, Jatta A, Jeng-Barry A, Wegmuller R, Moore SE, Baldeh I, Taal M, D'Alessandro U, Whittle H, Njie R, Thursz M, Mendy M. Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia. Gut 2016; 65:2007-2016. [PMID: 26185161 DOI: 10.1136/gutjnl-2015-309892] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/15/2015] [Accepted: 06/25/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The natural history of chronic HBV infection in sub-Saharan Africa is unknown. Data are required to inform WHO guidelines that are currently based on studies in Europe and Asia. METHODS Between 1974 and 2008, serosurveys were repeated in two Gambian villages, and an open cohort of treatment-naive chronic HBV carriers was recruited. Participants were followed to estimate the rates of hepatitis B e (HBeAg) and surface antigen (HBsAg) clearance and incidence of hepatocellular carcinoma (HCC). In 2012-2013, a comprehensive liver assessment was conducted to estimate the prevalence of severe liver disease. RESULTS 405 chronic carriers (95% genotype E), recruited at a median age of 10.8 years, were followed for a median length of 28.4 years. Annually, 7.4% (95% CI 6.3% to 8.8%) cleared HBeAg and 1.0% (0.8% to 1.2%) cleared HBsAg. The incidence of HCC was 55.5/100 000 carrier-years (95% CI 24.9 to 123.5). In the 2012-2013 survey (n=301), 5.5% (95% CI 3.4% to 9.0%) had significant liver fibrosis. HBV genotype A (versus E), chronic aflatoxin B1 exposure and an HBsAg-positive mother, a proxy for mother-to-infant transmission, were risk factors for liver fibrosis. A small proportion (16.0%) of chronic carriers were infected via mother-to-infant transmission; however, this population represented a large proportion (63.0%) of the cases requiring antiviral therapy. CONCLUSIONS The incidence of HCC among chronic HBV carriers in West Africa was higher than that in Europe but lower than rates in East Asia. High risk of severe liver disease among the few who are infected by their mothers underlines the importance of interrupting perinatal transmission in sub-Saharan Africa.
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Affiliation(s)
- Yusuke Shimakawa
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Maud Lemoine
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- Department of Hepatology, Imperial College London, London, UK
| | | | - Christian Bottomley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gibril Ndow
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Banjul, The Gambia
| | - Robert D Goldin
- Department of Hepatology, Imperial College London, London, UK
| | | | | | - Rita Wegmuller
- MRC International Nutrition Group, MRC Keneba, West Kiang, The Gambia
| | - Sophie E Moore
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- MRC International Nutrition Group, MRC Keneba, West Kiang, The Gambia
| | | | - Makie Taal
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hilton Whittle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ramou Njie
- Medical Research Council (MRC) Unit, Banjul, The Gambia
- The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Banjul, The Gambia
| | - Mark Thursz
- Department of Hepatology, Imperial College London, London, UK
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC), Lyon, France
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Joo EJ, Yeom JS, Kwon MJ, Chang Y, Ryu S. Insulin resistance increases loss of antibody to hepatitis B surface antigen in nondiabetic healthy adults. J Viral Hepat 2016; 23:889-896. [PMID: 27279074 DOI: 10.1111/jvh.12556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 05/12/2016] [Indexed: 01/04/2023]
Abstract
The aim of this study was to evaluate the impact of insulin resistance on the persistence of a protective level of anti-HBs (hepatitis B surface antigen) in a nondiabetic general population. A cohort study was designed comprising of 38 473 Korean men and women with anti-HBs at concentrations ≥10 mIU/mL, who underwent a health examination. Insulin resistance was assessed with a homoeostasis model assessment of insulin resistance (HOMA-IR). A decline in anti-HBs to <10 mIU/L during the follow-up was considered to be a loss of protective anti-HBs. Cox-proportional hazard models were used to estimate the adjusted hazard ratios and 95% confidence intervals for anti-HBs loss across quintiles of HOMA-IR and insulin. We identified 20 826 incidents of loss of anti-HBs antibody during 180 522 person-years of follow-up (incident rate 11.5 per 100 person-years). Increasing HOMA-IR was positively associated with incident loss of anti-HBs. The multivariable-adjusted hazard ratios (95% confidence intervals) for incident loss of anti-HBs comparing quintiles 2-5 vs quintile 1 of HOMA-IR were 1.09 (1.04-1.14), 1.14 (1.09-1.19), 1.14 (1.09-1.19) and 1.21 (1.16-1.27), respectively. These associations were stronger in younger individuals under the age of 35 than in people 35 years of age or older (P for interaction = 0.004). The association was also more evident in subjects with higher titres (≥100 mIU/mL) of anti-HBs than in those with low titres (P for interaction < 0.001). Insulin resistance was associated with an increased risk for loss of vaccine-acquired anti-HBs in a large sample of a nondiabetic, general population, indicating a possible role of insulin resistance in vaccine-induced immunity.
