Hepatitis B Surface Antigen Carriers Research Articles

Successful use of hepatitis B surface antigen-positive liver grafts - an effective source for donor organs in endemic areas: a single-center experience.

Due to high prevalence of hepatitis B virus (HBV) infection in Taiwan, liver grafts from donors positive for hepatitis B surface antigen (HBsAg) without progressive disease can be effective alternative source of donor organs. This study aims to prove the safety of living donor liver transplantation (LDLT) using HBsAg-positive liver grafts and its long-term outcome. We studied 14 consecutive LDLT recipients that received HBsAg-positive grafts from November 2009 to December 2013 for various indications. All donors were chronic HBsAg carriers with normal liver function tests. Median follow-up was 46 months (range, 35-59). All the donors and recipients recovered well post-transplant with no reactivation of HBV to date. Two of the recipients died due to extra-hepatic recurrence of HCC. At median follow-up of 46 months, 4-year cumulative survival of recipients was 77.38%. In endemic areas, HBsAg-positive donor organs can clearly be used effectively under viral immunoprophylaxis. HBV disease reactivation does not appear to be a threat even with hepatitis B immunoglobulin (HBIG)-free antiviral monoprophylaxis regimen. This study thus proves the safety and feasibility of the option of using HBsAg-positive grafts in high-prevalence areas.

Hepatitis B virus vaccination booster does not provide additional protection in adolescents: a cross-sectional school-based study.

BackgroundCurrent consensus does not support the use of a universal booster of hepatitis B virus (HBV) vaccine because there is an anamnestic response in almost all children 15 years after universal infant HBV vaccination. We aimed to provide a booster strategy among adolescents as a result of their changes in lifestyle and sexual activity.MethodsThis study comprised a series of cross-sectional serological surveys of HBV markers in four age groups between 2004 and 2012. The seropositivity rates of hepatitis B surface antigen (HBsAg) and its reciprocal antibody (anti-HBs) for each age group were collected. There were two parts to this study; age-specific HBV seroepidemiology and subgroup analysis, including effects of different vaccine types, booster response for immunogenicity at 15 years of age, and longitudinal follow-up to identify possible additional protection by HBV booster.ResultsWithin the study period, data on serum anti-HBs and HBsAg in a total of 6950 students from four age groups were collected. The overall anti-HBs and HBsAg seropositivity rates were 44.3% and 1.2%, respectively. The anti-HBs seropositivity rate in the plasma-derived subgroup was significantly higher in both 15- and 18-year age groups. Overall response rate in the double-seronegative recipients at 15 years of age was 92.5% at 6 weeks following one recombinant HBV booster dose. Among the 24 recipients showing anti-HBs seroconversion at 6 weeks after booster, seven subjects (29.2%) had lost their anti-HBs seropositivity again within 3 years. Increased seropositivity rates and titers of anti-HBs did not provide additional protective effects among subjects comprehensively vaccinated against HBV in infancy.ConclusionsHBV booster strategy at 15 years of age was the main contributor to the unique age-related phenomenon of anti-HBs seropositivity rate and titer. No increase in HBsAg seropositivity rates within different age groups was observed. Vaccination with plasma-derived HBV vaccines in infancy provided higher anti-HBs seropositivity at 15–18 years of age. Overall booster response rate was 92.5% and indicated that intact immunogenicity persisted at least 15 years after primary HBV vaccination in infancy. Booster vaccination of HBV did not confer additional protection against HBsAg carriage in our study.

Age-specific prevalence of hepatitis B virus infection in young pregnant women, Hong Kong Special Administrative Region of China.

