Chronic Carriers Research Articles

Hepatitis B Seroprevalence among Egyptian University students in the postinfant compulsory vaccination period

Background The three doses constituting the hepatitis B (HB) vaccine series administered intramuscularly at birth, 1 month, and 6 months induce a protective antibody response (anti-HBs >10 IU/l) in more than 90% of recipients. Aim To analyze the long-term immunity and effectiveness of hepatitis B virus (HBV) vaccination and to detect hepatitis B infection situation and its risk factors among an adequate number of the university students in the postcompulsory infant vaccination period. Patients and methods A total of 400 university students (aged 17–25 years) were screened for quantitative detection of hepatitis B surface antibody, hepatitis B surface antigen (HBs Ag), and total hepatitis B core antibody (HBc Ab) using commercially available kits. HBV DNA PCR was evaluated in repeatedly positive HBs Ag and/or total HBc Ab. Results Nonprotective titer less than 10 IU/l was detected in 218/400 (54.5%), whereas protective titer more than or equal to 10 IU/l was detected in 182/400 (45.5%). Overall, 29/400 (7.3%) were positive for HBs Ag and 50/400 (12.5%) were positive for total HBc Ab, whereas only six (1.5%) were positive for HBV DNA PCR. Moreover, 45/400 (11.4%) students had a history of HBV vaccine booster dose in the protective group. Conclusions Marked reduction in HBs Ab titer was observed among university students where nonprotective titer less than 10 IU/l was detected in 54.5%. Chronic HBV inactive carrier was detected in 5.3%, chronic hepatitis B was detected in 1.5%, and resolved HBV infection was detected in 11%.

Chronic Carriage of Hepatitis B Virus at the University Teaching Hospital Yalgado Ouedraogo: Therapeutic Aspects and Outcome in a Cohort of HBeAg+ Outpatients

Introduction: The HbsAg prevalence in Burkina Faso was 9.1%. We aimed at describing the therapeutic features and the clinical outcome for the patients taking antiretroviral treatment. Materials and Methods: We implemented a cross-sectional study from January 1st, 2004 to December 31st, 2015. Patients aged more than 15 years with positive hepatitis B surface antigen for over six months and positive hepatitis B e-antigen were included. Results: We analyzed the data of 148 participants for a sex ratio of 3; sixty-three patients including 49 men (77.8%) were on treatment. and 81.5% had inflammatory activity greater than one. Under tenofovir, the normalization of ALT was observed in 42 (84%) patients while HBV-DNA became undetectable in 24/33 patients. HBeAg negativation was observed in 16/25 (64%) patients after seven years of treatment. With lamivudine, 2/9 patients had a complete virologic response and six had a normalization of their ALT. Two and 9 patients lost HBeAg after 7 and 9 years of treatment, respectively. Overall 63% and 27% of the patients were in the high or low-adherence group, respectively. In the low-adherence group, all patients had normal or abnormal ALT, but detectable HBV DNA. Ten patients taking lamivudine developed resistance including primary resistance in three patients. No resistance has been observed with tenofovir. Conclusion: The management of the viral hepatitis B includes often a long follow up period without any medication. When antiviral is indicated, the adherence to the treatment is crucial to a long-term control of the virus. In our setting, the low purchase power of the patients may jeopardize their therapeutic future and there is a need to support this group of patients with free-of-charge medicines as it is provided for the HIV infected people.

Evaluation of antigenic load in pregnant sows and identification of isoimmunization markers in offspring to increase productive and reproductive indicators for obtaining biologically safe organic products

Immunological aspects of the relationship in the functional system “mother-fetus” are consciously important both in the scientific and practical direction of the life of living organisms. The formation of the main parameters of isoimmunization is an equivalent aspect in relation to the basics of the formation of artificial tolerance mechanisms. Changes in immunological reactivity to viral and bacterial antigens may cause increased susceptibility to infectious diseases. Different levels of this condition in newborn and adult animal organisms should be based on the fact that the fetus and newborn after birth first comes into contact with the antigen, while the adult body already has partial sensitization. Chronic carrier of pathogens in animals and their influence on the spread of the infectious process is an urgent problem of modern veterinary medicine. The possibility of vaccination in newborns is limited by the presence of maternal antibodies that have an immunosuppressive effect.The immunological relationship between the fetal mother’s body in a non-inbred population should be considered in two aspects: the effects caused by maternal antigens in the fetus; the effect of fetal antigens on the mother’s body. Level of functional reserves of the pregnant body is important in the prevention of intrauterine infection.

