Cases Of Acute Hepatitis B Virus Infection Research Articles

Evaluating the independent influence of sexual transmission on HBV infection in China: a modeling study

BackgroundThe long-term impact of sexual transmission on the hepatitis B virus (HBV) infection in China remains unclear. This study aims to estimate the independent influence of sexual transmission on HBV infection.MethodsBased on the natural history of HBV infection and three national serosurvey data of hepatitis B in China, we developed an age- and sex-specific discrete model to describe the transmission dynamics of HBV. The initial conditions of the model were determined according to the age- and sex-specific national serosurvey data in 1992. Based on the national survey data of hepatitis B in 1992 and 2006, by using the Markov Chain Monte Carlo (MCMC) method, we estimated the age- and sex-specific seroclearance rates of hepatitis B surface antigen (HBsAg) and the horizontal transmission rates as well as their 95% confidence intervals (CI). Then we used the age- and sex-specific national serosurvey data of hepatitis B in 2014 to test the accuracy of our model-based estimation. Finally, we evaluated the independent impact of sexual transmission on HBV infection and discussed the long-term effect of promotion of condom use in China.ResultsWe estimated that the annual rates of HBsAg seroclearance for males and females aged 1–59 years were respectively 1.04% (95% CI, 0.49–1.59%) and 1.92% (95% CI, 1.11–2.73%). Due to sexual transmission, in 2014, the total number of chronic HBV infections in people aged 0–100 years increased 292,581, of which males increased 189,200 and females increased 103,381. In 2006, the acute HBV infections due to sexual transmission accounted for 24.76% (male: 31.33%, female: 17.94%) and in 2014, which accounted for 34.59% (male: 42.93%, female: 25.73%). However, if the condom usage rate was increased by 10% annually starting in 2019, then compared with current practice, the total number of acute HBV infections from 2019 to 2035 would be reduced by 16.68% (male: 21.49%, female: 11.93%). The HBsAg prevalence in people aged 1–59 years in 2035 would be reduced to 2.01% (male: 2.40%, female: 1.58%).ConclusionsSexual transmission has become the predominant route of acute HBV infection in China, especially for men. The promotion of condom use plays a significant role in reducing the cases of acute HBV infection.

Trends in the Acute Hepatitis B and Acute Hepatitis C in Bulgaria.

Bulgaria joined European Union (EU) on 1 January 2007. Since the accession all regulations, directives, decisions, recommendations, and opinions of the European Parliament, the Council of the European Union, and the European Commission are being implemented. The purpose of this study was to present the morbidity of acute hepatitis B virus (HBV) and acute hepatitis C virus (HCV) in Bulgaria before and after accession to the EU. A retrospective study was performed. The morbidity of acute HBV and acute HCV infections in Bulgaria was analyzed over a period of sixteen years (2000-2016). The collected data were based on the National Center of Infectious and Parasitic Diseases (NCIPD) and the National Center of Public Health and Analyses (NCPHA). Between 2000 and 2016, 11038 cases of acute HBV infection and 1681 cases of acute HCV infection were reported in Bulgaria. Before the accession to EU, the morbidity rates of acute HBV and acute HCV infections were 12.77 cases per 100000 population (95% CI: 11.45-13.97) and 1.52 cases per 100000 population (95% CI: 1.17-1.96), respectively. After the accession to the EU, the morbidity rates of acute HBV and acute HCV infections were 5.29 cases per 100000 population (95% CI: 3.86-6.73) and 1.14 cases per 100000 population, respectively. Analysis of the data suggests that there is a tendency for lower morbidity rates of acute HBV. The situation with acute HCV is relatively stable over the years regardless of EU membership.