ObjectiveTo investigate the age-specific prevalence of hepatitis B virus (HBV) infection in young pregnant women in Hong Kong Special Administrative Region (SAR), China, and to determine whether an increase in prevalence occurs during adolescence.MethodsHBV prevalence was quantified using data from routine antenatal screening for hepatitis B surface antigen (HBsAg) in 10 808 women aged 25 years or younger born in Hong Kong SAR and managed at a single hospital between 1998 and 2011. The effect on prevalence of maternal age, parity and birth before or after HBV vaccine availability in 1984 was assessed, using Spearman’s correlation and multiple logistic regression analysis.FindingsOverall, 7.5% of women were HBsAg-positive. The prevalence ranged from 2.3% to 8.4% in those aged ≤ 16 and 23 years, respectively. Women born in or after 1984 and those younger than 18 years of age were less likely to be HBsAg-positive (odds ratio, OR: 0.679; 95% confidence interval, CI: 0.578–0.797) and (OR: 0.311; 95% CI: 0.160–0.604), respectively. For women born before 1984, there was no association between HBsAg carriage and being younger than 18 years of age (OR: 0.60; 95% CI: 0.262–1.370) Logistic regression analysis showed that the prevalence of HBsAg carriage was influenced more by the woman being 18 years old or older (adjusted OR, aOR: 2.80; 95% CI: 1.46–5.47) than being born before 1984 (aOR: 1.42; 95% CI: 1.21–1.67).ConclusionImmunity to HBV in young pregnant women who had been vaccinated as neonates decreased in late adolescence.

Factors Affecting the Natural Decay of Hepatitis B Surface Antigen in Children with Chronic Hepatitis B Virus Infection during Long-Term Follow-Up

To investigate the factors predicting spontaneous clearance of hepatitis B surface antigen (HBsAg) in a long-term, prospectively followed cohort from childhood into adult life. Children with chronic hepatitis B virus (HBV) infection without treatment were followed longitudinally every 6months. At each visit, liver profiles and HBV markers were assessed. Hepatitis B vaccination history and the maternal HBV markers also were studied. A total of 349 children (205 male) were followed for 20.6±4.4years with initial ages of 8.4±3.9years; 42 (12.0%) cleared HBsAg spontaneously. The HBsAg titers decayed with age, with an average annual clearance rate of 0.58%. Children had a lower annual HBsAg decay rate if their mothers are HBsAg carriers (P<.001). Hepatitis B e antigen-seroconversion is a favorable predictor for spontaneous HBsAg clearance (P=.04). Those with HBsAg titer ≤1000 IU/mL at enrollment during childhood have a higher rate of HBsAg clearance (hazard ratio=5.23; P<.001). Using HBsAg titer ≤1000 IU/mL to predict HBsAg clearance, the sensitivity is 38.1%, specificity is 90.6%, positive predictive value is 35.6%, and negative predictive value is 91.4%. During long-term follow-up, spontaneous HBsAg clearance is most likely to occur in a patient born to a non-HBsAg-carrier mother, is a hepatitis B e antigen-seroconverter, and had an initial HBsAg level ≤1000 IU/mL.

Preventing hepatitis B and hepatocellular carcinoma in South Africa: The case for a birth-dose vaccine

Hepatitis B is a global public health issue, with some 2 billion people having current or past infection. In Africa, 65 million are chronically infected, an estimated 2.5 million of them in South Africa (SA). Hepatitis B and the associated complications of cirrhosis and hepatocellular carcinoma are entirely vaccine preventable. SA was one of the first ten countries in Africa to introduce universal hepatitis B vaccination in April 1995, but has no birth dose or catch-up programme. Although universal infant vaccination in SA has been successful in increasing population immunity to hepatitis B, improvements in terms of implementing protocols to screen all pregnant mothers for hepatitis B surface antigen (HBsAg) and ensuring full hepatitis B coverage, especially in rural areas, is justified. The World Health Organization has recommended a birth dose of hepatitis B vaccine in addition to the existing hepatitis B vaccine schedule in order to further decrease the risk of perinatal transmission. We recommend that SA implement a birth-dose vaccine into the existing schedule to attenuate the risk of perinatal transmission, prevent breakthrough infections and decrease HBsAg carriage in babies born to HIV-positive mothers.

A genome-wide association study on chronic HBV infection and its clinical progression in male Han-Taiwanese.

