Antibody anti-HBs Research Articles

Prevalence and risk factors of hepatitis B virus reactivation in patients with solid tumors with resolved HBV infection.

BackgroundReports of hepatitis B virus (HBV) reactivation in solid tumors are very limited, and their frequencies and risk factors were previously unknown.AimTo evaluate the prevalence and risk factors of HBV reactivation in patients with solid tumors with resolved HBV infection.MethodsAll 1088 patients with solid tumors were assessed for eligibility; 251 patients had resolved HBV infection (negative for HBs antigen and positive for anti‐HBc antibody and/or positive for anti‐HBs antibody), and HBV‐DNA was assessed for 243 of these patients in whom we analyzed the prevalence of HBV reactivation. Risk factors for HBV reactivation were exploratorily evaluated by analysis of a case–control study.ResultsThe prevalence of HBV‐DNA reactivation was 2.1% (95% confidence interval [CI], 0.3–3.9%). We did not observe any exacerbation of HBV‐DNA by early intervention. A low anti‐HBs antibody titer (<10.0 mIU/mL) and high average daily dexamethasone dose (>1.0 mg/day) were high risk factors, with odds ratios of 5.94 (95% CI, 1.15–30.6, P = 0.03) and 8.69 (95% CI, 1.27–58.8, P = 0.02), respectively.ConclusionHBV reactivation in solid tumor patients was relatively rare. Therefore, risk factors that can identify targets for HBV screening must be determined in future studies.

Evaluation of impact of occult hepatitis B infection in chronic HCV-infected patients: A retrospective cohort study

CONTEXT:Occult hepatitis B infection (OBI) may contribute to liver damage and variable therapeutic response in patients with chronic hepatitis C (CHC) infection.AIMS:To study the prevalence of OBI and to evaluate its impact and/or that of anti-HBc total seropositivity on clinical outcomes and response to directly acting antiviral (DAA) therapy in CHC-infected patients.SETTINGS AND DESIGN:A retrospective cohort study was conducted in a tertiary care liver hospital from January to May 2017.SUBJECTS AND METHODS:Eighty HBsAg-negative CHC patients who were initiated on DAA therapy were retrospectively included. Archived pretreatment baseline plasma samples were retrieved and tested for quantitative HBV DNA, anti-HBs, and anti-HBc total antibodies. HCV RNA, genotype, clinical, biochemical and histopathological parameters & treatment response data were obtained from the hospital information system.STATISTICAL ANALYSIS USED:Comparison of continuous variables was done by Mann–Whitney and Kruskal–Wallis tests and categorical variables by Fisher's exact test or Pearson's Chi-square test.RESULTS:Prevalence of OBI was 1.25%. Anti-HBc total positivity was seen in 25% patients. Based on anti-HBc total status, patients were categorized into two groups namely Group 1 (anti-HBc positive) and Group 2 (anti-HBc negative). Group 1 patients were further categorized into three subgroups based on signal/cutoff (S/Co) of HBc total antibody semi-quantitative values. HBc total antibody levels did not influence the severity of CHC disease. Comparative evaluation of parameters such as median log10 baseline RNA (P = 0.929 and 0.464), median alanine aminotransferase (ALT 0) (P = 0.519 and 0.449), ALT at 12 weeks (P = 0.875 and 0.594), sustained virological response (SVR) at 12 weeks (P = 0.405 and 0.263) and SVR at 24 weeks (P = 0.265 and 0.625) between Groups 1 and 2 and among three categories within Group 1, respectively, were not found to be statistically significant.CONCLUSIONS:Very low prevalence of OBI was seen in CHC patients. HBc total antibody levels did not influence clinical outcome and response to DAA therapy in this cohort.

Prophylactic hepatitis B immunization in chronic kidney disease patients, Oran, Algeria