Hepatitis B virus coinfection is associated with high early mortality in HIV-infected Tanzanians on antiretroviral therapy

There is limited data on the effect of antiviral therapies on clinical outcomes in HIV and hepatitis B virus (HBV)-infected individuals in sub-Saharan Africa. Single center, prospective longitudinal cohort study at Management and Development for Health supported HIV Care and Treatment clinics in Dar es Salaam, Tanzania. Between April 2014 and December 2015, HIV-infected, HBV-infected and HIV/HBV-coinfected, treatment naïve, Tanzanian adults more than 18 years of age were eligible for enrollment and followed for 10-18 months after initiating antivirals. All HIV-infected and HIV/HBV-coinfected participants received tenofovir, lamivudine and efavirenz; HBV-infected participants received lamivudine. Multivariate regression models were constructed to identify factors associated with mortality in HIV-infected and HIV/HBV-coinfected participants. A total of 265 HIV-infected, 165 HBV-infected and 64 HIV/HBV-coinfected participants were analyzed. At baseline, HBV-infected participants were younger and had a higher BMI than HIV-infected and HIV/HBV-coinfected participants. After a median of 371 (interquartile range 50) days on treatment, there were 40 deaths. Mortality was significantly higher among HIV/HBV-coinfected participants compared with HIV and HBV-infected participants [HIV/HBV-coinfected 12 of 64 (19%) vs. HIV-infected 26 of 265 (10%) and HBV-infected two of 265 (1%), P < 0.01]. High baseline HIV RNA and low hemoglobin levels, but not HBV coinfection were independently associated with early mortality in multivariate analyses of HIV-infected participants. High rates of early mortality were observed after treatment initiation in HIV/HBV-coinfected individuals compared with participants with HIV or HBV alone, despite robust aspartate aminotransferase to platelet ratio index declines and high rates of virologic suppression. HIV rather than HBV-related factors are more important contributors to mortality in these individuals.

Acute Hepatitis B Co-infection in HIV-Infected Patients Despite Prior Hepatitis B Vaccination

Clinicians often assume that patients vaccinated for hepatitis B virus (HBV) have immunity. We report three cases of acute HBV infection in HBV-vaccinated HIV patients. These cases illustrate that patients at an elevated risk of HBV exposure presenting with acute hepatitis should be tested for HBV infection regardless of previous vaccination status.

Outbreak of acute hepatitis B virus infection associated with exposure to acupuncture.

The most common risk factors for acute hepatitis B virus (HBV) infection are sexual contact, injection drug use and perinatal, or nosocomial exposure. Acupuncture, used in China for over 2,500 years, has been gaining popularity as an alternative medical therapy in the western world, but when associated with poor infection control practices, is also a risk for blood-borne infections. To describe the outbreak investigation following detection of two cases of acute HBV infection associated with acupuncture services from the same provider within four months of symptom onset. The outbreak investigation included genotyping of HBV from the identified cases, on-site assessment of the acupuncturist's infection prevention and control practices and chart review of known clients. Both cases had HBV genotype D1 with an identical fingerprint and both clients had visited the clinic on the same day denying other recent risk exposures. Inspection of the acupuncturist's practice revealed high-risk re-use and inappropriate storage of disposable needles. The Regional Health Authority ordered cessation of clinic practice until infection control measures were remediated. A public service announcement and mailed notifications to clients identified from practitioner records recommended that all clients be tested for HBV, human immunodeficiency virus (HIV) and hepatitis C. A clear epidemiological linkage of these two acute HBV infections to the same acupuncture clinic, evidence of substandard infection control practice in the clinic and identical HBV molecular and genotypic profiles of the two cases are highly suggestive that contaminated acupuncture needles likely resulted in at least two cases of acute HBV infection. This is the first known reported transmission of HBV from acupuncturists re-use of disposable needles and the first HBV outbreak associated with exposure to acupuncture reported this century in an industrialized country. Increased provider oversight and patient education may prevent future outbreaks.

Molecular Evolution and Phylodynamics of Acute Hepatitis B Virus in Japan.