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Affiliation(s)
- E-J Joo
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J-S Yeom
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - M-J Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Y Chang
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - S Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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Nayagam S, Conteh L, Sicuri E, Shimakawa Y, Suso P, Tamba S, Njie R, Njai H, Lemoine M, Hallett TB, Thursz M. Cost-effectiveness of community-based screening and treatment for chronic hepatitis B in The Gambia: an economic modelling analysis. Lancet Glob Health 2016; 4:e568-78. [PMID: 27443782 DOI: 10.1016/s2214-109x(16)30101-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the high burden of hepatitis B virus (HBV) infection in sub-Saharan Africa, absence of widespread screening and poor access to treatment leads to most people remaining undiagnosed until later stages of disease when prognosis is poor and treatment options are limited. We examined the cost-effectiveness of community-based screening and early treatment with antiviral therapy for HBV in The Gambia. METHODS In this economic evaluation, we combined a decision tree with a Markov state transition model to compare a screen and treat intervention consisting of adult community-based screening using a hepatitis B surface antigen (HBsAg) rapid test and subsequent HBV antiviral therapy versus current practice, in which there is an absence of publicly provided screening or treatment for HBV. We used data from the PROLIFICA study to parameterise epidemiological, primary screening, and cost information, and other model parameter inputs were obtained from a literature search. Outcome measures were cost per disability-adjusted life-year (DALY) averted; cost per life-year saved; and cost per quality-adjusted life-year (QALY) gained. We calculated the incremental cost-effectiveness ratios (ICERs) between current practice and the screen and treat intervention. Costs were assessed from a health provider perspective. Costs (expressed in 2013 US$) and health outcomes were discounted at 3% per year. FINDINGS In The Gambia, where the prevalence of HBsAg is 8·8% in people older than 30 years, adult screening and treatment for HBV has an incremental cost-effectiveness ratio (ICER) of $540 per DALY averted, $645 per life-year saved, and $511 per QALY gained, compared with current practice. These ICERs are in line with willingness-to-pay levels of one times the country's gross domestic product per capita ($487) per DALY averted, and remain robust over a wide range of epidemiological and cost parameter inputs. INTERPRETATION Adult community-based screening and treatment for HBV in The Gambia is likely to be a cost-effective intervention. Higher cost-effectiveness might be achievable with targeted facility-based screening, price reductions of drugs and diagnostics, and integration of HBV screening with other public health interventions. FUNDING European Commission.
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Affiliation(s)
- Shevanthi Nayagam
- Division of Digestive Diseases, St Mary's Hospital, Imperial College, London, UK; Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK.
| | - Lesong Conteh
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK
| | - Elisa Sicuri
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Yusuke Shimakawa
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia; Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Penda Suso
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Saydiba Tamba
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Ramou Njie
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Harr Njai
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Maud Lemoine
- Division of Digestive Diseases, St Mary's Hospital, Imperial College, London, UK; Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK
| | - Mark Thursz
- Division of Digestive Diseases, St Mary's Hospital, Imperial College, London, UK
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Poorolajal J, Hooshmand E, Cochrane Hepato‐Biliary Group. Booster dose vaccination for preventing hepatitis B. Cochrane Database Syst Rev 2016; 2016:CD008256. [PMID: 27271960 PMCID: PMC7154826 DOI: 10.1002/14651858.cd008256.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Antibodies against hepatitis B surface antigen (HBsAg) wane over time following hepatitis B immunisation; hence, it is unclear whether people vaccinated in three-dose or four-dose schedules of the hepatitis B vaccine are still immune when the hepatitis B surface antibody (anti-HBs) level in their body is undetectable, or lower than the level usually considered protective. This question may potentially be answered indirectly by measuring the anamnestic immune response to a booster dose of vaccine. The term 'booster' (or revaccination) refers to an additional dose of hepatitis B vaccine (HBV) given some time post-primary vaccination to induce immune memory and improve protection against hepatitis B virus (HBV) infection. OBJECTIVES To assess the benefits and harms of booster dose hepatitis B vaccination, more than five years after the primary vaccination, for preventing HBV infection in healthy individuals previously vaccinated with the hepatitis B vaccine, and with hepatitis B surface antibody (anti-HBs) levels below 10 mIU/mL. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded, conference databases, and reference lists of articles to January 2016. We also contacted authors of articles. In addition, we searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (May 2016). SELECTION CRITERIA Randomised clinical trials addressing anamnestic immune response to a booster dose of hepatitis B vaccine, more than five years after the primary vaccination, in apparently healthy participants, vaccinated in a three-dose or four-dose schedule of the hepatitis B vaccine during the primary vaccination, without receiving an additional dose or immunoglobulin. DATA COLLECTION AND ANALYSIS Both review authors decided if the identified studies met the inclusion criteria or not. Primary outcomes included the proportion of participants with anamnestic immune response in non-protected participants and signs of HBV infection. Secondary outcomes were the proportion of participants that developed local and systemic adverse events following a booster dose injection. We planned to report the weighted proportion with 95% confidence intervals (CIs). MAIN RESULTS There were no eligible randomised clinical trials fulfilling the inclusion criteria of this review. AUTHORS' CONCLUSIONS We were unable to include any randomised clinical trials on the topic; only randomised clinical trials will be able to provide an answer as to whether a booster dose vaccination is able to protect against hepatitis B infection.
