HBsAg Test Research Articles

The epidemiological pattern of chronic liver diseases in a community undergoing voluntary screening for hepatitis B and C

Background Vallecamonica-Sebino is a community in Northern Italy (99,776 inhabitants) with one of the highest mortality rates for primary liver cancer and cirrhosis in Italy, and voluntary screening for HCV and HBV is widespread. The aim of this study was to estimate the prevalence of chronic liver diseases and their aetiology in the area. Methods We used the following sources of data, linked at an individual level: (1) hospital discharge data; (2) local Viral Hepatitis Services; (3) tests for anti-HCV antibodies and HBsAg from local laboratories; (4) Local Health Authority registry of chronic liver disease patients; (5) drug prescriptions for HBV and HCV treatment; (6) archives of Alcohol Units. Results 3.5% of the residents had chronic liver disease, mainly chronic hepatitis (61.6%), followed by cirrhosis (14.0%) and alcoholic liver disease (11.2%). HCV was the main cause of chronic liver disease in females (46.3%) and males (29.8%), followed by alcohol abuse in males (22.9%) and HBV (10.9% males and 9.2% females). Prevalence of anti-HCV positivity was 3.2%, and increased with age to 8.8% in subjects aged 65 years and over. Conclusion This study shows that an epidemiologic pattern of the prevalence of chronic liver diseases and their aetiology can be obtained using routinely collected data.

Screening for latent BK virus infection in a renal transplant population for the first time in Romania: a single-center experience

The BK virus nephropathy (BKVN) is one of the most important infectious complications in renal transplant recipients. As BKVN lacks any effective antiviral treatment, early diagnosis is required in order to try to limit viral replication and subsequent damage to the renal allograft, by reducing the immunosuppressive therapy. Our study, the first of its kind in Romania, aimed to assess the prevalence of BKVN among renal transplant patients in our center. In this cross-sectional study, we included 143 renal transplant patients from our center who had received their renal allograft between 2005 and 2010. We searched for latent BK virus infection by detection of serum anti-BK virus antibodies, using an in-house developed enzyme-linked immunosorbent assay (ELISA) technique. Serology was considered positive if results were >0.33 optical density units. In patients with positive serology, we searched for BKVN with qualitative (polymerase chain reaction, PCR) and quantitative (TaqMan real-time PCR) molecular techniques. Additionally, we searched for other viral infections, including hepatitis B (with HBsAg test), hepatitis C (with anti-HCV Abs test), and cytomegalovirus (CMV, with pp65Ag test). All patients screened with ELISA were found to have positive BK virus serology and two of these were diagnosed with BKVN. Both patients with BKVN presented with acute impairment of the renal graft function, and one of them also developed a ureteral graft stenosis. In both cases, BKVN resolved after reduction of immunosuppressive doses. We also diagnosed hepatitis B in 18.18%, hepatitis C in 7.0%, and CMV in 27.97% of patients. Our study demonstrates for the first time the existence of BK virus in Romania, and we believe it opens the prospective of diagnosing BKVN in high-risk patients in our country in the future. In renal transplant patients from our center, we found the prevalence of BK virus infection to be as high as 100%. The prevalence of hepatitis B and CMV was also remarkably high. In patients with BKVN, the reduction of immunosuppression enables the spontaneous resolution of the disease.

The Study of Cerumen Hepatitis B Infection in Chronic Hepatitis B Patients by Real-Time PCR

Introduction: The hepatitis B is a viral infection that causes a big problem globally. About 2 billion people worldwide are infected and there are now about 400 million HBV-DNA carriers around the world. HBV infection is the ninth cause of death worldwide and infects about 350 million new cases each year in the world. HBV-DNA can be spotted in different body secretions and fluids, including serum, saliva, tears, urine, amniotic fluid index, and cerumen isolated. Materials and Methods: This is a case - control study on the population of 140 participants (70 patients with chronic hepatitis B as cases and 70 healthy volunteers community as a control). The presence of HBV-DNA in their serum and ears cerumen using qualitative PCR and quantitative molecular detection Real-Time PCR (BioRad-CFX system) was determined. Results: Copy of serum HBV were detected in 98.5 % of case group and 7 % of healthy population (control group). In case group, 61 patients (87.2%) had HBV-DNA in their cerumens and 5control subjects (about 7 %) were positive for HBV-DNA in their cerumens. All patients group and two subject (2.8%) of control group, were positive in HBsAg test. Average HB virus genome load in cerumen and serum of chronic HBV patients (group) were 8.98×10 6 and 3.60×10 8 copies per ml of the sample respectively.