It is common to observe the clustering of chronic hepatitis B surface antigen (HBsAg) carriers in families. Intra-familial transmission of hepatitis B virus (HBV) could be the reason for the familial clustering of HBsAg carriers. Additionally, genetic and gender factors have been reported to be involved. We conducted a three-stage genome-wide association study to identify genetic factors associated with chronic HBV susceptibility. A total of 1,065 male controls and 1,623 male HBsAg carriers were included. The whole-genome genotyping was done on Illumina HumanHap550 beadchips in 304 healthy controls and HumanHap610 beadchips in 321 cases. We found that rs9277535 (HLA-DPB1, P = 4.87×10−14), rs9276370 (HLA-DQA2, P = 1.9×10−12), rs7756516 and rs7453920 (HLA-DQB2, P = 1.48×10−11 and P = 6.66×10−15 respectively) were significantly associated with persistent HBV infection. A novel SNP rs9366816 near HLA-DPA3 also showed significant association (P = 2.58×10−10). The “T-T-G-G-T” haplotype of the five SNPs further signified their association with the disease (P = 1.48×10−12; OR = 1.49). The “T-T” haplotype composed of rs7756516 and rs9276370 was more prevalent in severe disease subgroups and associated with non-sustained therapeutic response (P = 0.0262). The “G-C” haplotype was associated with sustained therapeutic response (P = 0.0132; OR = 2.49). We confirmed that HLA-DPB1, HLA-DQA2 and HLA-DQB2 loci were associated with persistent HBV infection in male Taiwan Han-Chinese. In addition, the HLA-DQA2 and -DQB2 complex was associated with clinical progression and therapeutic response.

Reactivation from occult HBV carrier status is characterized by low genetic heterogeneity with the wild-type or G1896A variant prevalence

Individuals negative for hepatitis B surface antigen (HBsAg) but positive for antibodies to hepatitis B core antigen (anti-HBc) are at risk of hepatitis B virus (HBV) reactivation under immunosuppressive conditions. We investigated clinical features and viral genetics in patients with reactivation from occult HBV infection triggered by chemotherapy or immunosuppressive therapy. Clinical courses of 14 individuals originally HBsAg-negative but anti-HBc-positive that experienced HBV reactivation were examined. Ultra-deep sequencing analysis of the entire HBV genome in serum was conducted. Prevalence of the G1896A variant in latently infected livers was determined among 44 healthy individuals that were HBsAg-negative but anti-HBc-positive. In 14 cases, HBV reactivation occurred during (n=7) and after (n=7) termination of immunosuppressive therapy. Ultra-deep sequencing revealed that the genetic heterogeneity of reactivated HBV was significantly lower in patients with reactivation from occult HBV carrier status compared with that in patients from HBsAg carrier status. The reactivated viruses in each case were almost exclusively the wild-type G1896 or G1896A variant. The G1896A variant was detected in 42.9% (6/14) of cases, including two cases with fatal liver failure. The G1896A variant was observed in the liver tissue of 11.4% (5/44) of individuals with occult HBV infection. Reactivation from occult HBV infection is characterized by low genetic heterogeneity, with the wild-type G1896 or G1896A variant prevalent.

Anamnestic Findings and Alanine Aminotransferase Predict Accurately Chronic HBs Antigen Carriers among Black Africans in Côte d’Ivoire (West Africa)

Background: The high burden of viral hepatitis B (HBV) remains a challenge in Cote d’Ivoire where patients are mostly seen in hospital at the end stage of the disease. Aim: This cross sectional study is aimed at assessing the usefulness of anamnestic findings, clinical and biological factors in predicting chronic hepatitis B surface antigen (HBsAg) carriers in clinical practice. Patients and methods: The study was conducted in 230 workers (median age: 39 years, female: 20%) of government press enterprise (GPE) in 2010. Socio-demographic, clinical and biological parameters were collected. Chronic HBsAg carrier was defined as serum HBsAg positivity after 2 assessments within 6 months interval. Diagnostic accuracy of predictive factors was determined by multivariate logistic regression. Results: The prevalence of chronic HBsAg was 12.6% [95%CI: 8.61-17.60]. Chronic HBsAg carriers frequently expressed a history of hepatitis (13.8 vs 2.5%, p=0.003), or jaundice (37.9 vs 14.3, p=0.003), had slightly high level of AST (33 vs 25.5 IU/L, p=.004) and ALT (31.5 vs 22, p= 0.5, the model showed a specificity, positive and negative predictive values of 99, 66.7 and 88.9% respectively. The model correctly classified 192(99%) workers as non-chronic HBsAg carriers and 2(1%) were misclassified. Conclusion: This study suggests that age, history of hepatitis, unsafe injection with boiled syringe combined with ALT could be used to predict chronic HBsAg carrier in Cote d’Ivoire and other endemic areas in Africa.