A dual-therapy approach for the treatment of biofilm-mediated Salmonella gallbladder carriage.

Asymptomatic carriage of Salmonella Typhi continues to facilitate the transmission of typhoid fever, resulting in 14 million new infections and 136,000 fatalities each year. Asymptomatic chronic carriage of S. Typhi is facilitated by the formation of biofilms on gallstones that protect the bacteria from environmental insults and immune system clearance. Here, we identified two unique small molecules capable of both inhibiting Salmonella biofilm growth and disrupting pre-formed biofilm structures without affecting bacterial viability. In a mouse model of chronic gallbladder Salmonella carriage, treatment with either compound reduced bacterial burden in the gallbladder by 1–2 logs resulting in bacterial dissemination to peripheral organs that was associated with increased mortality. Co-administration of either compound with ciprofloxacin not only enhanced compound efficacy in the gallbladder by a further 1–1.5 logs for a total of 3–4.5 log reduction, but also prevented bacterial dissemination to peripheral organs. These data suggest a dual-therapy approach targeting both biofilm and planktonic populations can be further developed as a safe and efficient treatment of biofilm-mediated chronic S. Typhi infections.

Screening studies in the diagnosis of chronic carrier of the causative agent of the typhoid fever among residents of different countries

The results of screening studies of chronic carriage of the causative agent of typhoid fever (S. Typhi) among residents of various countries are presented. We studied 810 blood serums, including: 462 from citizens of the Republic of Guinea, 244 from labor migrants who arrived in the Russian Federation from Central Asia, and 104 from residents of St. Petersburg. Antibodies to S. Typhi Vi antigen were determined in the passive hemagglutination reaction as a marker of possible chronic carriage of bacteria. When screening studies of sera of citizens of the Republic of Guinea in 21 (4,5%) cases, a positive result was obtained. The level of antibodies to Vi- antigen above diagnostic was found in 6 (1,3%) sera. In 5 samples, the level of antibodies was 1:80, in one - 1: 160. Positive results in a screening study of the sera of labor migrants were obtained in 24 people. A confirmatory test revealed antibodies to the Vi antigen in the diagnostic titer in 9 sera. Positive results were obtained from 2 (3,64%) citizens of Tajikistan and 7 (4,09%) citizens of Uzbekistan. Antibodies to the S. Typhi Vi antigen were not found in residents of St. Petersburg (citizens of the Russian Federation). A comparable level of possible chronic carriage of typhoid fever was revealed for residents of epidemiologically unfavorable territories (Africa) and labor migrants coming to our country from Central Asia. The chances of the emergence of sources of infection in our country are increasing due to the increase in international contacts, which requires additional preventive measures.

Persistence of intrahepatic hepatitis B virus DNA integration in patients developing hepatocellular carcinoma after hepatitis B surface antigen seroclearance.

Background/AimsThe role of hepatitis B virus (HBV) integration into the host genome in hepatocarcinogenesis following hepatitis B surface antigen (HBsAg) seroclearance remains unknown. Our study aimed to investigate and characterize HBV integration events in chronic hepatitis B (CHB) patients who developed hepatocellular carcinoma (HCC) after HBsAg seroclearance.MethodsUsing probe-based HBV capturing followed by next-generation sequencing technology, HBV integration was examined in 10 samples (seven tumors and three non-tumor tissues) from seven chronic carriers who developed HCC after HBsAg loss. Genomic locations and patterns of HBV integration were investigated.ResultsHBV integration was observed in six patients (85.7%) and eight (80.0%) of 10 tested samples. HBV integration breakpoints were detected in all of the non-tumor (3/3, 100%) and five of the seven (71.4%) tumor samples, with an average number of breakpoints of 4.00 and 2.43, respectively. Despite the lower total number of tumoral integration breakpoints, HBV integration sites in the tumors were more enriched within the genic area. In contrast, non-tumor tissues more often showed intergenic integration. Regarding functions of the affected genes, tumoral genes with HBV integration were mostly associated with carcinogenesis. At enrollment, patients who did not remain under regular HCC surveillance after HBsAg seroclearance had a large HCC, while those on regular surveillance had a small HCC.ConclusionsThe biological functions of HBV integration are almost comparable between HBsAg-positive and HBsAg-serocleared HCCs, with continuing pro-oncogenic effects of HBV integration. Thus, ongoing HCC surveillance and clinical management should continue even after HBsAg seroclearance in patients with CHB.