Background It is estimated that > 2 billion people worldwide have been infected with HBV. Of these, approximately 360 million individuals are chronically infected and at-risk of serious illness and death, mainly from liver cirrhosis and hepatocellular carcinoma (HCC). Algeria is situated in areas of intermediate endemicity (prevalences of endemicity of HBsAg 2–7%). Patients suffering from chronic kidney disease (CKD) are at particular risk of infection with HBV, they are associated with reduced immunogenicity following vaccine administration. Because of that, these patients have been offered schedules containing more than 3 doses and larger doses of the vaccine (schedule containing 4 double doses of standard hepatitis B vaccine). Those found to have anti-HBs concentrations Aim Determine the efficacy of the four double doses schedule of hepatitis B vaccine in preventing infection up postvaccination of chronic renal failure patients. Patients and methods It is a retrospective descriptive study including 209 chronic kidney disease patients. All patients had received hepatitis B vaccine with follow-up at epidemiology service of Oran university hospital (EHUO), during a period 2011–2012. Patients have been offered immunization schedule containing double doses (40 μg) of monovalant recombinant hepatitis B vaccine. The primary immunization series consists of 4 doses of vaccine (at 0, 1, 2, 6 month) followed by anti-HBs testing. People who do not respond (anti-HBs antibody titres Results The average age of patients is 61.2 ± 1.1 years old with a sex ratio of 1.1. Non-dialyzed CKD patients accounted for 78.9%. Vaccine seroprotection was obtained in 82% of non-hemodialysis CKD patients and in 76% of CKD hemodialysis patients after primary vaccination. Nevertheless, 12% of non-hemodialysis CKD patients and 12.5% of CKD hemodialysis patients are low responders (10 ≤ AC-HBS Conclusion The four doses of 40 μg vaccine schedule has proven its effectiveness with good seroprotection in chronic kidney disease patients. The vaccination against hepatitis B represents a considerable advance in the prophylaxis of this disease but unfortunately no regulatory text governs this vaccination in CKD patients in our country. Early vaccination (before dialysis) is recommended.

7. Immune responses to hepatitis B vaccination in HBSAG-patient who cleared serum-hepatitis B surface antigen and not developed anti-HBS antibody

7. Immune responses to hepatitis B vaccination in HBSAG-patient who cleared serum-hepatitis B surface antigen and not developed anti-HBS antibody

Correlations of indoleamine 2,3-dioxygenase, interferon-λ3, and anti-HBs antibodies in hemodialysis patients

BackgroundIndoleamine 2,3-dioxygenase (IDO) contributes to maintaining immune homeostasis. Polymorphisms (SNPs) of the IDO encoding gene (IDO1) influence the IDO activity. Interferon (IFN)-λ3 induces IDO expression. We aimed to investigate whether IDO1 variants are associated with anti-HBs production in response to HBV vaccination or infection, interact with IFN-λ3 associated variants of IFNL4, and influence survival of hemodialysis (HD) patients. We also tested circulating IDO concerning IDO1 SNPs and plasma IFN-λ3 and anti-HBs levels. MethodsThe study included HD patients who had established status concerning responsiveness to HBV vaccination (n = 1022) or were exposed to HBV (n = 315). Ability to generate anti-HBs was diagnosed if anti-HBs after vaccination or infection exceeded 10 IU/L. Genotyping of IDO1 (rs3739319 A < G, rs9657182 C < T), IFNL4 rs8099917 G < T and IFNL4 rs12979860 C > T polymorphisms was carried out by high-resolution melting curve analysis. Circulating IDO and IFN-λ3 were measured with ELISA in 57 subjects. Survival probability was analyzed using the Kaplan-Meier method. ResultsIDO1 SNPs did not correlate with the ability to produce anti-HBs after vaccination or infection. Anti-HBs titers, including a frequency of anti-HBs ≥ 1000 IU/l, also did not associate with IDO1 SNPs, but there was an epistatic interaction between rs9657182, rs8099917, and rs12979860 concerning anti-HBs titers (P = 0.028). Significant associations between IDO1 SNPs and circulating IDO were not demonstrated. Anti-HBs titers negatively correlated with plasma IDO (r = −0.358, P = 0.006), and positively with circulating IFN-λ3 (r = 0.498, P = 0.00008). IDO and IFN-λ3 did not correlate. Patients possessing the rs9657182 TT genotype showed higher infection-related mortality, also in multivariate analysis (HR 2.073, 1.221–3.518, P = 0.007). ConclusionsIDO1 rs9657182, IFNL4 rs8099917, and IFNL4 rs12979860 show epistatic interaction concerning anti-HBs titers. Overreacting immune responses to HBsAg occur in patients with lower IDO but simultaneously higher IFN-λ3 levels. The rs9657182 TT genotype associates with infection-related mortality of HD patients.