Maternal ABO and rhesus blood group phenotypes and hepatitis B surface antigen carriage

In view of a persistently high prevalence of hepatitis B surface antigen (HBsAg) carriage in our obstetric population, we examined the association between HBsAg carriage with maternal ABO and rhesus (Rh) blood group phenotypes determined at routine antenatal screening. In a retrospective study, the antenatal screening results of women booked for confinement between 1998 and 2011 in our hospital were examined for the relationship between HBsAg carriage with the ABO and rhesus blood groups, taking into account also the effects of advanced maternal age (≥ 35 years) and parity status (nulliparous or multiparous), and year of birth before or following the availability of the hepatitis B vaccine (1984). HBsAg carriage was found in 9.9%, 9.6%, 9.1% and 10.2% (P = 0.037) for group-A (n = 20 581 or 26.1%), -B (n = 20 744 or 26.4%), -AB (n = 5138 or 6.5%) and -O (n = 32 242 or 41.0%) among the 78705 women in the study cohort. Rhesus negativity was found in 0.6%, and HBsAg carriage was 12.3% and 9.8%, respectively, for the Rh-negative and Rh-positive women (P = 0.071). Carriage rate between group-O and non-O was influenced by nulliparity, age ≥ 35 years and Rh-positive status. Regression analysis indicated that group-B (P = 0.044, aOR = 1.062, 95% CI 1.002-1.127) and group-AB (P = 0.016, aOR = 1.134, 95% CI 1.024-1.256) were associated with HBsAg carriage. Blood groups-B and -AB are associated with increased hepatitis B virus (HBV) infection in our population, and further studies are warranted to elucidate the implications of this on the sequelae of HBV infection.

Performance of a new rapid test for the detection of hepatitis B surface antigen in various patient populations

BackgroundRapid diagnostic tests (RDT) have been developed for the detection of hepatitis B surface antigen (HBsAg). They represent a promising alternative to enzyme immunoassays and a powerful tool for large-scale screening and diagnosis of HBV infection, especially in regions without easy access to serological and molecular testing. ObjectivesThe aims of the present study were to evaluate the characteristics and clinical performance of a new CE-marked HBsAg RDT, DRW-HBsAg v2.0 assay (Diagnostics for the Real World™, Ltd., USA), in various patient populations, including those chronically infected with HBV, patients with severe acute hepatitis of unknown origin and pregnant women with unknown HBV serological status at delivery. ResultsThe lower limit of detection of the assay, evaluated in 21 clinical samples, ranged from 0.30±0.07 to 0.97±0.26 international units/mL (using Abbott Architect as a reference), depending on the HBV genotype. The assay tested positive in 100% of patients with chronic hepatitis B, 96.3% of HBsAg-positive acute hepatitis patients, and 95.2% of HBsAg-positive pregnant women. Its specificity was 98.8% in HBsAg-negative patients, 98.7% in HBsAg-negative patients with acute hepatitis of unknown origin and 97.8% in HBsAg-negative pregnant women. Amino acid substitutions in the HBsAg major hydrophilic region did not affect HBsAg detection by DRW-HBsAg v2.0. ConclusionsThe new DRW-HBsAg v2.0 assay is a simple, rapid, easy-to-run and highly sensitive assay that can be used in both high- and low-risk populations for the diagnosis of HBsAg carriage. It appears to be a promising new tool for large-scale screening and diagnosis of HBV infection.