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Affiliation(s)
- Jalal Poorolajal
- School of Public Health, Hamadan University of Medical SciencesModeling of Noncommunicable Diseases Research Center, Department of EpidemiologyShahid Fahmideh AveHamadanHamadanIran6517838695
| | - Elham Hooshmand
- School of Public Health, Hamadan University of Medical SciencesDepartment of EpidemiologyHamadanIran
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Du J, Xu Y, Wang J, Liu S, Liu Y, Zhang X, Xu E. 24 year outcomes of hepatitis B vaccination in Hangzhou, China. Hum Vaccin Immunother 2016; 11:2051-60. [PMID: 25714188 DOI: 10.1080/21645515.2015.1008873] [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] [Indexed: 01/05/2023] Open
Abstract
To evaluate the impact of the universal infant HepB vaccination program on hepatitis B virus infection in Hangzhou, China. Hepatitis B incidences and HepB vaccination rates of Hangzhou from 1990 to 2003 were acquired from the historical paper-documents, while which were derived from China Information System for Diseases Control and Prevention and Zhejiang Information System for Immunization Program respectively from 2004 to 2013. A serology survey among person aged 0-59 y was conducted in Hangzhou in 2006. Participants were selected by stratified, multi-stage random sampling. Serum specimens were tested for HBsAg, anti-HBs , anti-HBc , HBeAg and anti-HBe by ELISA. For the past 24 years, hepatitis B incidence and mortality of Hangzhou declined dramatically (χ(2) = 3.2 × 10(4); χ(2) = 172.443; both P for trend < 0.001). Both urban and rural incidence descended (χ(2)urban = 1.904 × 10(4); χ(2)rural = 1.633 × 10(4) ; both P for trend < 0.001).Hepatitis B patients mainly concentrated in 20-40 y old; workers and farmers were the main infection occupations, which was varies in different years (χ(2) = 1.619 × 10(3), P < 0.001). Significant association was found between incidence of hepatitis B and HepB vaccination rate (r = 0 .946, χ(2) = 11.813, Pfor trend = 0.001). A total of 5605 participants aged 0-59 y included in this serological survey. The prevalence of HBsAg, anti-HBs, anti-HBc, HBeAg and anti-HBe were 6.19%, 45.83%, 57.25%, 0.62%, and 4.37%, respectively. Hangzhou has successfully integrated the HepB into routine immunization programs and this has had a significant impact on decreasing the incidence of hepatitis B infection.
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Affiliation(s)
- Jian Du
- a Hangzhou Center for Disease Control and Prevention ; Hangzhou , China
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Pinto M, Scheifele D. Discussing the need for an adolescent hepatitis B vaccine booster in infant vaccinees. Paediatr Child Health 2014; 19:404. [PMID: 25382994 DOI: 10.1093/pch/19.8.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 01/05/2023] Open
Affiliation(s)
- Michelle Pinto
- Infectious Diseases, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia
| | - David Scheifele
- Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia
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Sadoh AE, Ofili A. Hepatitis B infection among Nigerian children admitted to a children's emergency room. Afr Health Sci 2014; 14:377-83. [PMID: 25320587 DOI: 10.4314/ahs.v14i2.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Nigeria commenced her hepatitis B immunization programme in 2004 but there have been few evaluations of the programme in different parts of the country given the fact that prevalence in different regions of the country varies. The objective of this study was to determine the prevalence of HBsAg and the hepatitis B immunization status among children admitted to the children's emergency room (CHER) in Benin Teaching Hospital. METHODS A descriptive cross-sectional study carried out in 150 consecutively recruited children aged 2 months to 15 years admitted to the CHER of the University of Benin Teaching Hospital. HBsAg was assayed for in blood. RESULTS HBsAg seroprevalence was 13.9%. Majority (83%) of the children were age appropriately immunized for hepatitis B. Mean age at receipt of the birth dose of hepatitis B (28.0 ± 20.4 days) was significantly delayed (p<0.0001). Mean age at completion of the schedule(110 ± 18.6 days) was significantly delayed compared to the recommended age of 98 days p<0.0002). Age, sex and socioeconomic status were not significantly associated with being seropositive(p>0,05). CONCLUSION HBsAg seroprevalence was high despite high immunization coverage. Lack of timeliness in the receipt of the birth dose and in completion of the schedule may have contributed to the seeming lack of effectiveness of the immunization programme.
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Affiliation(s)
- Ayebo E Sadoh
- Department of Child Health, University of Benin Teaching Hospital Benin City, Nigeria
| | - Antoinette Ofili
- Department of Community Health, University of Benin Teaching Hospital, Benin City, Nigeria
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REZAEI M, NOORIPOOR S, GHORBANI R, RAMEZANSHAMS F, MAMISHI S, MAHMOUDI S. Seroprotection after hepatitis B vaccination in children aged 1 to 15 years in central province of Iran, Semnan. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2014; 55:1-3. [PMID: 25916024 PMCID: PMC4718339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION There are controversies over the long-term persistence of post vaccination immunity to hepatitis B and the need for booster doses of the vaccine. The aim of this study was to verify antibody levels of antibody against hepatitis B virus surface antigen (anti-HBs) in children aged 1 to 15 years who received vaccination against hepatitis B in the central province of Iran, Semnan. MATERIALS AND METHODS We performed a seroepidemiological survey (n = 210) of anti-HBs in 2011 in the central province of Iran, Semnan using enzyme-linked immunosorbent assay (ELISA). The levels of anti-HBs < 10 mIU/mL were considered to be negative and samples showing an anti-HBs titer ≥ 10 mIU/mL was considered protective. RESULTS Protective antibody levels were detected in 88% of the children less than 5 year after vaccination, decreased to 78% between 5 to 10 years after vaccination, and further declined to 74% in 10 years after vaccination, respectively. CONCLUSION The vaccination program has been proven effective in Semnan and immunological protection against hepatitis B infection was found in the majority of children even more than 10 years after being vaccinated.