Hepatitis B virus (HBV) is prevalent worldwide and causes liver diseases, including acute and chronic hepatitis. Ten HBV genotypes (A–J) with distinct geographic distributions have been reported. Cases of acute HBV infection with genotype A have increased in Japan nationwide since the 1990s, mainly through sexual transmission. To investigate the molecular evolution and phylodynamics of HBV genotypes, we collected acute HBV isolates acquired in Japan from 1992–2002. Full genomes were obtained for comprehensive phylogenetic and phylodynamic analysis, with other Japanese HBV sequences from GenBank that were isolated during 1991–2010. HBV genotypes were classified using the maximum-likelihood and Bayesian methods. The GMRF Bayesian Skyride was used to estimate the evolution and population dynamics of HBV. Four HBV genotypes (A, B, C, and H) were identified, of which C was the major genotype. The phylodynamic results indicated an exponential growth between the 1960s and early 1990s; this was followed by a population bottleneck after 1995, possibly linked with successful implementation of a nationwide vaccination program. However, HBV/A increased from 1990 to 2003–2004, and then started to decrease. The prevalence of genotype A has increased over the past 10 years. Phylodynamic inference clearly demonstrates a steady population growth compatible with an ongoing subepidemic; this might be due to the loss of immunity to HBV in adolescents and people being born before the vaccination program. This is the first phylodynamic study of HBV infection in Japan and will facilitate understanding the molecular epidemiology and long-term evolutionary dynamics of this virus in Japan.

Increases in Acute Hepatitis B Virus Infections - Kentucky, Tennessee, and West Virginia, 2006-2013.

As many as 2.2 million persons in the United States are chronically infected with hepatitis B virus (HBV) (1), and approximately 15%-25% of persons with chronic HBV infection will die prematurely from cirrhosis or liver cancer (2). Since 2006, the overall U.S. incidence of acute HBV infection has remained stable; the rate in 2013 was 1.0 case per 100,000 persons (3). Hepatitis B vaccination is highly effective in preventing HBV infection and is recommended for all infants (beginning at birth), all adolescents, and adults at risk for HBV infection (e.g., persons who inject drugs, men who have sexual contact with men, persons infected with human immunodeficiency virus [HIV], and others). Hepatitis B vaccination coverage is low among adults: 2013 National Health Interview Survey data indicated that coverage with ≥3 doses of hepatitis B vaccine was 32.6% for adults aged 19-49 years (4). Injection drug use is a risk factor for both hepatitis C virus (HCV) and HBV. Among young adults in some rural U.S. communities, an increased incidence of HCV infection has been associated with a concurrent increase of injection drug use (5); and recent data indicate an increase of acute HCV infection in the Appalachian region associated with injection drug use (6). Using data from the National Notifiable Diseases Surveillance System (NNDSS) during 2006-2013, CDC assessed the incidence of acute HBV infection in three of the four Appalachian states (Kentucky, Tennessee, and West Virginia) included in the HCV infection study (6). Similar to the increase of HCV infections recently reported, an increase in incident cases of acute HBV infection in these three states has occurred among non-Hispanic whites (whites) aged 30-39 years who reported injection drug use as a common risk factor. Since 2009, cases of acute HBV infection have been reported from more non-urban than urban regions. Evidence-based services to prevent HBV infection are needed.

Epidemiology of Viral Hepatitis and Hepatocellular Carcinoma

Most cases of hepatocellular carcinoma (HCC) are associated with cirrhosis related to chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Changes in the time trends of HCC and most variations in its age-, sex-, and race-specific rates among different regions are likely to be related to differences in hepatitis viruses that are most prevalent in a population, the timing of their spread, and the ages of the individuals the viruses infect. Environmental, host genetic, and viral factors can affect the risk of HCC in individuals with HBV or HCV infection. This review summarizes the risk factors for HCC among HBV- or HCV-infected individuals, based on findings from epidemiologic studies and meta-analyses, as well as determinants of patient outcome and the HCC disease burden, globally and in the United States.

Economic Analysis of Hepatitis B Screening and Treatment

Economic Analysis of Hepatitis B Screening and Treatment

Nosocomial outbreak of hepatitis B virus infection involving two hospitals in the Republic of Ireland