Changes in lymphocyte surface expression of CD8 and CD38 molecules in peripheral blood of inactive HBsAg carriers following pegylated interferon a-2a therapy

To investigate the effects of pegylated interferon a-2a (Peg-INFa-2a) treatment on expression of CD8 and CD38 surface molecules on lymphocytes from peripheral blood of inactive hepatitis B surface antigen (HBsAg) carriers. Forty-four patients with hepatitis B virus (HBV) chronic infection (CHB) received a 48-week course of Peg-INFa-2a treatment, with 30 administered 135 mug/week and 14 administered 180 mug/week. Every 12 weeks of treatment, the subjects were assessed for HBsAg titer, presence of anti-hepatitis B e (HBe) antibody, serum alanine amino transaminase (ALT) levels, and lymphocyte surface expression of CD8 and CD38 molecules. Patients were classified as responders and non-responders according to standard parameters. Dynamic differences between the two groups over time were assessed by multivariate repeated measures ANOVA with Greenhouse-Geisser correction and differences at single time points were assessed by univariate ANOVA. Linear regression analysis was performed to evaluate the relationship of two variables. The responders showed a significantly higher increase in ALT at week 12 (60.75+/-24.95 U/L vs. non-responders: 37.03+/-18.45 U/L; t = 2.905, P less than 0.01) and significantly higher proportion of CD8+CD38+ cells at week 24 (71.20+/-11.70% vs. non-responders: 56.79+/-7.72%; F = 23.941, P less than 0.01). The decline in level of HBsAg at week 24 was positively correlated with the increase in ALT level at week 12 (r = 0.386, P less than 0.01) and with expression levels of CD8 and CD38 molecules on lymphocytes at week 24 (r = 0.397, P less than 0.01). Lower baseline levels of HBsAg correlated to better Peg-INFa-2a-related HBsAg clearance. Increased expression of CD8 and CD38 on lymphocytes is suggestive of intensive cellular immunity in CHB patients and may be related to HBV-induced hepatocyte damage and may promote the HBsAg clearance.

A paucity of liver disease in Canadian Inuit with chronic hepatitis B virus, subgenotype B6 infection

Clinical observations suggest that chronic hepatitis B virus (HBV) infections in the Canadian Inuit are less often associated with serious adverse outcomes than has been described in other HBV-infected patient populations. The aim of this study was to document the clinical and biochemical features, liver-related morbidity and all-cause mortality in Canadian Inuit with chronic HBV infections. Administrative databases were reviewed for individuals identified as hepatitis B surface antigen (HBsAg) positive during a 1983-85 seroepidemiological survey of viral hepatitis in Baffin Island, Canada. An equal number of age- and gender-matched HBsAg-negative individuals from the same communities served as controls. Baseline HBV viral loads, genotypes and specific mutations were compared in HBsAg-positive survivors and nonsurvivors. A subset of surviving HBsAg-positive carriers were reassessed 25-30 years following their initial diagnosis for evidence of advanced liver disease and changes to their serological/virological findings. One hundred and forty four HBsAg-positive individuals were identified. All were Canadian Inuit. The mean age at diagnosis was 38 ± 17 years and 69 (61%) were male. Median follow-up was 23 years (range: 2-28 years). Viral quantitation from stored sera could be performed in 70 infected individuals. The median viral load was 4.3 log 10 IU/ml (range: 2.3-8.8 log 10 IU/ml), and all were genotype B, subgenotype B6. Liver biochemistry, morbidity and all-cause mortality rates were similar in HBsAg-positive carriers and controls. Following multivariate analyses, only age at diagnosis predicted mortality in HBsAg carriers. In a subset of 30 HBsAg-positive survivors who underwent follow-up assessments, clinical, biochemical and radiological examinations of the liver were essentially normal. 23/30 (77%) remained HBsAg positive and 17/19 (90%) HBV-DNA positive. The genotype and prevalence of genomic mutations in this cohort remained largely unchanged, but quantifiable viral loads were significantly lower (P < 0.003). The results of this study suggest that chronic HBV infections in the Canadian Inuit are infrequently associated with serious adverse outcomes. Whether this finding reflects unique features of the host, presence or absence of external factors that influence the course of HBV and/or intrinsic properties of the HBV B6 subgenotype remains to be determined.