Anti-HBs Antibody Levels and Anti-HBc Detection Among HBV-Vaccinated Freshmen Enrolled in the Department of Laboratory Sciences, Shiraz University of Medical Sciences, Iran

Background: There are few studies indicating the post-neonatal HBV vaccination level of anti-HBs antibody in first-year enrolled university students in Iran. In addition, anti- HBc antibody detection, which is a good indicator of virus exposure, has not been reported in vaccines. Hence, this study was conducted to determine the level of anti-HBs and anti-HBc antibodies in the serum sample of medical laboratory students who had received primary infantile HBV vaccination. Methods: This study was conducted on first-year students enrolled in the department of laboratory sciences at Shiraz University of Medical Sciences, Iran. For determining anti-HBs and anti-HBc titers, 5 mL of venous blood was aseptically collected. Anti-HBs and anti-HBc antibody levels were determined by enzyme-linked immunosorbent assay. HBV DNA was also performed on DNA extracted from individuals positive for an anti-HBc antibody test. Results: Of the 257 vaccinated individuals (188 females and 69 males) who participated in this study, 36.2% showed a non-protective anti-HBs response (anti-HBs < 10 mIU/mL) and 164/257 individuals (63.8%) showed a protective anti-HBs response (anti-HBs ≥ 10 mIU/mL). Significant numbers of females had protective levels of anti-HBS antibody in serum samples in comparison with the males (P < 0.001). Anti-HBc antibody was detected in 3 participants; however, HBsAg was not detected in any of the cases. HBV DNA was found in two. Conclusions: Our results indicate that a substantial number of our study population vaccinated against HBV during childhood showed non-protective anti-HBs antibody level. Therefore, a booster dose of vaccine needs to be scheduled for students with anti-HBs level < 10 mIU/mL prior to the start laboratory internship.

Anti-Hepatitis B Antibody status in children with coeliac disease

Objective: This study aimed to compare the antibodies response to hepatitis B virus (HBV) vaccine between Libyan children with coeliac disease (CD) and healthy control. Subjects and Methods: A total of 66 children with CD on a gluten-free diet (GFD) and 31 randomly allocated healthy children who received HBV vaccination according to the standard immunization schedule were included. Hepatitis B virus surface antigen (HBsAg) and the production of specific anti-HBs antibodies were evaluated in all patients and control participants using standard techniques. Patients with &lt;10 IU/L anti-HBs antibodies were considered nonresponses to the vaccination. Results: None of the participants were HBsAg reactive. Forty-one of the 66 patients (62%) were female, and 25 (37.8%) were male. The mean age of the CD patients was 8.2 years (range, 22 months-15 years). Anti-HBs titers were positive in 40 (60.6%) patients and negative in 26 (39.3%) patients, whereas they were positive in 19 (61.2%) of the children in the control group and negative in 12 (38.7%).There was no significant difference in response to vaccine between the two groups (P = 0.83), the study revealed a statistically significant relation between negative anti-HBs titers and duration from the last dose of HBV vaccine (P = 0.004). Conclusion: In the present study, the response rate in Libyan children with CD on GFD was not different from healthy control. However, not all children need booster dose; only nonresponders need an intradermal test-booster dose to reassess the state of their memory cell before considering revaccination.

Antiviral prophylaxis during chemotherapy or immunosuppressive drug therapy to prevent HBV reactivation in patients with resolved HBV infection: a systematic review and meta-analysis.

Until recently, the role of antiviral prophylaxis in preventing hepatitis B virus (HBV) reactivation during immunosuppressive therapy or chemotherapy in patients with resolved HBV infection was unclear. The aim of the study reported here was to compare the efficacy of antiviral prophylaxis versus that of non-prophylaxis in resolved HBV-infected patients undergoing chemotherapy or immunosuppressive therapy. PubMed, the Cochrane library, and the ClinicalTrials.gov website were searched from inception until December 2017. Studies comparing reactivation in prophylaxis versus non-prophylaxis in patients undergoing immunosuppressive therapy or chemotherapy were included. The meta-analysis was performed to calculate the relative risk (RR) and the pooled estimates. A meta-analysis was conducted of 13 studies (2 randomized controlled trials [RCTs] and 11 cohort studies). The summary RR for HBV reactivation was 0.47 (95% confidence interval [CI] 0.13-1.69) for antiviral prophylaxis versus non-prophylaxis. Both of the RCTs included in the meta-analysis enrolled patients treated with rituximab. Subgroup analyses showed that the two RCTs ± high-quality cohort studies showed a decreased risk of HBV reactivation among the antiviral prophylaxis groups (RCT 1: RR 0.13, 95% CI 0.02-0.70; P = 0.02; RCT 2: 0.28, 95% CI 0.08-0.98; P = 0.05). Subgroup analyses further showed that the cohort studies did not support an association between the antiviral prophylaxis groups and HBV reactivation (RR 0.62, 95% CI 0.14-2.83; P = 0.54); adjusting for confounding factors, such as detectable anti-HBs antibodies, failed to produce a significant association (RR,0.29, 95% CI 0.07-1.28; P = 0.10). Our meta-analyses did not show an association between antiviral prophylaxis use and risk of HBV reactivation. As using only the RCTs ± high-quality cohort studies data rendered this association significant, clinicians can consider providing antiviral prophylaxis to patients with resolved HBV infection who are undergoing rituximab-based therapy.