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Affiliation(s)
- M. REZAEI
- Department of Pediatrics, Amir Almomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - S. NOORIPOOR
- Department of Pediatrics, Amir Almomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - R. GHORBANI
- Department of Pediatrics, Amir Almomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - F. RAMEZANSHAMS
- Department of Pediatrics, Amir Almomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - S. MAMISHI
- Department of Pediatrics, Children Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran;, Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - S. MAHMOUDI
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Shima Mahmoudi, Pediatric Infectious Diseases Research Center, Children Medical Center Hospital, School of Medicine, Tehran University of Medical Sciences No. 62, Gharib St., Keshavarz Blvd., Tehran, Iran - Tel. +98- 021- 6642- 8996; Fax +98- 021- 6642- 8996 - E-mail:
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Peto TJ, Mendy ME, Lowe Y, Webb EL, Whittle HC, Hall AJ. Efficacy and effectiveness of infant vaccination against chronic hepatitis B in the Gambia Hepatitis Intervention Study (1986-90) and in the nationwide immunisation program. BMC Infect Dis 2014; 14:7. [PMID: 24397793 PMCID: PMC3898092 DOI: 10.1186/1471-2334-14-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/04/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gambian infants were not routinely vaccinated against hepatitis B virus (HBV) before 1986. During 1986-90 the Gambia Hepatitis Intervention Study (GHIS) allocated 125,000 infants, by area, to vaccination or not and thereafter all infants were offered the vaccine through the nationwide immunisation programme. We report HBV serology from samples of GHIS vaccinees and unvaccinated controls, and from children born later. METHODS During 2007-08, 2670 young adults born during the GHIS (1986-90) were recruited from 80 randomly selected villages and four townships. Only 28% (753/2670) could be definitively linked to their infant HBV vaccination records (255 fully vaccinated, 23 partially vaccinated [1-2 doses], 475 not vaccinated). All were tested for current HBV infection (HBV surface antigen [HBsAg]) and, if HBsAg-negative, evidence of past infection (HBV core-protein antibody [anti-HBc]). HBsAg-positive samples (each with two age- and sex-matched HBsAg-negative samples) underwent liver function tests. In addition, 4613 children born since nationwide vaccination (in 1990-2007) were tested for HBsAg. Statistical analyses ignore clustering. RESULTS Comparing fully vaccinated vs unvaccinated GHIS participants, current HBV infection was 0.8% (2/255) vs 12.4% (59/475), p < 0.0001, suggesting 94% (95% CI 77-99%) vaccine efficacy. Among unvaccinated individuals, the prevalence was higher in males (p = 0.015) and in rural areas (p = 0.009), but adjustment for this did not affect estimated vaccine efficacy. Comparing fully vaccinated vs unvaccinated participants, anti-HBc was 27.4% (70/255) vs 56.0% (267/475), p < 0.00001. Chronic active hepatitis was not common: the proportion of HBsAg-positive subjects with abnormal liver function tests (ALT > 2 ULN) was 4.1%, compared with 0.2% in those HBsAg-negative. The prevalence of antibodies to hepatitis C virus was low (0.5%, 13/2592). In children born after the end of GHIS, HBsAg prevalence has remained low; 1.4% (15/1103) in those born between 1990-97, and 0.3% (9/35150) in those born between 1998-2007. CONCLUSIONS Infant HBV vaccination achieves substantial protection against chronic carriage in early adulthood, even though approximately a quarter of vaccinated young adults have been infected. This protection persists past the potential onset of sexual activity, reinforcing previous GHIS findings of protection during childhood and suggesting no need for a booster dose. Nationwide infant HBV vaccination is controlling chronic infection remarkably effectively.
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Affiliation(s)
- Thomas J Peto
- Medical Research Council Laboratories, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok, 10400, Thailand
| | - Maimuma E Mendy
- Medical Research Council Laboratories, Fajara, The Gambia
- International Agency for Research on Cancer, Lyon, France
| | - Yamundow Lowe
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, London, UK
| | - Hilton C Whittle
- Medical Research Council Laboratories, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew J Hall
- London School of Hygiene and Tropical Medicine, London, UK
- International Agency for Research on Cancer, Lyon, France
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Bevers TB, Brown PH, Maresso KC, Hawk ET. Cancer Prevention, Screening, and Early Detection. ABELOFF'S CLINICAL ONCOLOGY 2014:322-359.e12. [DOI: 10.1016/b978-1-4557-2865-7.00023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Abstract
Hepatocellular carcinoma (HCC) is one of the five leading causes of cancer death in human. Hepatitis B virus (HBV) is the most common etiologic agent of HCC in the world, particularly in areas prevalent for HBV infection such as Asia, Africa, southern part of Eastern and Central Europe, and the Middle East. Risk factors of HBV-related HCC include (1) viral factors-persistent high viral replication, HBV genotype C or D, pre-S2 or core promoter mutants; (2) host factors-older age (>40 years old) at HBeAg seroconversion, male gender; (3) mother-to-infant transmission; and (4) other carcinogenic factors-smoking, habitual use of alcohol, etc. Prevention is the best way to control cancer. There are three levels of liver cancer prevention, i.e., primary prevention by HBV vaccination targeting the general population, secondary prevention by antiviral agent for high-risk subjects with chronic HBV infection, and tertiary prevention by antiviral agent to prevent recurrence for patients who have been successfully treated for liver cancer. Primary prevention by hepatitis B vaccination is most cost effective. Its cancer preventive efficacy supports it as the first successful example of cancer preventive vaccine in human. This experience can be extended to the development of other cancer preventive vaccine. Careful basic and clinical research is needed to develop ideal vaccines to induce adequate protection. Understanding the main transmission route and age at primary infection may help to set the optimal target age to start a new cancer preventive vaccination program. Besides timely HBV vaccination, the earlier administration of hepatitis B immunoglobulin immediately after birth, and even antiviral agent during the third trimester of pregnancy to block mother-to-infant transmission of HBV are possible strategies to enhance the prevention efficacy of HBV infection and its related liver cancer.