Maternal hepatitis B surface antigen status and incidence of pre‐eclampsia

The relationship between chronic hepatitis B virus (HBV) infection with atherosclerosis and cardiovascular disorders remains unclear, and the impact of maternal HBV infection on the development of pregnancy-induced hypertension (PIH) and pre-eclampsia (PE) is also controversial. This retrospective cohort study was conducted to examine the relationship between maternal hepatitis B surface antigen (HBsAg) status with PIH and PE in singleton pregnancies that delivered at 24weeks of gestation and beyond. Among the 86537 cases in the cohort, 10% were HBsAg positive, and overall 2.0% had PIH, of whom 56.3% developed PE. HBsAg-positive women had higher weight and body mass index (BMI), but lower incidences of advanced age, nulliparity, PIH (1.6% vs 2.0%, P=0.007) and PE (0.8% vs 1.1%, P=0.005). On multiple logistic regression analysis adjusting for the effects of nulliparity, advanced age, high BMI, and underlying renal, cardiac and autoimmune diseases, HBsAg carriage was associated with significantly reduced incidence of PIH (aOR 0.79, 95% CI 0.66-0.95) and PE (aOR 0.71, 95% CI 0.56-0.91). Our results indicate that maternal HBsAg carriage is independently associated with reduced PE. As chronic HBV infection alters the immune response of the individual, our observation could be related to enhanced maternal immunotolerance of the foetus and hence a reduction in the incidence of PE. The implications of our findings on the long-term health outcome of the infected women, from cardiovascular morbidity to malignancies, warrant further studies.

Cost-effectiveness of Augmenting Universal Hepatitis B Vaccination With Immunoglobin Treatment

To compare the cost-effectiveness of hepatitis B virus (HBV) control strategies combining universal vaccination with hepatitis B immunoglobulin (HBIG) treatment for neonates of carrier mothers. Drawing on Taiwan's experience, we developed a decision-analytic model to estimate the clinical and economic outcomes for 4 strategies: (1) strategy V-universal vaccination; (2) strategy S-V plus screening for hepatitis B surface antigen (HBsAg) and HBIG treatment for HBsAg-positive mothers' neonates; (3) strategy E-V plus screening for hepatitis B e-antigen (HBeAg), HBIG for HBeAg-positive mothers' neonates; (4) strategy S&E-V plus screening for HBsAg then HBeAg, HBIG for all HBeAg-positive, and some HBeAg-negative/HBsAg-positive mothers' neonates. Strategy S averted the most infections, followed by S&E, E, and V. In most cases, the more effective strategies were also more costly. The willingness-to-pay (WTP) above which strategy S was cost-effective rose as carrier rate declined and was <$4000 per infection averted for carrier rates >5%. The WTP below which strategy V was optimal also increased as carrier rate declined, from $1400 at 30% carrier rate to $3100 at 5% carrier rate. Strategies involving E were optimal for an intermediate range of WTP that narrowed as carrier rate declined. HBIG treatment for neonates of HBsAg carrier mothers is likely to be a cost-effective addition to universal vaccination, particularly in settings with adequate health care infrastructure. Targeting HBIG to neonates of higher risk HBeAg-positive mothers may be preferred where WTP is moderate. However, in very resource-limited settings, universal vaccination alone is optimal.