A Study of Persistence of Anti-HBs Antibodies after Vaccination with Recombinant Hepatitis B Vaccine in Healthcare Workers

A Study of Persistence of Anti-HBs Antibodies after Vaccination with Recombinant Hepatitis B Vaccine in Healthcare Workers

INCIDENCE OF NEEDLE STICK AND SHARPS INJURIES AMONG HEALTH CARE WORKERS IN A TERTIARY HOSPITAL, SAUDI ARABIA

Introduction: Needle Stick Injuries are common and expected among health‑care workers during execution of their patient care services. Aim of work: To estimate annual incidence of needle stick and sharps injuries among health care workers and to describe the associated factors and type of injuries in a tertiary hospital in Eastern Province, Saudi Arabia. Materials and Methods: The target group was all health care workers who obligatory reported for needle stick, sharp injuries during the period from January 2013 to December 2015. The occupational health specialist of the hospital interviewed them to take full documented history through standard questionnaire, performed examination if needed and requested for necessary investigations for the workers and the source patient if known. Results: about 30% of the injuries occurred in Emergency Rooms, followed by Operating Theater (about 20%). The commonest site of injury was fingers (70%). It was more common among female, especially nurses (33.3%). Investigating their Anti HBs antibody titre showed 90.6 % immune. The highest reported incidence occurs during blood sample collection (28.2%). Health care workers explained the cause of injury in form of being rushed (38.46%) or feeling fatigued (28.20%). Majority of them (58.12%) squeezed and cleaned the affected part with disinfectant as immediate actions following exposure. Conclusion: Occupational injuries with needles or other sharps are common among health care professionals especially nurses. It is more incident at emergency room due to high level of stress and rush at work. Training of workers and is recommended to increase their knowledge about the danger of injuries and the appropriate immediate action to be done after injury. Safety boxes, strict policy of reporting and follow up of the injured workers is mandatory for preventing further injuries and decreasing danger of blood borne diseases.

Reactivation of Hepatitis B virus in kidney transplant recipients with previous clinically resolved infection: A single-center experience

BackgroundHepatitis B virus (HBV) reactivation in kidney transplant recipients (KTR) involves important morbidity and mortality. Despite being more common in patients who are HBsAg-positive, it may occur in patients with clinically resolved infection (HBsAg-negative and anti-HBc-positive), in whom the presence of the protective anti-HB antibody is thought to decrease the risk of reactivation. Data regarding reactivation rates in this population are scarce. ObjectiveTo retrospectively evaluate the risk of HBV reactivation in KTR with previously resolved infection. Material and methodsRetrospective cohort study including patients who underwent a kidney transplant between January 1994 and December 2014 with resolved HBV infection at the time of transplantation (anti-HBc seropositivity without detectable HBsAg, with or without anti-HB-positive antibodies and normal liver enzymes). ResultsOut of 966 patients, 95 patients with evidence of resolved HBV infection were analyzed, of which 86 had a titer of anti-HBs >10mIU/ml. Mean follow-up time was 93 months; 12 patients had lost anti-HBs. Two patients showed evidence of reactivation. Risk factors associated with loss of anti-HBs were elderly age (>60) and occurrence of acute graft rejection (p<0.05). ConclusionThe risk of HBV reactivation in KTR with previously resolved infection is not negligible at 2%. Elderly age and acute rejection were associated with loss of anti-HBs, and these patients may benefit from closer monitoring of HBV DNA levels. Routine serology and/or HBV viral load monitoring in HBsAg-negative, anti-HBc-positive patients is recommended and should be emphasized in these patients.