Role of Innate Immunity in Patients with HBV Infection

Background: The hepatitis B virus [HBV] is an infectious disease and its one of the great public health problem, its outcome depends on the kinetics of the virus-host interaction and specifically on the strength of the innate and adaptive, humoral and cellular immune response. Thus interactions between the virus and the components of immune systems plays an important role in the pathogenesis of the disease. This study aimed to evaluate innate immune response in different clinical courses of HBV infection by estimation serum levels of granulocytemacrophagecolony stimulating factor (GM-CSF), Interleukin-1 (IL-1 ), Interleukin-8 (IL-8 ) , immunoglobulin A (IgA), IgM, IgG and Complement component (C3and C4) levels. Aim of study: to evaluate role of immune response in clinical course of hepatitis B infection Patients and Method: This study based on 78 patients with HBV infection attending the Public Health Laboratories. Their ages ranged from (14-65) years, (58 males and 20 females) compared with 20 healthy subjects (12 males and 8 females) as control group. This study extended from first of January 2015 to first of January 2017. The patients were classified to three groups on the bases of serologic markers (HBsAg, HBe Ag, HBc Ab IgM) according to WHO department of communicable disease surveillances and response, liver function tests which are used as supportive indicator for the liver injury, history of the illness, and full clinical assessment. The first group includes twenty-eight patients with acute HBV infection, second group include twenty cases identified as chronic healthy HBsAg carriers group and the last third group include thirty cases of chronic HBV group Results: By using enzyme immuno assay [ELISA] technique, serum levels of interleukin1alpha [IL-1α], interleukin-8 [IL-8], and granulocyte-macrophage-colony stimulating factor [GM-CSF] were measured in all patients compared to that of healthy control group. The mean levels of IL-1α and IL-8 showed a significant increase in serum of patients with newly infected (acute) HBV and chronic HBV compared with studied control group [P=0.04 and P=0.001 respectivel]. However, the mean serum levels for IL-1α and IL-8 recorded a non significant increase in patients with chronic healthy HBsAg carriers [P=0.17 and P=0.4 respectively]. While the mean serum levels of GM-CSF showed a significant rise in acute HBV only [P=0.01]. Moreover, serum immunoglobulins [IgG, IgM, IgA] and complement component [C3, C4] levels also evaluated by using single radial immunodiffusion test (SRID). The mean serum IgA, IgG and IgM levels showed a significant increase in chronic HBV group as compared to that of control group [ P=0.000 ,P=0.000 and P=0.001 respectively].. The mean serum C3 and C4 levels showed a significant lower serum level in all groups compared to control studied group [P=0.000]. Conclusion: this data demonstrate that immunological differences do exist between different clinical groups with HBV infection and may reflect the role of the innate immune system in host defense and disease

Elaboration of a flowchart for healthcare quality improvement of patients with diabetic foot ulcer

Objective: The aim of this study is to map the work process of a Municipal Centre for the care of diabetic foot ulcer, in order to elaborate a multi-professional flowchart for the management of these patients. Methods: Qualitative study, developed by means of Bizagi software version 3.7.0.107, for the purpose to map the flow of activities encompassing the first attendance for people with diabetic foot ulcer, through observational record, elaborating a multi-professional flowchart for improving quality of care. Results: The investigation, mapping and comparison between two flowcharts, current and future directions, highlighted the need to offer multi-professional care for patients, besides of implementing improvements in the quality of care, emphasizing the importance of holistic approach over the chronic wound carrier, avoiding, consequently, futures complications. Conclusion: Finally, it was elaborated a new map of work process to consolidating the presence of multi-professional team for treatment of people with diabetic foot ulcer.