Maternal HBsAg carrier and pregnancy outcome

Background : Hepatitis B virus infection is still a major public health concern all over the world, and much research must be carried out on the various aspects of this issue. Since infection with hepatitis B virus in pregnant mothers is a threat for both mother and her fetus, this study was performed to To assess the impact of maternal HBsAg carrier status on pregnancy outcomes Materials and Methods: one hundred fifty carriers of hepatitis B surface antigen (HBsAg) with singleton pregnancy, were compared with two hundred controls matched for age and parity. Results:Women with HBsAg carriers had higher incidences of preterm labour (21.2% vs. 13.9%, P=0.037), gestational diabetes (23.2% vs. 11.6%, P=0.003), cesarean section (32.4% vs. 28.2, P<0.000), prelabor rupture of membranes(7.1% vs. 4.0%, P=0.011) and Apgar scores lower 7 in their infants at the 5th minute (16.8% vs. 9.0%, P=0.006). Conclusion:HBsAg carriers have increased risk of adverse pregnancy outcomes. The role of chronic HBV infection in pregnancy complications is not clear and needs more investigation.

Is maternal HBsAg carrier status associated with adverse pregnancy outcome?

Although various studies have suggested that chronic hepatitis B virus infection is associated with several pregnancy and neonatal complications, the scientific information is still conflicting. Methods. In an attempt to clarify these suppositions we conducted a retrospective case-control study on 52 hepatitis B surface antigen (HBsAg) positive pregnant women (case group) and 111 HBsAg negative women (control group). The main outcome was to evaluate the effect of maternal HBsAg carrier status on pregnancy outcome in terms of preterm birth, preterm premature rupture of membranes (PPROM), prelabor rupture of membranes (PROM), hemorrhagic complications (abruptio placentae, postpartum hemorrhage), fetal weight and Apgar score. No case of HBsAg vertical transmission was registered, irrespectively of the delivery way. No significantly association was found between HBsAg carrier status and preterm birth (13,21% vs. 20,72%, p=1,24), PPROM (7,69% vs. 9,91%, p=0,63), PROM (18,87% vs. 23,42%, p=0,36), large for gestational age (3,85% vs. 4,50%, p=0,59), small for gestational age (7,69% vs. 6,31%, p=0,38), antepartum hemorrhage (p=0,51), postpartum hemorrhage (p=0,62) and Apgar Score (p=0,72). According to our findings, there is no association between HBsAg carrier status and adverse pregnancy and maternal perinatal outcome. <br/><a href=

Prevalence of hepatitis B infection and factors associated in children of Ivorian HBsAg carrier subjects

Aims of the Study: 1) Determine the Prevalence of Hepatitis B virus (HBV) infection in children (contact subjects) of chronic Hepatitis B surface antigen (HBsAg) carrier subjects (index subjects); 2) Search for factors associated with HBV infection in these children. Patients and Methods: Retrospective-crosssectional study (January 5th, 2006 through December 31st, 2012). Studied parameters: biological and clinical characteristics of index subjects; Prevalence of HBsAg and Hepatitis B core antibody (HBcAb) in their children. Search for the HBV infection associated factors in the children (univariate analyses through Chi-square or Fisher’s exact test; multivariate analysis through a backward logistic regression). Results: Our 44 subjects’ median age was 43.1 ± 7.49 years and 88.6% of them lived with a spouse. Average number of children per index subjects was 2.3 ± 1.1. Our 92 children’s median age was 9.3 ± 4.55 (ranging from 1 to 15 years), and 43 (44.8%) were vaccinated against HBV. HBV infection prevalence was 24% (23/96 of which, 4 were HBsAg positive and 19 HBcAb positive subjects without HBsAg). Independent factors associated with HBV infection in children of index subjects were HBV DNA for index subjects >2000 IU/ml (OR = 11.5; p = 0.001), existence of HBV in two parents (OR = 7.9; p = 0.03) and absence of HBV vaccination in the children (OR = 30.9; p = 0.003). Conclusion: Immunization coverage for children of index subjects was insufficient, especially before the introduction of HBV vaccine into the enlarged vaccination program. Outside vertical transmission, those children were more exposed to HBV intrafamilial transmission risk when they were not immunized against HBV, when both parents were infected and when HBV viremia in index subjects was higher than 2000 IU/ml.