SAT-407 - A novel chimpanzee adenoviral vectored HBV vaccine, encoding multiple HBV antigens with a shark invariant chain adjuvant, for use in HBV immunotherapy

Background: Chronic hepatitis B virus (HBV) infects 257 million people globally. Current therapies suppress HBV but rebound occurs on cessation of therapy; novel therapeutic strategies are urgently required. Aim: To develop a potent therapeutic HBV vaccine that will induce T-cells to all major HBV antigens and generate anti-HBs antibodies, using Chimpanzee adenoviral vectors and shark class-II invariant (sIi) chain as a genetic adjuvant. Method: We designed two HBV immunogens SIi-HBV-CPmutS and HBV-CPmutS; encoding precore (PreC), core, non-functional polymerase (Pmut), PreS1, PreS2 and surface antigens (Figure 1a). The large envelope protein of HBV (composed of PreS1, PreS2 and surface proteins) was generated separately using furin 2A (F2A) peptide cleavage protein. A 26 amino-acid sequence, derived from shark invariant chain (sIi), was inserted at the 5’ end of the SIi-HBV-CPmutS immunogen. The immunogens were encoded in chimpanzee-adenoviral vector (ChAdOx2) and tested in naive mice given i.m. HBV-specific T-cell responses were assessed using IFN-ϒ ELISpot and intracellular cytokine (ICCS) assays. Results: Vaccination generated very high magnitude HBV specific T-cell responses to all HBV antigens (Figure 1b). The mean magnitude of total HBV-specific T-cell responses in inbred BALB/c and outbred CD1 mice were 3858 and 3821 spot forming units [SFU]/106 splenocytes (shown on the left side of figure 1b) and 4514 and 2979 SFU/106 intrahepatic lymphocytes (shown on the right side of figure 1b) respectively. ICCS showed that HBV specific CD8+ T cells were poly-functional producing both IFN-ϒ and TNF-α. The inclusion of shark invariant chain (data shown in blue coloured bars in figure 1b) significantly enhances the T-cell magnitude for both splenocytes (3821 mean total SFU/106 with sIi vs. 386 mean total SFU/106 without sIi, p<0.0001) and intrahepatic lymphocytes (2979 mean total SFU/106 with sIi vs. 461 mean total SFU/106 without SIi, p=0.0002). Importantly, T cells to the non-HBV SIi peptides were not generated. Conclusion: We have generated a highly potent HBV vaccine that induces T-cells against all major HBV proteins, using chimpanzee adenoviral vector and class-II invariant chain technologies. These pre-clinical studies pave the way for new studies of HBV immunotherapy in humans with chronic HBV infection.

Comparison of immunogenicity between hepatitis B vaccines with different dosages and schedules among healthy young adults in China: A 2-year follow-up study

ABSTRACTImmunogenicity of hepatitis B vaccine between 20 μg with 3-dose schedule and 60 μg with 2-dose regimens was compared 2 years after primary immunization. A total of 353 healthy adults aged 18–25 years were enrolled in the study and randomly assigned (1: 1: 1) into 3 vaccine groups: A (20 μg, 0–1–6 month), B (60 μg, 0–1 month) and C (60 μg, 0–2 month). Serum samples were collected at 1 month after a series vaccination and 12 months, 24 months after the first-dose. The GMC level of anti-HBs antibody was measured using Chemiluminescent Microparticle ImmunoAssay (CMIA). There were 59, 45 and 55 vaccinees available to follow-up with 2 year later in vaccine groups A, B and C, respectively. No significant differences existed in sex ratio, age and body mass index (BMI) among vaccinees at month 24 and the corresponding participants at baseline in each group (P > 0.05). The seroprotection rates in group A, B and C were 98.31%, 88.37% and 85.19%, respectively (P = 0.014), reflecting the fact that the rate of group A was significantly higher than that in group C (P = 0.026). Also, the GMC level of anti-HBs antibody in group A was significantly higher than those of other two groups (427.46 mIU/ml vs. 89.74 mIU/ml, 89.80 mIU/ml, respectively; all P < 0.01). This data suggested that the standard 20 μg (0–1–6 month) regimen of hepatitis B vaccine should be recommended as a priority on the premise of complete compliance in adults.