The routes of nosocomial hepatitis B virus (HBV) transmission have changed over the years. Initiatives to prevent transfusion-associated HBV and healthcare worker-to-patient transmission have had a positive impact on these transmission routes. Recent reports of outbreaks of nosocomial HBV have implicated breaches in standard precautions as important causes of HBV transmission. This report describes a nosocomial outbreak of HBV infection in the Republic of Ireland, which occurred between January 2005 and March 2006. The outbreak was detected following identification of a case of acute HBV infection in a patient whose only risk factor was a recent surgical procedure. The extensive multi-agency investigation that followed revealed that the patient was one of five cases of acute HBV infection and that four separate transmission events between infectious cases had occurred in two different hospitals over a 15-month period. A definitive cause for each transmission event was not identified, although lapses in adherence to standard precautions, safe injection and phlebotomy practices could not be ruled out. Two secondary cases of acute HBV infection in community contacts of two of the nosocomial cases were identified. Phylogenetic analysis proved a useful tool in confirming infection with a pre-core HBV mutant and viral transmission between the seven patients. Apatient notification exercise involving 1028 potentially exposed patients found no evidence of additional cases of nosocomial HBV infection. These findings highlight the importance of consistent application of standard precautions.

Caring for Healthcare Workers A Global Perspective

From the International Healthcare Worker Safety Center, University of Virginia Health System, University of Virginia, Charlottesville. Received December 6, 2006; accepted December 6, 2006; electronically published January 3, 2006. Infect Control Hosp Epidemiol 2007; 28:1-4 2006 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2007/2801-0001$15.00. This issue of the journal reflects broadly upon the risks of bloodborne pathogen exposure—risks faced by healthcare workers (HCWs) everywhere. The articles cover an array of issues, including the impact of work schedules, healthcare settings, culture-specific practices, and the implementation of safety-engineered sharp devices on the occupational risk of injuries from sharp devices and blood contact. It is a fitting occasion to reflect on the state of the art in providing a safe working environment for HCWs and to consider a future path towards equitable access to its basic elements. It has been more than 2 decades since the first case of needlestick-transmitted infection with human immunodeficiency virus (HIV; then referred to as “human T-lymphotropic virus III”) was reported in The Lancet, triggering a high alert for the exposure risk faced by HCWs. Although lifethreatening bloodborne pathogens had been a recognized risk to HCWs for at least a century, it was the epidemic of acquired immunodeficiency syndrome (AIDS) that delivered the wakeup call leading to remedial action. Today, infection from bloodborne pathogens, primarily HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), remains the most lifethreatening occupational risk for HCWs. Despite this fact, we can take heart from the dramatic reduction that has occurred in the magnitude of this risk as a direct result of effective prevention initiatives during the past 20 years. It constitutes one of the remarkable success stories in the annals of public health practice. As a public health target, HCWs are usually considered to be (and treated as) a narrow subset of the general population. But globally, their numbers are large and their impact is felt everywhere. The total number of HCWs worldwide is estimated to be 35.7 million, which is greater than the population of Morocco, the 35th most populous nation in the world. HCWs provide care in every country and to every social and cultural group, in sophisticated and humble settings alike. Their global reach is matched only by the significance of their work. In all corners of the globe we depend on them for lifesustaining services. The effective assault on bloodborne pathogens that plague HCWs began with the availability of the hepatitis B vaccine in 1982. In the United States in 1983, the incidence of HBV among HCWs was 3 times higher than the incidence in the general population; by 1995, it was 5 times lower. The annual incidence fell from 386 to 9 infected HCWs per 100,000. In the early 1980s, it was estimated that more than 12,000 HCWs were occupationally infected with HBV annually, resulting in an estimated 250 deaths per year. Between 1990 and 1998, during which time high rates of HCW vaccination were achieved in the United States, only 13 cases of acute HBV infection in HCWs were reported. The advent of the hepatitis B vaccine was a major advance in preserving the health and lives of HCWs. The risk of occupational infection with HIV, although alarming, has never reached the scale of hepatitis B. As of 1997, a total of 94 documented and 170 possible cases of occupational HIV infection had been identified worldwide; nearly two-thirds of cases were reported from the United States. Since then, 15 more documented cases have been identified. However, most countries, especially those with a high population prevalence of HIV infection, have never instituted surveillance systems that would capture data on such cases. Although the development of an AIDS vaccine still eludes us, new treatments for HIV infection appear to have had an appreciable impact on the risk of occupational exposure and infection. In 1997, it was shown that postexposure prophylaxis with zidovudine alone after occupational blood exposure to HIV reduced the risk of seroconversion by more than 80%. Combination antiretroviral drug regimens, introduced in 1997, are believed to be even more effective at preventing seroconversion in HIV-exposed individuals. Combination treatment has altered the risk equation for HCWs in other ways, as well. Shortly after these drugs became widely available in 1997, there was a precipitous drop in the number of HIV-positive in-patients in US hospitals. The risk of HCWs being exposed to HIV dropped in direct proportion to the decline in the number of HIV-infected patients in hospitals. Furthermore, a low viral load, which is common in patients receiving combination drug therapies, is associated with reduced transmission risk when an occupational exposure to