First Reported Case of Ceftriaxone-Resistant Typhoid Fever in the Middle-East

Introduction: Typhoid fever is a potential febrile illness caused by Salmonella enterica serovar Typhi. It is mainly transmitted through contaminated food and water, and spreads from infected persons and chronic carriers. Humans are the only reservoir host. There were many multi-drug resistant S. Typhi cases reported in many parts of South Asia and Africa. However, since 2016there were reported case series of extended drug resistant S. Typhi from Pakistan (resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones and third generation cephalosporines). Genomic sequencing analysis of this organism was of haplotype H58 transmitted by a plasmid. Case Presentation: This is the first reported case of ceftriaxone-resistant typhoid fever in the Middle-East, who travelled from Pakistan to Qatar in September 2019. He recovered completely with injection meropenem and oral azithromycin. Conclusion: A detailed travel history and early diagnosis and treatment with appropriate drugs are inevitable in the management of such cases. Safe drinking water, improved sanitation and effective public health infrastructure will play a key role in the control of the disease.

Hepatocellular carcinoma risk in patients with HBV-related liver disease receiving anti-viral therapy

Hepatitis B virus is a major health problem worldwide, with approximatively 240 million people living with a chronic HBV infection. HBV chronic infection remains the major cause of hepatocellular carcinoma worldwide, with more than half of HCC patients being chronic HBV carriers, even if underlying mechanisms of tumourigenesis are not totally understood. HBV-related HCC can be prevented by reducing the exposure to HBV by vaccination or by treatment of CHB infection. Current treatment of CHB are Peg-IFN alpha and oral NUCs. Treating HBV infection, either with IFN or NUCs, substantially reduces the risk of HCC development, even if anti-viral therapy fails to completely eliminate HCC risk. Among treated patients, cirrhosis, HBeAg negative at baseline, and failure to remain in virological remission were associated with an increased risk of HCC. The reduction of the risk of developing HCC during anti-viral therapy is largely dependent upon the maintenance of virological remission, since viral load is found to be the most important factor leading to cirrhosis and its complications, including liver cancer development. The question whether Peg-IFN-alpha is superior to NUCs and whether there is a superior agent among NUCs is still controversial. Several studies demonstrated that anti-viral therapy with NUCs could reduce the risk of HCC recurrence after curative treatment of HBV-related HCC.

Hepatocellular carcinoma risk in patients with HBV-related liver disease receiving antiviral therapy.

Hepatitis B virus (HBV) is a major health problem worldwide, with approximatively 240 million people living with a chronic HBV infection. HBV chronic infection remains the major cause of hepatocellular carcinoma worldwide, with more than half of HCC patients being chronic HBV carriers, even if underlying mechanisms of tumorigenesis are not totally understood. HBV-related HCC can be prevented by reducing the exposure to HBV by vaccination or by treatment of CHB infection. Current treatment of CHB are Peg-IFN alpha and oral NUCs. Treating HBV infection, either with IFN or NUCs, substantially reduces the risk of HCC development, even if antiviral therapy fails to completely eliminate HCC risk. Among treated patients, cirrhosis, HBeAg negative at baseline and failure to remain in virological remission were associated with an increased risk of HCC. The reduction of the risk of developing HCC during antiviral therapy is largely dependent upon the maintenance of virological remission, since viral load is found to be the most important factor leading to cirrhosis and its complications, including liver cancer development. The question whether Peg-IFN-alpha is superior to NUCs and whether there is a superior agent among NUCs is still controversial. Several studies demonstrated that antiviral therapy with NUCs could reduce the risk of HCC recurrence after curative treatment of HBV-related HCC.

Serpentovirus (Nidovirus) and Orthoreovirus Coinfection in Captive Veiled Chameleons (Chamaeleo calyptratus) with Respiratory Disease.

Serpentoviruses are an emerging group of nidoviruses known to cause respiratory disease in snakes and have been associated with disease in other non-avian reptile species (lizards and turtles). This study describes multiple episodes of respiratory disease-associated mortalities in a collection of juvenile veiled chameleons (Chamaeleo calyptratus). Histopathologic lesions included rhinitis and interstitial pneumonia with epithelial proliferation and abundant mucus. Metagenomic sequencing detected coinfection with two novel serpentoviruses and a novel orthoreovirus. Veiled chameleon serpentoviruses are most closely related to serpentoviruses identified in snakes, lizards, and turtles (approximately 40–50% nucleotide and amino acid identity of ORF1b). Veiled chameleon orthoreovirus is most closely related to reptilian orthoreoviruses identified in snakes (approximately 80–90% nucleotide and amino acid identity of the RNA-dependent RNA polymerase). A high prevalence of serpentovirus infection (>80%) was found in clinically healthy subadult and adult veiled chameleons, suggesting the potential for chronic subclinical carriers. Juvenile veiled chameleons typically exhibited a more rapid progression compared to subadults and adults, indicating a possible age association with morbidity and mortality. This is the first description of a serpentovirus infection in any chameleon species. A causal relationship between serpentovirus infection and respiratory disease in chameleons is suspected. The significance of orthoreovirus coinfection remains unknown.