Persistence of hepatitis B immune memory until 9–10 years of age following hepatitis B vaccination at birth and DTaP-IPV-HB-PRP∼T vaccination at 2, 4 and 6 months

ABSTRACTObjective: To evaluate the long-term persistence of anti-hepatitis B surface (HBs) antibodies and the response to a HB challenge re-vaccination in children who had received a primary series of DTaP-IPV-HB-PRP∼T (Hexaxim™) or DTaP-IPV-HB/PRP∼T (Infanrix hexa™).Methods: Two cohorts of participants who had previously received HB vaccine at birth followed by either DTaP-IPV-HB-PRP∼T or DTaP-IPV-HB/PRP∼T co-administered with PCV7 at 2, 4, 6 months of age in a randomized, Phase III, observer-blind study in Thailand, were followed up for anti-HBs antibodies (geometric mean concentrations [GMCs] and seroprotection [SP] rate [% of participants with a titer ≥10 mIU/mL]) at 12–18 months of age and 9–10 years of age. A monovalent HB challenge re-vaccination was administered at 9–10 years of age and the anamnestic response was evaluated.Results: Anti-HBs GMCs and SP rates in the DTaP-IPV-HB-PRP∼T and DTaP-IPV-HB/PRP∼T groups were high and similar post-primary vaccination series (2477 mIU/mL and 99.5% and 2442 mIU/mL and 99.5%, respectively) and declined to a similar extent in each group at 12–18 months (154.5 mIU/mL and 90.8% and 162.3 mIU/mL and 96.5%, respectively). Antibody levels further declined at 9–10 years of age (13.3 mIU/mL and 49.3% and 8.0 mIU/mL and 42.9%) and a strong anamnestic response occurred in each group post-HB challenge re-vaccination (92.8% and 98.7%, respectively).Conclusion: The kinetics of long-term anti-HBs antibody persistence were similar following a primary series of DTaP-IPV-HB-PRP∼T or DTaP-IPV-HB/PRP∼T. The response to a subsequent HB challenge re-vaccination was strong and similar in each group, demonstrating persisting immune memory.

Anti-HBs Titers Following Pentavalent Immunization (DTwP-HBV-Hib) in Term Normal Weight vs Low Birthweight Infants

To compare anti-HBs titers between term low birth weight (1800-2499 g) infants and normal birthweight infants, 6 weeks after last dose of primary immunization with pentavalent vaccine, and to study adverse events following immunization (AEFI) with pentavalent vaccine. Cohort study. Tertiary-care hospital predominantly catering to urban poor population of East Delhi. 265 low birthweight (1800-2499 g) and 265 normal birthweight (2500-4000 g) infants. Monovalent Hepatitis B vaccine was administered within 24 hours of birth followed by three primary doses of pentavalent vaccine at 6, 10 and 14 weeks. Anti-HBs titers were estimated after 6 weeks of third dose of pentavalent vaccine. Adverse events following immunization (AEFI) month were observed for a month after each dose of pentavalent vaccine. Anti HBs antibody titers after 6 weeks of primary immunization, and AEFI. 443 (83.5%) infants (225 low birthweight and 218 normal birthweight infants) completed the follow-up. Seroprotection against hepatitis B virus was achieved in both groups after pentavalent vaccine administration. Anti HBs GMTs in low birthweight infants (194.8 mIU/mL) and normal birthweight infants (204.2 mIU/mL) were comparable (P = 0.17). No serious adverse events were observed in either group. Three primary doses of pentavalent vaccine administered along with zero dose of Hepatitis B vaccine at birth provide good seroprotection. The vaccine appears to be safe in both low birth weight and normal birthweight infants born at term.

P378 Immunisation practices for hepatitis B and response to vaccination in Greek patients with inflammatory bowel disease