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Affiliation(s)
- Mei-Hwei Chang
- Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan,
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Alexandre KVF, Martins RMB, Souza MMD, Rodrigues IMX, Teles SA. Brazilian hepatitis B vaccine: a six-year follow-up in adolescents. Mem Inst Oswaldo Cruz 2013; 107:1060-3. [PMID: 23295759 DOI: 10.1590/s0074-02762012000800016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 08/16/2012] [Indexed: 01/05/2023] Open
Abstract
The protective anti-HBs titres were examined six-year post-immunisation with the Brazilian recombinant hepatitis B vaccine. After the primary vaccination, all adolescents (n = 89) responded with protective anti-HBs titres and had a geometric mean titre (GMT) of 4031.8 mIU/mL. In 2010, 94.5% maintained protective anti-HBs (> 10 mIU/mL) antibodies, with a GMT of 236.0 mIU/mL. A positive correlation was observed between the anti-HBs titres after the primary vaccination and the titres at the six-year follow-up (p < 0.01). Eleven subjects showed anti-HBs titres suggestive of a natural booster. Prostitution and tattoos/piercings were marginally associated with natural boosters in the multivariate analysis. This study showed the first data on anti-HBs persistence following the Brazilian hepatitis B vaccine in sexually active individuals and highlights its effectiveness in the medium term.
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Schönberger K, Riedel C, Rückinger S, Mansmann U, Jilg W, Kries RV. Determinants of Long-term protection after hepatitis B vaccination in infancy: a meta-analysis. Pediatr Infect Dis J 2013; 32:307-13. [PMID: 23249904 DOI: 10.1097/inf.0b013e31827bd1b0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The duration of protection after hepatitis B vaccination in early infancy is unclear and may be related to vaccination schedule, dosage, vaccine type and population characteristics. Factors potentially influencing waning immunity were assessed. METHODS A systematic review was performed. The main outcomes were prevalence of anti-hepatits B antibodies ≥ 10 mIU/mL after primary or booster vaccination. Factors potentially influencing protection were assessed in an adjusted random-effects meta-analysis model by age for both outcomes. Results of both meta-analyses were combined in a prognostic model. RESULTS Forty-six studies reporting on the anti-hepatits B antibodies ≥ 10 mIU/mL 5 to 20 years after primary immunization and 29 on booster response were identified. The adjusted meta-analyses identified maternal carrier status (odds ratio [OR]: 2.37 [1.11; 5.08]), lower vaccine dosage than presently recommended (OR: 0.14 [0.06; 0.30]) and gap time between last and preceding dose of the primary vaccine series (OR: 0.44 [0.22; 0.86]) as determinants for persistence of anti-hepatits B antibodies ≥ 10. A lower vaccine dosage was also associated with failure to respond to booster (OR: 0.20 [0.10; 0.38]). The prognostic model predicted long-term protection of 90% [77%; 100%] at the age of 17 years for offspring of noncarrier mothers vaccinated with a presently recommended dose and vaccination schedule. CONCLUSIONS Based on meta-analyses, predictors of waning immunity after hepatitis B vaccination in infancy could be identified. A prognostic model for long-term protection after hepatitis B vaccination in infancy was developed.
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Affiliation(s)
- Katharina Schönberger
- Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, Biostatistics and Epidemiology, Ludwig Maximilians University of Munich, Germany.
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Mendy M, Peterson I, Hossin S, Peto T, Jobarteh ML, Jeng-Barry A, Sidibeh M, Jatta A, Moore SE, Hall AJ, Whittle H. Observational study of vaccine efficacy 24 years after the start of hepatitis B vaccination in two Gambian villages: no need for a booster dose. PLoS One 2013; 8:e58029. [PMID: 23533578 PMCID: PMC3606345 DOI: 10.1371/journal.pone.0058029] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
Objectives To determine the duration of protection from hepatitis B vaccine given in infancy and early childhood and asses risk factors for HBV infection and chronic infection. Methods In 1984 infant HBV vaccination was started in two Gambian villages. Cross sectional serological surveys have been undertaken every 4 years to determine vaccine efficacy. In the current survey 84.6% of 1508 eligible participants aged 1–28 years were tested. A spouse study was conducted in females (aged 14 years and above) and their male partners. Results Vaccine efficacy against chronic infection with hepatitis B virus was 95.1% (95% confidence interval 91.5% to 97.1%), which did not vary significantly between age groups or village. Efficacy against infection was 85.4% (82.7% to 87.7%), falling significantly with age. Concentrations of hepatitis B antibody fell exponentially with age varying according to peak response: 20 years after vaccination only 17.8% (95% CI 10.1–25.6) of persons with a low peak response (10–99 mIU/ml) had detectable HBs antibody compared to 27% (21.9% to 32.2%) of those with a high peak response (>999 mIU/ml). Time since vaccination and a low peak response were the strongest risk factors for HBV infections; males were more susceptible, marriage was not a significant risk for females. Hepatitis B DNA was not detected after infection, which tested soley core antibody positive. An undetectable peak antibody response of <10 mIU/ml and a mother who was hepatitis B e antigen positive were powerful risk factors for chronic infection. Conclusions Adolescents and young adults vaccinated in infancy are at increased risk of hepatitis B infection, but not chronic infection. Married women were not at increased risk. There is no compelling evidence for the use of a booster dose of HBV vaccine in The Gambia.
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Affiliation(s)
- Maimuna Mendy
- Medical Research Council Laboratories, The Gambia, Banjul, the Gambia, West Africa.