Intérêt de la quantification de l’AgHBs chez le porteur chronique du virus de l’hépatite B

La quantification de l’AgHBs a montré un intérêt dans la classification du patient dans les différentes phases de l’infection chronique B. Pour évaluer l’impact de celle-ci, nous avons mené une étude prospective chez les porteurs chroniques du VHB, sur une période de 5 ans. Nous avons colligé 210 patients (114 hommes ; 96 femmes), avec un âge moyen de 43 ans (18 – 80 ans), une cytolyse dans 12% des cas (25/210) et 90% des patients AgHBe négatif (189/210). L’ADN-VHB moyen est de 3,25 ± 2 Log UI/ml. Une fibrose modérée à sévère (F2, F3, F4) est noté dans 21,42% (45/210). Le taux moyen de l’AgHBs est de 2,84 ± 1,1 Log UI/ml, il est de 4,36 LogUI/ml chez le sujet jeune versus 3 LogUI/ml pour le sujet âgé. Nous avons noté une corrélation entre le taux de l’AgHBs et celui de l’ADN VHB (r=0,40, p<0,001). Ce taux est plus élevé pour l’AgHBe positif (3,81 LogUI/ml vs 2,77 LogUI/ml). Les taux moyens d’AgHBs sont de 4,33 ; 3,13 ; 2,87 et 3,19 logUI/ml aux phases 1, 2, 3 et 4 respectivement. Entre phase 1 et phase 3, il est de 3,6 ± 1,5 vs 2,07 ± 1 (p< 0,001). Entre phase active (2 et 4) et phase inactive (3), il est de 3,35 ± 0,7 vs 2,07 ± 1 (p<0,00001). Pour un taux d’ADN VHB < 2000 UI/ml et d’AgHBs < 1000 UI/ml, la proportion de porteurs inactifs est de 43% (90/210) contre 59% (124/210) par la définition usuelle (ADN VHB (<2000 UI/ml).

Detection-based prioritisation: Framework of multi-laboratory characteristics for asymptomatic COVID-19 carriers based on integrated Entropy–TOPSIS methods

Context and backgroundCorona virus (COVID) has rapidly gained a foothold and caused a global pandemic. Particularists try their best to tackle this global crisis. New challenges outlined from various medical perspectives may require a novel design solution. Asymptomatic COVID-19 carriers show different health conditions and no symptoms; hence, a differentiation process is required to avert the risk of chronic virus carriers. ObjectivesLaboratory criteria and patient dataset are compulsory in constructing a new framework. Prioritisation is a popular topic and a complex issue for patients with COVID-19, especially for asymptomatic carriers due to multi-laboratory criteria, criterion importance and trade-off amongst these criteria. This study presents new integrated decision-making framework that handles the prioritisation of patients with COVID-19 and can detect the health conditions of asymptomatic carriers. MethodsThe methodology includes four phases. Firstly, eight important laboratory criteria are chosen using two feature selection approaches. Real and simulation datasets from various medical perspectives are integrated to produce a new dataset involving 56 patients with different health conditions and can be used to check asymptomatic cases that can be detected within the prioritisation configuration. The first phase aims to develop a new decision matrix depending on the intersection between ‘multi-laboratory criteria’ and ‘COVID-19 patient list’. In the second phase, entropy is utilised to set the objective weight, and TOPSIS is adapted to prioritise patients in the third phase. Finally, objective validation is performed. ResultsThe patients are prioritised based on the selected criteria in descending order of health situation starting from the worst to the best. The proposed framework can discriminate among mild, serious and critical conditions and put patients in a queue while considering asymptomatic carriers. Validation findings revealed that the patients are classified into four equal groups and showed significant differences in their scores, indicating the validity of ranking. ConclusionsThis study implies and discusses the numerous benefits of the suggested framework in detecting/recognising the health condition of patients prior to discharge, supporting the hospitalisation characteristics, managing patient care and optimising clinical prediction rule.