Low vaccination rates against hepatitis B virus(HBV) and sub-optimal response to vaccination are reported in patients with IBD. We initiated a multi-centre study in the metropolitan area of Athens, to assess: a)the percentage of IBD patients with protective anti-HBs levels and b)the response to vaccination. We reviewed the clinical records of all IBD patients with regular follow-up at 4 tertiary hospitals in Athens. All patients were tested for HBsAg, anti-HBs and anti-HBc antibodies. Patients with negative tests for both HBsAg and anti-HBc were managed as follows: a)negative anti-HBs without history of vaccination: 3-dose vaccination(0,1,6mo) with 20μg b)history of vaccination: anti-HBs levels >100 IU/l: annual follow-up of anti-HBs levels; anti-HBs 10–100 IU/l, 1–3 20μg doses with anti-HBs measurement after each dose; undetectable anti-HBs, 1–3 20μg doses with anti-HBs measurement after each dose. Vaccination was considered complete when anti-HBs>100 IU/l were detected. In patients with negative anti-HBs levels after 3x20μg doses, vaccination was repeated with a double dose(40μg) with anti-HBs measurement after each dose. Our study population consists of 686 IBD patients. Among those, 575 patients had recent HBV serology(84%). In our cohort we identified 8 cases of chronic HBV infection(HBsAg+) and 38 patients with previous exposure to HBV(HBsAg-, anti-HBc+). Protective immunity due to previous vaccination(HBsAg-, anti-HBc-, anti-HBs+>100 iu/l) was detected in 24%(n = 140). Sub-optimal anti-HBs levels were seen in 12%(n = 70). The majority of patients were negative for all three markers, indicating lack of effective vaccination(n = 319, 56%). Vaccination has been commenced in 243 patients. 206 patients completed their regimens. Response has been assessed in 177 patients: 106(60%) demonstrated sufficient response while 71 failed to develop immunity to HBV. Among non-responders, 39 received repeat vaccination, with 22 having achieved protective anti-HBs levels and 17 failing to respond again. There was a significant correlation between “low-tier”(only 5-ASA or no treatment) therapy at time of vaccination and successful response (p = 0.015). There was also strong association (p < 0.001) between age and presence of protective immunity, probably due to the application of HBV vaccination in the last 2 decades in Greece. A significant percentage of Greek IBD patients lack protective immunity against HBV. Classical vaccination regimen often fails to induce adequate levels of anti-HBs antibodies especially in cases that are receiving “high-tier” treatment (immunomodulation and/or immunosuppression). Increased awareness, intensified vaccination protocols and frequent testing of response may be required in this population.

Efficacy and safety of long-term entecavir therapy in a European population.

Therapy in chronic hepatitis B (chronic hepatitis B) patients aims at improving their survival by preventing disease progression to cirrhosis and its complications. Entecavir (ETV) is currently a first line therapeutic agent recommended for the treatment of CHB. Our aim was to evaluate the long term outcome of a cohort of CHB patients treated with ETV. Thirty-four patients treated with ETV for at least 6 months were included in this study. The virologic response was determined by the dosage of serum HBV-DNA, HBsAg, HBeAg, anti-HBs and anti-HBe antibodies. Death, acute pancreatitis, lactic acidosis and kidney function impairment were considered as major adverse events. The median period of treatment was 55 months (range 15-81). Thirty-three (97%) patients responded to the therapy after a mean time of 14.7 weeks (4-60); of these, 29 (85.3%) maintained the HBV-DNA negativity in serum, while 4 patients (11.8%) had a breakthrough. The remaining patient did not respond. Seroconversion to anti-HBs and anti-HBe was not observed, although 2 patients lost the e and the s antigen, respectively. Baseline alanine aminostransferase (ALT) levels in serum were altered in 18 patients (52.9%), and returned to normal levels during the follow-up, with a reduction of 87.7 IU/L (P<0.0001). A case (3.4%) of hepatocellular carcinoma was observed after 24 months. No major adverse events were recorded. ETV is effective in suppressing viral replication as well as in normalizing serum ALT levels, without anti-HBs seroconversion. Finally, ETV is a safe drug, substantially free of major side effects.

IgG antibody prevalence suggests high immunization needs in newcomers to Luxembourg, 2012

Vaccine coverage of the general population in Luxembourg is high, but refugees or asylum seekers may be incompletely vaccinated and susceptible to vaccine-preventable diseases.In order to assess protection rates, serum and oral fluid samples were collected from 406 newcomers aged between 13 and 70 years arriving between May and September 2012. Sera were screened for IgG antibodies against measles, rubella, mumps, hepatitis B, tetanus, diphtheria and pertussis. Oral fluid samples were screened for antibodies against measles, mumps and rubella virus to investigate their suitability for antibody prevalence studies.More than 90% of the participants had IgG antibodies against rubella, 73% against measles and 56% against mumps. Less than 19% had anti-HBs antibodies. Nearly 84% of the participants had an adequate protection against tetanus, 73% against diphtheria and 40% had pertussis antibodies. 93%, 95% and 78% of the measles, rubella and mumps test results obtained with serum and oral fluid were concordant.The majority of the participants lacked antibodies against at least one of the measles/mumps/rubella (58%) and diphtheria/tetanus/pertussis (72%) vaccine components and against hepatitis B virus (82%) and might thus profit from vaccination. Oral fluid is a suitable alternative and non-invasive specimen for measles/rubella antibody prevalence studies.