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Management of chronic hepatitis B: Canadian Association for the Study of the Liver consensus guidelines. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 26:917-38. [PMID: 23248795 DOI: 10.1155/2012/506819] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic hepatitis B (CHB) is a dynamic disease that is influenced by host and virological factors. The management of CHB has become more complex with the increasing use of long-term oral nucleos⁄tide analogue antiviral therapies and the availability of novel diagnostic assays. Furthermore, there is often a lack of robust data to guide optimal management such as the selection of therapy, duration of treatment, potential antiviral side effects and the treatment of special populations. In November 2011, the Canadian Liver Foundation and the Canadian Association for the Study of the Liver convened a consensus conference to review the literature and analyze published data, including other international expert guidelines on CHB management. The proceedings of the consensus conference are summarized and provide updated clinical practice guidelines to assist Canadian health care providers in the prevention, diagnosis, assessment and treatment of CHB.
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Hepatitis B vaccines. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025] Open
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Han K, Shao X, Zheng H, Wu C, Zhu J, Zheng X, Zhang Y. Revaccination of non- and low- responders after a standard three dose hepatitis B vaccine schedule. Hum Vaccin Immunother 2012; 8:1845-9. [PMID: 22906933 DOI: 10.4161/hv.21818] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Guangdong province of China is HBV high endemicity and 1.6 million neonates are administrated 5 μg yeast recombinant anti-HBV vaccine each year. But few studies are performed to evaluate the immunogenicity and revaccination effect on non- and low- responders. METHODS 2,199 children were administered intramuscularly with 5 μg vaccine at 0, 1 and 6 mo after birth. A 3 ml blood sample was drawn from each infant 1 mo after the third dose for determination of anti-HBs level. Three additional doses (10 μg each) were given to non- and low- responders. RESULTS Of 1,814 subjects, 3.1% were non-responders (anti-HBs titer < 10 mIUml (-1) ) and 28.9% were low-responders (anti-HBs ≥ 10 mIUml (-1) and < 100 mIUml (-1) ). Low birth weight (LBW) was a risk factor for non- and low- responders (RR = 1.6, 95%CI = 1.2-2.0). After revaccination, of the 34 non-responders, 14.7% became low-responders and 85.3% became responders. Of the 74 low-responders, 21.6% remained at the same level and 78.4% shifted into responder category. CONCLUSIONS Based on the lower responding rate after the primary immunization cycle and the higher responding rate after the additional cycle, measurement of anti-HBs level should be considered for people who had been immunized with three-dose 5 μg HB vaccine in Guangdong, especially for specific populations including LBW infants, healthcare workers, and patients with immunodeficiency disorders. An amount of 10 μg vaccine should be revaccinated to any non- and low- responders to provide adequate seroprotection.
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Affiliation(s)
- Ke Han
- Guangdong Center for Disease Control and Prevention, Guangzhou, Guangdong, P.R. China
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Mayer TK, Vargas RL, Knebel AE, Williams SA, Culver SP, Clark DM, King LR. Hepatitis B assays in serum, plasma and whole blood on filter paper. BMC Clin Pathol 2012; 12:8. [PMID: 22606954 PMCID: PMC3674795 DOI: 10.1186/1472-6890-12-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 05/09/2012] [Indexed: 12/14/2022] Open
Abstract
Background Screening and determining the immune status of individuals for hepatitis B is
usually done by detecting hepatitis B surface antigen (HBsAg) and hepatitis
B surface antigen-specific antibodies (HBsAb). In some countries with the
highest viral burden, performing these assays is currently impractical. This
paper explores the use of filter paper as a blood specimen transport
medium. Methods Samples, chosen from routine clinical laboratory pool, were applied and dried
onto filter paper. Eluates, from the paper samples, were analyzed as routine
clinical specimens on ADVIA Centaur 5634® immunoassay analyzers using
the standard HBsAg and HBsAb kits. Dried blood samples were subjected to a
range of environmental conditions in order to assess stability. Results After drying and elution the assays showed linearity and precision comparable
to clinical assays performed on fresh serum. Elutions at various times
during a 149 day incubation period showed very little variability in the
Index numbers. All analytes were temperature stable except for a decrease in
the HBsAg signal at 42°C. Conclusions Filter paper is an acceptable storage and transport medium for serum to be
used in the detection of hepatitis B markers if atmospheric variability can
be controlled. HBsAg, HBsAb and HBcAb are all stable for at least five
months under storage conditions below room temperature. Drying specimens,
particularly serum, on filter paper at remote locations, offers a reasonable
solution to the problem of hepatitis surveillance in underdeveloped regions,
although some attempt at temperature control might be desirable.
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Affiliation(s)
- Theodor K Mayer
- Department of Chemistry, Rochester Institute of Technology, 85 Lomb Memorial Drive, Rochester, NY, 14623, USA.
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Fagundes GD, Tabalipa FDO, Silva JD. Antibody levels in children after 10 years of vaccination against hepatitis B: a brazilian community-based study. Rev Soc Bras Med Trop 2012; 45:260-2. [DOI: 10.1590/s0037-86822012000200024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Accepted: 07/28/2011] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION: It is known that the hepatitis B (HB) vaccine is effective, but it is alarming that sudden drops of antibody levels may coincide with the onset of adolescence. METHODS: Antibody levels against HB vaccine surface antigen (anti-HBs) and HB vaccine core antigen (anti-HBc) were measured on the blood samples of children with a mean age of 11.4 years. RESULTS: About 54.8% had protective levels of anti-HBs. Of those who were anti-HBc-positive (4.4%), an average of 218.4 anti-HBs mIU/mL was found. CONCLUSIONS: Immunological protection was found in the majority of children. However, more studies are needed to elucidate the heritability of nonresponders and establish strategies against such events.