Widespread dissemination in England of a stable and persistent hepatitis B virus variant.

Outbreaks of acute hepatitis B among inmates of 6 prisons in 3 regions of northern England occurring from 1992 through 1994 were found to be associated with a single hepatitis B virus (HBV) variant, which was carried by 20 of the 24 case patients. We instigated a study of cases of acute hepatitis B to trace the spread and prevalence of this variant. A denaturing gradient gel electrophoresis assay was optimized to detect the HBV variant, and cases of acute HBV infection in 3 regions in England occurring from 1990 through 1996 were screened for its presence. Samples from HBV-transmission incidents that were received for molecular investigation were also tested. The variant was identified in 117 (41%) of the 266 cases of acute hepatitis examined in representative regions in England. In North Humberside, but not in southeast England or the West Midlands, a trend toward an increase in the prevalence of the variant was observed. Furthermore, the same variant was identified in the case patients or the individuals implicated in transmission in 11 (22%) of 51 transmission incidents occurring in England from 1997 through 2002. The spread of the variant was primarily associated with injection drug use. The finding of a single, genetically identical variant (over the 600 bp sequenced) occupying a large niche among the circulating viruses was unexpected. This finding has major implications for the use of DNA sequencing analysis in the investigation of chains of transmission. The study also highlights the need for better protection of at-risk groups through vaccination against HBV, a strategy that currently achieves poor coverage.

Incidence and routes of transmission of hepatitis B virus in England and Wales, 1995-2000: implications for immunisation policy.

The incidence of hepatitis B virus (HBV) infection in the UK is low. Since the infection can have serious sequelae, there is a continuing need to examine its epidemiology so as to inform control measures. We aimed to describe the current HBV incidence and patterns of transmission in the UK, to estimate the rate of new carrier infections, and to discuss implications for the control of HBV through immunisation. We analysed routine England and Wales laboratory surveillance data of acute HBV infection (1995-2000) and data on migration and global HBsAg prevalence. The estimated annual incidence of HBV infection in England and Wales was 7.4 per 100,000. Injecting drug use was the most frequently reported route of transmission. The number of cases attributed to heterosexual contact was fairly stable, whereas the number of cases in men having sex with men decreased. These observations continue trends reported for the early 1990s. Transmission during childhood was rarely reported, but was more frequent among South Asians. The incidence in South Asians is relatively high, and their main risk factors are medical treatment overseas and heterosexual contact. For about a third of cases of acute HBV infection no route of transmission is reported, but analysis of secular trends and age distribution suggest that many of these may be related to injecting drug use. Endemic transmission gives rise to only a small proportion of all new chronic infections, with the vast majority arising from immigration of established HBV carriers. The incidence of acute HBV infection in England and Wales has remained low, with a similar pattern of reported routes of transmission compared to the early 1990s. The UK prevalence of HBV infection is dependant on global rather than national immunisation policy. Endemic transmission may be reduced by improving immunisation coverage among injecting drug users, which is expected to also reduce the number of cases without a risk factor reported. In addition, immunisation options that better suit the needs of ethnic minorities need to be explored.

Injections in health care settings: a risk factor for acute hepatitis B virus infection in Karachi, Pakistan.