Natural History of Chronic Hepatitis B Virus Infection in Ahvaz City, Iran

Objective:A long persistent of Chronic Hepatitis B (CHB) infection may develop liver cirrhosis or hepatocellular carcinoma (HCC) and about one million people die due to HBV -related liver cancer and end-stage liver disease annually worldwide. The natural history of CHB phases comprises four phases: immune tolerant (HBeAg detectable and ALT (Alanine Transaminase) normal, HBeAg-positive immune active (HBeAg detectable, anti-HBe antibodies undetectable and ALT persistently elevated), HBeAg-negative immune active (HBeAg undetectable, anti-HBe antibodies present and ALT persistently elevated), inactive carrier (HBeAg undetectable, anti-HBe antibodies present and ALT normal). The evaluation of chronic hepatitis B phases is a crucial to manage the burden of disease and limit the development of associated complications, such as cirrhosis and hepatocellular carcinoma (HCC). Thus this study conducted to evaluate the natural history of HBV infection in patients with chronic HBV infection in Ahvaz city, Iran.Methods:In this study, 71 non-treated CHB individuals were recruited including 44 (62%) males and 27(38%) females. The sera were tested for HBV markers, HBsAg, HBcIgG, HBeAg, and HBeAb. ALT assay and HBV viral load were carried out for each CHB individual.Results:Based on the analysis of serological, ALT status and viral load, the results showed: immune tolerance 5(7%), eAg+ Immune Clearance 14(19.7%), eAg- Immune Clearance 29 (40.84%) and Inactive Carrier 23 (32.39%). The HBeAg seroconversion was observed in a male age 18 year.Conclusion:The results of the natural history of individuals with chronic hepatitis B phases CHB shows immune tolerance (7%), eAg+ Immune Clearance (19.7%), eAg- Immune Clearance (40.84%) and Inactive Carrier (32.39%). To prevent the consequence of CHB infection, an individual in immune tolerance phase should be tested periodically for ALT level, HBV markers, HBsAg, HBcIgG, HBeAg, HBeAb and HBV viral load. Then decision-making therapy can be applied for CHB patients at early stage of immune clearance.

Inclusion of Seromarkers to Exclude Hepatitis B Virus Infection via Transfusion in Voluntary Blood Donors

Introduction: Hepatitis B Virus (HBV) infection is a serious viral infection causes acute and chronic hepatitis. Transfusion of blood and blood products is the predominant route of transmission of HBV. As per NACO guidelines, in India, donor blood is screened for HBsAg, anti-HCV antibodies, anti-HIV antibodies; slide/card rapid screening for malarial parasites and VDRL for Syphilis.Blood banks in India are only equipped to carry out rapid card test or ELISA for routine screening of HBV, HCV and HIV infections. In developed countries use Nucleic Acid Testing (NAT) were in place for screening and diagnosis of viral infections during window period. NAT assays are highly sensitive, specific and robust but require skilled manpower and specialized infrastructure and thus may not be cost-effective.Objectives: To explore the current sero-prevalence of HBsAg, Anti-HCV antibodies and anti-HIV antibodies (and other relevant seromarkers) by routine screening tests in a cohort of voluntary blood donors and to determine the efficiency of NAT over the routinely used rapid card and ELISA tests. To include any additional seromarker of HBV infection to detect the antigen in the window period.Methods: In this cross-sectional observational study, 3160 voluntary blood donors were screened for HBsAg. Samples were also subjected to screening of additional seromarkers such as HbeAg, anti-HBs and anti-HBc antibodies. Thirty samples were randomly selected from each HBsAg positive and HBsAg negative groups and were subjected to HBV DNA PCR for viral load estimation.Results: ELISA testing is more specific than rapid card test in detecting HBV infection, whereas NAT testing was beneficial in identification of added HBV infection. Both ELISA and rapid card test methods were found to be equally sensitive and specific in diagnosing HCV and HIV infections. NAT testing did not yield any significant increase in positive results compared to serological/rapid methods. HBeAg was found to be positive in 2 samples which are tested negative for HBsAg. HBV DNA was also found to be positive in one sample which is negative for HBsAg (1 out of 30), which might be cryptic HBV infection.Conclusion: Though NAT would be the choice of screening for Hepatitis B, it not cost-effective. Therefore, inclusion of one or more seromarkers for screening HBV, such as HBeAg, might be helpful in preventing transfusion transmitted infection.