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Affiliation(s)
| | | | - Jane da Silva
- Universidade do Sul de Santa Catarina; Universidade do Sul de Santa Catarina
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Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine 2012; 30:2212-9. [PMID: 22273662 DOI: 10.1016/j.vaccine.2011.12.116] [Citation(s) in RCA: 1323] [Impact Index Per Article: 101.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 12/09/2011] [Accepted: 12/23/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Chronic hepatitis B virus infection is one of the most serious infections and a major risk factor for deaths from cirrhosis and liver cancer. We estimate age-, sex- and region-specific prevalence of chronic HBV infection and calculate the absolute number of persons being chronically infected. METHODS A systematic review of the literature for studies reporting HBV infection was conducted and worldwide HBsAg seroprevalence data was collected over a 27-year period (1980-2007). Based on observed data, age-specific prevalence and endemicity were estimated on a global level and for all world regions for 1990 and 2005 using an empirical Bayesian hierarchical model. FINDINGS From 1990 to 2005, the prevalence of chronic HBV infection decreased in most regions. This was particularly evident in Central sub-Saharan Africa, Tropical and Central Latin America, South East Asia and Central Europe. Despite this decrease in prevalence, the absolute number of HBsAg positive persons increased from 223 million in 1990 to 240 million in 2005. Age-specific prevalence varied by geographical region with highest endemicity levels in sub-Saharan Africa and prevalence below 2% in regions such as Tropical and Central Latin America, North America and Western Europe. Asian regions showed distinct prevalence patterns with lower intermediate prevalence in South Asia, but up to 8.6% HBsAg prevalence in East Asia. Strong declines were seen in South East Asian children. CONCLUSION Declines in HBV infection prevalence may be related to expanded immunization. The increasing overall number of individuals being chronically infected with HBV, and the widespread global differences in HBV prevalence call for targeted approaches to tackle HBV-related mortality and morbidity. HBV infection prevalence data are needed at country and sub-national level to estimate disease burden and guide health and vaccine policy.
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Affiliation(s)
- J J Ott
- World Health Organization, 20, Avenue Appia, 1211 Geneva 27, Switzerland
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Stroffolini T, Guadagnino V, Caroleo B, De Sarro G, Focà A, Liberto MC, Giancotti A, Barreca GS, Marascio N, Lombardo FL, Staltari O. Long-term immunogenicity of hepatitis B vaccination in children and adolescents in a southern Italian town. Infection 2011; 40:299-302. [PMID: 22173948 DOI: 10.1007/s15010-011-0233-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 11/28/2011] [Indexed: 01/05/2023]
Abstract
PURPOSE Universal anti-hepatitis B vaccination of infants and of 12-year-old children became mandatory in Italy in 1991. The purpose of this study was to evaluate the persistence of anti-hepatitis B surface (HBs) antibodies several years after a primary course of vaccination. METHODS In 2010, anti-HBs titers were measured in all subjects aged between 5 and 25 years residing in a southern Italian town. Individuals with an anti-hepatitis B antibody concentration of 10 IU/ml or more were considered to be protected. RESULTS Of the 671 subjects evaluated, 149 (30%) lacked protective antibodies. Fifty-three (29.4%) of the subjects had been vaccinated ≤10 years earlier and 96 (30.3%) more than 10 years earlier (P = not significant). Subjects vaccinated in infancy were more likely to lack protective anti-HBs antibodies than subjects vaccinated at 12 years of age, regardless of the years elapsed since immunization. CONCLUSIONS Most subjects maintained protective antibodies for a considerable number of years after vaccination. Vaccination in adolescence results in more prolonged immunogenicity than vaccination in infancy.
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Affiliation(s)
- T Stroffolini
- Department of Infectious and Tropical Diseases, Institute of Tropical Diseases, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
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Villar S, Le Roux-Goglin E, Gouas DA, Plymoth A, Ferro G, Boniol M, Lereau M, Bah E, Hall AJ, Wild CP, Mendy M, Norder H, van der Sande M, Whittle H, Friesen MD, Groopman JD, Hainaut P. Seasonal variation in TP53 R249S-mutated serum DNA with aflatoxin exposure and hepatitis B virus infection. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:1635-40. [PMID: 21768053 PMCID: PMC3226502 DOI: 10.1289/ehp.1103539] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 07/18/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Chronic hepatitis B virus (HBV) infection and dietary aflatoxin B1 (AFB1) exposure are etiological factors for hepatocellular carcinoma (HCC) in countries with hot, humid climates. HCC often harbors a TP53 (tumor protein p53) mutation at codon 249 (R249S). In chronic carriers, 1762T/1764A mutations in the HBV X gene are associated with increased HCC risk. Both mutations have been detected in circulating cell-free DNA (CFDNA) from asymptomatic HBV carriers. OBJECTIVE We evaluated seasonal variation in R249S and HBV in relation to AFB1 exposure. METHODS R249S was quantitated by mass spectrometry in CFDNA in a cross-sectional survey of 473 asymptomatic subjects (237 HBV carriers and 236 noncarriers) recruited in three villages in the Gambia over a 10-month period. 1762T/1764A HBV mutations were detected by quantitative polymerase chain reaction. In addition, the HBV S gene was sequenced in 99 subjects positive for HBV surface antigen (HBsAg). RESULTS We observed a seasonal variation of serum R249S levels. Positivity for R249S and average concentration were significantly higher in HBsAg-positive subjects surveyed during April-July (61%; 5,690 ± 11,300 R249S copies/mL serum) than in those surveyed October-March [32% and 480 ± 1,030 copies/mL serum (odds ratio = 3.59; 95% confidence interval: 2.05, 6.30; p < 0.001)]. Positivity for HBV e antigen (HBeAg) (a marker of HBV replication) and viral DNA load also varied seasonally, with 15-30% of subjects surveyed between April and June HBeAg positive, compared with < 10% surveyed during other months. We detected 1762T/1764A mutations in 8% of carriers, half of whom were positive for R249S. We found HBV genotype E in 95 of 99 HBsAg-positive subjects. CONCLUSION R249S is detectable in CFDNA of asymptomatic subjects. Evidence of temporal and quantitative variations suggests an interaction among AFB1 exposure, HBV positivity, and replication on TP53 mutation formation or persistence.