Carrier rate of hepatitis B surface antigen (HBsAg) among urban pregnant women in a secondary health facility in Maiduguri, Northeastern Nigeria

A serological survey conducted among 196 pregnant women resident in and around Maiduguri, an urban town in north eastern Nigeria showed that 33 (16.8%) were asymptomatic carriers of hepatitis B virus surface antigen (HBsAg). They are within the age range of 14-40 years with mean (± SD) age of 24.7 (± 6.3). The women attend antenatal clinic at the State Specialist Hospital, a secondary health facility in Maiduguri, Borno state. The women are all heterosexuals. The distribution of HBsAg carrier rate according to age of women studied showed a significant (p = 0.0061) increase of the prevalence of HBsAg from 4 (8.7%) in the lower age group (39 years). According to the number of pregnancies, the prevalence of HBsAg infection increased significantly from 6 (9.2%) among primiparous to 13 (13.7%) and 14 (38.9%) among multiparous and grand multiparous respectively. The carrier rate of HBsAg infection among the pregnant women studied based on their duration of pregnancies and their social class showed no significant differences. However, according to the factors known to be commonly associated with the highest risk of transmission of HBV such as history of blood transfusion, Tribal marks/tattooing, use of sharps, sharing of articles, history of jaundice in the women and husbands, history of sexually transmitted infections (STIs) of the women and husbands and the type of marriage (monogamous or polygamous), number of sexual relationships per week, only the history of blood transfusion was significantly associated with HBsAg carrier rate (RR = 3.71., 95% Confidence Interval (C.I.), 1.89-7.30, p = 0.0078). The study confirms that pregnant women who attend antenatal clinic in this secondary health facility are at higher risk of being infected with the HBV, which could lead to both prenatal and post natal transmission to their newborns.

Impact of neonatal hepatitis B vaccination programme on age-specific prevalence of hepatitis B infection in teenage mothers in Hong Kong

We examined the impact of the neonatal hepatitis B immunization programme, first provided to all neonates born to mothers screened positive for hepatitis B surface antigen (HBsAg) in late 1983, on the age-specific prevalence of HBsAg carriage in teenage mothers managed in 1998–2008. HBsAg carriage was found in 2.5%, 2.7%, 8.8% and 8.0% of mothers aged ≤ 16, 17, 18, and 19 years, respectively (P=0.004), which was also correlated with advancing age (P=0.011). While neither difference nor correlation with age was found in mothers born before 1984, the prevalence of 1.2%, 1.5%, 7.1% and 8.3%, respectively, was significantly different among (P=0.008) and correlated with (P=0.002) age in mothers born 1984 onwards. Regression analysis indicated there was a significantly higher incidence of HBsAg carriage from age 17 onwards (adjusted odds ratio 2.55, 95% confidence interval 1.07–6.10, P=0.035), suggesting that the protective effect of the vaccine declined in late adolescence.

Hepatitis B screening: Who to target? A French sexually transmitted infection clinic experience

Hepatitis B virus (HBV) infection is a major public health burden in France and worldwide. Routine screening for hepatitis B is not currently recommended in France. Medical experts and public health agencies opinions can differ concerning targeting criteria. Our study aims at developing a risk assessment strategy for identifying possible hepatitis B cases among the patients consulting in a French Sexually Transmitted Infection (STI) clinic. 6194 asymptomatic patients requesting an STI screening were also screened for hepatitis B infection. The association between hepatitis B surface antigen (HBsAg) positivity and/or total hepatitis B core antibody (anti-HBc) positivity and self-reported risk factors for hepatitis were analysed. Only male gender, lack of employment, and birth, in medium or high endemic country, were independently associated with HBsAg positivity in multivariate analysis. Sexual behaviour or self-reported vaccination status is therefore not necessary to target high-risk populations. These three simple criteria could save 25% of unnecessary tests and 6-16% undiagnosed hepatitis B compared to usual targeting criteria. To detect HBsAg carriers, only three simple targeting criteria, without taking into account the self-reported vaccination status or sexual behaviour, could improve screening efficiency and save unnecessary testing.