Hepatitis D virus in Bulgaria: virology, epidemiology and pathogenesis in chronic HBV carriers with liver dysfunction

Inroduction: Hepatitis D (HDV) is the most interesting and unique among animal viruses. It causes viral hepatitis D only in individuals already infected with HBV (hepatitis B). This dual infection leads to the most aggressive hepatic dysfunction of all human viral hepatitis. Aim: This study was made to outline the hepatitis D virus among patients with chronic liver disorders in northeastern Bulgaria, in the sight of virus epidemiology, pathogenicity and viral genotype. Materials and methods: This is a retrospective study conducted between 2013-2019 at St. Marina University Hospital,Varna, Bulgaria. We have analyzed 418 serum samples from 391 patients with chronic liver disease using ELISA, PCR and HDV sequencing and genotyping. Results and Discussion: From 391 patients with chronic liver abnormalities, 16.6% (95% CI: 15.9% - 23.8%, n = 65) had an etiological association with HDV in ELISA. We found HDV RNA positive results in 63 out of all 65 anti-HDV Ab (antibody) positive patients (96.9%). Twenty-four of them, or 38.1% (95% CI: 26.1% - 51.2%, n = 24), were on antiviral HBV/HDV therapy. For five of them, or 20.8% (95% CI: 7.1% - 42.2%, n = 5), HDV genotype I was found. Conclusion: HDV infection has still many mysteries to discover - in terms of pathogenesis, clinical outcome in chronic HBV/HDV-infected individuals, as well as genotype variations and their role in avoiding immune elimination of the virus. All these unanswered questions pose a great challenge to the scientific thought and efforts of humankind to reduce and gradually eliminate viral hepatitis D.

Tams 1 based PCR assay for detection of theileriosis in indigenous calves from semi-arid regions of India

Lower parasitemia often skips the conventional microscopic and serological techniques from detecting latent, cryptic and/or chronic carrier states of bovine tropical theileriosis (BTT). Hence the molecular detection of the parasitic DNA remains a highly authenticated tool. Oligonucleotide primers (TBR F/R) were custom designed and used for PCR amplification of T. annulata. The sensitivity and specificity of PCR was compared with blood microscopy based on kappa value predictions. A total of 8 samples were found positive by blood smear examination whereas PCR detected 12 infections. Blood smear examination was kept as a gold standard for detecting actual number of confirmed positive cases, for being 100% sensitive along with 93.65% specific, respectively, in detecting calf theileriosis. The described PCR-based assay provides a valuable tool to study the epidemiology of BTT in calves and some vital data regarding epidemiology of theileriosis in calves from semi-arid parts of India has been generated. Such a record for screening of calves for theileriosis is missing from Indian context.

A Perspective on Re-Detectable Positive SARS-CoV-2 Nucleic Acid Results in Recovered COVID-19 Patients.

There have been reports on re-detectable positive nucleic acid tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in recovered coronavirus disease (COVID-19) patients. In this study, we look at the clinical characteristics, possible causes, pathogenesis, and infectivity of re-detectable positive patients and provide up-to-date information to public health policy planners and clinicians. By consulting the latest research data and related progress data of re-detectable positive patients, this study addresses the implications that this special group brings to clinical work and disease prevention and control. We discuss in detail the phenomenon of re-detectable positive nucleic acid tests for recovered patients. There are many possible causes of a re-detectable positive, but there is no 1 factor that can fully explain this phenomenon. It can't be completely ruled out that the re-detectable positive patients are infectious. We should be alert to these re-detectable positive patients becoming chronic virus carriers, and virus serological IgM and IgG antibody tests should be added before patient discharge. It is urgent to find a more powerful evidence-based and virological basis for the integrity of viral ribonucleic acid and the variation of viral virulence with time through cell experiments in vitro and animal experiments in vivo.

European Recommendations for the Management of Healthcare Workers Occupationally Exposed to Hepatitis

Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up. Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, -or=10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted. Isolated anti-HBc positive HCWs should be tested for anti-HBcIgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs -or=50 mIU/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs -or=10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days). In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected. Introduction Bloodborne pathogens such as hepatitis B (HBV) and C virus (HCV) represent an important hazard for healthcare workers (HCWs) [1]. In the general population, HCV prevalence varies geographically from about 0.5 percent in northern countries to 2 percent in Mediterranean countries, with some 5 million chronic carriers estimated in Europe; while HBV prevalence ranges from 0.3 percent to 3 percent. The World Health Organization (WHO) estimates that each year in Europe 304 000 HCWs are exposed to at least one percutaneous injury with a sharp object contaminated with HBV, 149 000 are exposed to HCV and 22 000 to HIV. The probability of acquiring a bloodborne infection following an occupational exposure has been estimated to be on average. Bloodborne pathogens such as hepatitis B (HBV) and C virus (HCV) represent an important hazard for healthcare workers (HCWs) [1]. In the general population, HCV prevalence varies geographically from about 0.5 percent in northern countries to 2 percent in Mediterranean countries, with some 5 million chronic carriers estimated in Europe; while HBV prevalence ranges from 0.3 percent to 3 percent. The World Health Organization (WHO) estimates that each year in Europe 304 000 HCWs are exposed to at least one percutaneous injury with a sharp object contaminated with HBV, 149 000 are exposed to HCV and 22 000 to HIV.We present here recommendations for the general management of occupational risk of bloodborne infections, HBV vaccination and management of HBV and HCV exposures. A description of the project and recommendations for HIV post-exposure management, including antiretroviral prophylaxis, has been previously published [2], and so issues related to occupational risk and prevention of HIV infection following an occupational exposure will not be discussed further.

STUDY OF THE IMMUNOGENICITY OF RECOMBINANT HEPATITIS B VACCINE: COMPARISON OF TWO NATIONAL IMMUNIZATION PROGRAMS IN EGYPT

Hepatitis B virus, approximately 2 billion persons, one-third of the world's population, have serologic evidence of past or ongoing infection with the virus. Average 1 million die of hepatitis and its consequences each year. HBV is considered moderately endemic in Egypt with 4% of the population having evidence of chronic HBV infection. Nearly 2 - 3 million Egyptians are chronic carriers of HBV. Vaccination against hepatitis B is the most effective strategy to control HBV infection. Human beings are the sole major reservoir of HBV and hence a complete control strategy by HBV vaccination could lead to virus eradication. HBV vaccine is the first vaccine against a major human cancer. The highest anti-HBs titers are attained 1–3 months following administration of the primary course of hepatitis B vaccine, and are considered a reliable marker of immediate and long-term protection against infection. Anti-HBs response is significantly enhanced after the third injection, with an overall 97–100% anti-HBs ≥10 IU/L. In intermediate and highly endemic countries, universal vaccination without screening of pregnant women is clearly cost-effective. Vertically transmitted HBV infection is becoming an important risk factor for acquisition of HBV among children born after the era of mass vaccination in Egypt. A rate of maternofetal transmission of 51.8% was reported among HBsAg-positive women in Egypt and routine HBV antenatal screening is not practiced. So, stimulated us to perform this work in order to assess the effect of adding the birth dose of HBV vaccine to Egypt’s national immunization program.

Chronic hepatitis B virus infection in Italy during the twenty-first century: an updated survey in 2019.

The aim of this study is to provide updates on the characteristics of chronic HBsAg carriers in Italy before the advent of new drugs eliminating or functionally inactivating the genome HBV reservoirs. HBV endemicity has greatly decreased in Italy over the past decades. A not negligible number of chronic HBsAg carriers are still alive in the country. Chronic HBsAg carriers consecutively referring to 9units in Italy were prospectively enrolled for a 6-month period in 2019. Multiple logistic regression analysis was performed to identify independent predictors of treatment. A total of 894 cases was recruited (sex ratio 1.6; mean age 53.7 ± 13.5years). The proportion of subjects born abroad was 19.0%; only 1% of cases reported current heavy alcohol intake (> 4 units/day). Chronic HBV infection, chronic HBV hepatitis, and subjects with liver cirrhosis and/or HCC represented 24.8%, 55%, and 19.3% of cases, respectively. After exclusion of the 222 subjects with chronic HBV infection, the proportion of subjects under therapy was as high as 89.3%. A more severe liver disease (OR 2.52; 95% CI = 1.25-5.14) resulted an independent predictor of the likelihood of treatment; male sex was marginally associated (OR 1.67; 95% CI = 1.02-2.76) to the chance of treatment. People born abroad had same chance than Italians native to be treated (OR 2.12; 95% CI = 0.9-4.97). The high proportion of subjects under treatment and the absence of gender and ethnic barrier against treatment sound good news. These updated figures may represent reference data for evaluating the potential impact of forthcoming new therapy against HBV-related disease.