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Affiliation(s)
- Stéphanie Villar
- Molecular Carcinogenesis Group, International Agency for Research on Cancer, Lyon, France
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Junqueira ALN, Tavares VR, Martins RMB, Frauzino KV, Costa e Silva AMD, Rodrigues IMX, Minamisava R, Teles SA. Presence of maternal anti-HBs antibodies does not influence hepatitis B vaccine response in Brazilian neonates. Mem Inst Oswaldo Cruz 2011; 106:113-6. [DOI: 10.1590/s0074-02762011000100018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Accepted: 08/12/2010] [Indexed: 01/05/2023] Open
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Huang LM, Lu CY, Chen DS. Hepatitis B virus infection, its sequelae, and prevention by vaccination. Curr Opin Immunol 2011; 23:237-43. [PMID: 21257300 DOI: 10.1016/j.coi.2010.12.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/23/2010] [Indexed: 12/16/2022]
Abstract
Hepatitis B virus (HBV) infection is a global health problem. There are >350 million of people chronically infected with this virus worldwide. Hepatitis B vaccines are effective in preventing the infection. Humoral immunity is the key factor in conferring the protection. Hepatitis B surface antibody titers of ≥10mIU/mL are protective. Chronic carriage of HBV is related to the age when the infection occurs, the younger the age the higher the chronicity rate. Hence, vaccination should be given in early childhood. People vaccinated in infancy have a protection of >20 years, and hepatocellular carcinoma decreases in them. Although the vaccine-conferred immunity wanes by time, a universal booster is not recommended at present.
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Affiliation(s)
- Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan
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Lasemi E, Haddadpour N, Navi F, Rakhshan A, Rakhshan V. Rate of acquired immunity in dental students after hepatitis B vaccination. Dent Res J (Isfahan) 2011; 8:128-131. [PMID: 22013475 PMCID: PMC3177387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Triple-course vaccination against hepatitis B might sometimes fail to increase antibody titers or maintain it at sufficient levels. The aim of this study was to evaluate the rate of seroprotection in dental students after receiving recombinant hepatitis B vaccine. METHODS Anti-HBs levels of 124 dental students who had received triple-course hepatitis B vaccines (scheduled at months 0, 1, and 6) were examined. Titers ≥ 100 mIU/ml were considered as protective. Associations between age, gender and duration of being vaccinated with the titer of anti-HBs were assessed. RESULTS The participants' mean age was 24 ± 1.3 years and 93% of them were female. The time passed from receiving the final dose was 3.5 ± 1.4 years. Fifty four percent of the students had protective immune response (95% CI 45.2% to 62.8%), 24.2% had positive but weak immune response (anti-HBs titer was between 10 and 100 mIU/ml), and the rest of the subjects (21.8%) were seronegative after receiving routine HBV vaccination. CONCLUSION There was a considerable rate of failure in achieving or maintaining acceptable titer levels following routine vaccination against HBV. Hence, determining serum anti-HBs titer after vaccination is recommended.
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Affiliation(s)
- Eshagh Lasemi
- Associate Professor, Department of Oral and Maxillofacial Surgery, Islamic Azad University, Dental Branch of Tehran, Iran
| | | | - Fina Navi
- Lecturer and Faculty Member, Department of Oral & Maxillofacial Surgery, Islamic Azad University, Dental Branch of Tehran, Iran
| | | | - Vahid Rakhshan
- Lecturer and Faculty Member, Department of Dental Morphology, Islamic Azad University, Dental Branch of Tehran, Iran and Faculty Member, Orofacial Bioengineering Research Center, Tehran University of Medical Sciences, Tehran, Iran and Director of the Dental Section, Farzan Clinical Research Institute, Tehran, Iran
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Epidemiological changes in hepatitis B prevalence in an entire population after 20 years of the universal HBV vaccination programme. Epidemiol Infect 2010; 139:1159-65. [PMID: 21156099 DOI: 10.1017/s0950268810002827] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A universal hepatitis B vaccination programme has been conducted in Long An county since 1986. To investigate the epidemiological changes in hepatitis B virus (HBV) infection we conducted a serosurvey there in 2005. A total of 4686 subjects were enrolled and vaccination history and blood samples collected. HBV infective markers were determined by radioimmunoassay. The results were compared with the data of 1985. Our results show that the overall HBsAg prevalence was 7·5%, less than half of the prevalence reported in 1985. HBsAg and anti-HBc antibody prevalence in people born after 1985 decreased markedly. The gender difference in HBsAg prevalence was abolished in subjects aged <20 years. The administration of a first dose of vaccine within 24 h could reduce the HBsAg prevalence by half. In conclusion, the marked epidemiological changes in HBV prevalence found in this serosurvey indicate that the implementation of HBV vaccination was highly successful.
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