A case control study was conducted to identify the association of therapeutic injections with acute hepatitis B virus (HBV) infection in Karachi, Pakistan. We enrolled 67 cases of acute HBV infection (IgM anti-HBc positive) and 247 controls (anti-HBc negative) from four hospitals of Karachi during July 2000-June 2001. Exposure to various risk factors during the period relevant to the incubation period of HBV was recorded both from cases and controls using a structured questionnaire. Multivariate logistic regression analysis of the data showed that cases were more likely to have received one injection (OR = 4.0; 95 % CI 1.4, 11.1), or more than one injection (OR = 6.3; 95 % CI 3.2, 12.4) compared to controls. The estimated population attributable risk (PAR) for therapeutic injections was 53%. Also the cases compared to controls were more likely to have household size of seven or more (OR = 1.9; 95 % CI 0.95, 3.9). This study showed that unsafe therapeutic injections appear to be the major risk factor for acute HBV infection and needs immediate focus from public health stand point.

Twenty-year survey of the epidemiology of hepatitis B in Denmark: effect of immigration.

Implementation of hepatitis B virus (HBV) vaccination is being considered in Denmark. Therefore, a 20 y survey on the epidemiology of HBV infection was performed. All notified cases of acute HBV infection in Denmark from 1982 to 2002 were reviewed retrospectively and all available data from 1970 to 2001 on the prevalence of hepatitis B surface antigen (HBsAg) in different groups of the Danish population were studied. The notified annual incidence of acute HBV infection has declined from more than 200 cases to fewer than 50 cases in 2001. In the indigenous population there has been a similar decline in prevalence of HBsAg carriers, from 0.15 to 0.03%, but owing to immigration of new HBsAg carriers from developing countries the overall number of carriers has not changed. The small effect of immigration on the incidence of acute HBV infections as well as the decreasing prevalence of HBsAg carriers among Danes should be taken into account when planning new vaccination strategies in Denmark.

Acute hepatitis B infection in England and Wales: 1985-96.

Confirmed acute hepatitis B infections are reported to the Public Health Laboratory Service Communicable Disease Surveillance Centre by laboratories in England and Wales. These reports have been used to monitor trends in the incidence of hepatitis B virus (HBV) infection over time, and between exposure categories and age groups. Between 1985 and 1996 a total of 9252 cases of acute HBV infection were reported; the number of reports fell from 1761 in 1985 to 581 in 1996. Most infections were reported in adults aged 15-44 years [n = 7365 (80%)], and infections were more commonly reported in males [n = 6490 (70%)] than females [n = 2658 (29%)]. The probable means of acquisition was known for just over half of all adult cases [4827/8956 (54%)]. Injecting drug use was the most common exposure [n = 1901 (21%)], followed by sex between men and women [n = 1140 (13%)] and sex between men [n = 1025 (11%)]. The number of infections in injecting drug users fell in the late 1980s, but increased again from 1991 onwards. In children aged under 15 years, infections acquired by mother to baby transmission accounted for 35/170 (21%) of the total. Surveillance indicates that the incidence of acute hepatitis B infection fell in the late 1980s, probably reflecting changed behaviour in injecting drug users. An increase in the number of infections in injecting drug users since 1993 may indicate ongoing transmission that has not been contained by the introduction of needle exchange schemes or by selective vaccination.

Distribution of HIV and Acute Hepatitis B Infection among Drug Injectors in Glasgow

This study compared the distributions of known human immunodeficiency virus (HIV) and acute hepatitis B virus (HBV) infection among drug injectors in Glasgow over a 3.5 year period. Data were obtained from all relevant laboratory request forms submitted to Glasgow's 3 virology laboratories during the period 1 January 1986 to 30 June 1989. The overall prevalence of HIV among those tested was 3.7% (66/1786). There were 125 cases of acute HBV infection. The male:female ratios for HIV and acute HBV were 1:1 and 2:1, respectively. Thirty-four per cent of persons with HIV were aged under 21 years compared with 53% with acute HBV. Three out of 10 areas of the city accounted for 92% of HIV infection but only 66% of acute HBV infection. HIV infection was not detected among drug injectors in 4 areas of the city but at least 2 cases of acute HBV infection were recorded in all 10 areas. The geographical and age distribution of acute HBV infection in Glasgow suggests that the potential for future spread of HIV among drug injectors remains considerable.