Efficacy of hepatitis B sero-vaccination in newborns of African HBsAg positive mothers

Background Maternal–infant transmission of hepatitis B virus (HBV) during birth carries a high risk of chronic HBV infection in infants. Appropriate neonatal prophylaxis is effective in preventing perinatal transmission of HBV. The purpose of this study was to evaluate the protective efficacy of anti-HBV sero-vaccination in newborns of HBsAg positive mothers from Mayotte, French island in the Mozambican canal. Patients and methods One-hundred newborns of HBsAg positive mothers were identified retrospectively on the basis of hospital medical record and hepatitis B immune globulin (HBIG) prescriptions review from 1994 to 2007. To determine the rate of protective efficacy of neonatal prophylaxis defined by anti HBs antibodies >10 IU/mL with negative HBsAg, anti HBc and HBV DNA testing, HBV serological markers were performed in vaccinated children. Results Eighty-three of 100 newborns (83%) were given a complete sero-vaccination. Maternal HBe Ag status at delivery (available in 93%) was positive in 56 (60%) of cases and HBV viral load (available in 57%) was <5 log IU/mL, between 5 and 7 logs IU/mL and >7 logs IU/mL in 23 (40.4%), 12 (21%) and 22 (38.6%), respectively. HBV markers in all children at a median age of 5 years [IQR 2–8] showed that 76% were protected with anti HBs >10 IU/mL, despite incomplete sero-vaccination in 12 infants; 6% of infants had anti-HBs and anti-HBc positivity with undetectable HBV DNA, 1% had isolated anti HBc while 14% were seronegative. Only 3% had evidence of immunoprophylaxis failure: 1 infant was HBsAg carrier and 2 had detectable HBV DNA without HBsAg (occult HBV infection). The only factor associated with sustained protective efficacy was on time serological control performed within one year of life, whereas maternal age, HBeAg status and HBV viral load on delivery were not. Conclusion The anti–HBV sero-vaccination of newborns of HBsAg-positive mothers is fairly done in Mayotte and allows a high protection of mother-to-child transmission in a mean endemic area with fair safety. Screening of sero-vaccination failures has to be reinforced in order either to revaccinate or to treat infected children.

Características dos doadores de córneas do Banco de Olhos de Cascavel: impacto do exame anti-HBc para hepatite B

To describe the characteristics of human ocular tissue donors from the Cascavel Eye Bank in the State of Paraná (PR) and investigate the impact of hepatitis B serologic test positivity on discarded ocular tissues. Cross-sectional study of data collected between March 2006 and April 2007 at the Cascavel Eye Bank. Information such as age, gender, cause of death, time between death and enucleation, and serologic tests results was collected. Data were used to characterize the study population and stratified according to hepatitis B (anti-HBc) status. Mean age of donors was 54.2 ± 20.6 years and a greater proportion of men (64,7%) was observed. Mean time between death and enucleation was 3.8 ± 2.4 hours, cardiovascular diseases were the main cause of death (34.5%). Positivity of anti-HBc and HBsAg tests was 47.4% and 1.5%, respectively. Hepatitis B was the main reason for discarding corneas. Donors whose serologic tests were positive for anti-HBc had higher mean age compared to those with negative tests (p<0.001). Only 0.8% of all donations tested positive for hepatitis C and donors with positive HIV test were not seen in our study. Activities of the Cascavel Eye Bank significantly increased the availability of corneas for transplant in the State of Paraná. The main contraindication for availability of ocular tissues was positivity of serologic tests for anti-HBc. Biosafety studies should be performed in order to investigate the potential transmission of hepatitis B virus for donors with positive tests for anti-HBc. The inclusion of these donors would increase the number of corneas available for transplant.

Predictors of hepatitis B screening among patients with cancer.

180 Background: Patients with hepatitis B virus (HBV) infection are at risk of reactivation after chemotherapy. It is unclear whether all patients or only those with certain risk factors should be screened for HBV before chemotherapy. The purpose of our study was to determine the clinical predictors of HBV screening in a single institution. Methods: In this retrospective, cross-sectional study, we evaluated new patients who received chemotherapy between 1/1/04 and 9/30/07. We collected data on patients' demographics, types of cancer and chemotherapy, and HBV risk factors such as a previous ICD-9 code for hepatitis C or other liver conditions. We searched for HBV screening as defined by an HBsAg or anti-HBc test ordered prior to chemotherapy. In univariate analyses, we examined the association between each of the patient-related variables and HBV screening. We then determined predictors of HBV screening in a multivariable logistic regression model. Results: We found 10,729 patients who had chemotherapy during the study period. Overall, 16.7% had HBV screening. All of the following predictors in the univariate analysis were significant for HBV screening at the p&lt;0.01 level: age, gender, ethnicity, U.S. residence, cancer type, chemotherapy type, and having a HBV risk factor. In multivariable logistic regression examining predictors for screening using HBsAg, we found that Asian ethnicity (OR 1.75; 1.16-2.66), hematologic malignancies (OR 22.65; 19.3-26.31), and the receipt of rituxamab (OR 3.71; 3.03-4.48) were significant predictors at the p&lt;0.01 level. Women were less likely to be screened than men (OR 0.68; 0.59-0.78). We repeated the analyses using the anti-HBc screening test, and the results were similar. Overall, 1.5% of the screened patients had a positive HBV test. Conclusions: We found that ethnicity, cancer types, and chemotherapy drugs predict physician-driven HBV screening. Future research is needed to study the predictors of a positive HBV screening test and reactivation of HBV after chemotherapy. [Table: see text]

Comparison of four domestic quantity assay reagents for detecting the weak-reactive results of HBsAg

To evalue the coincidence and correlation between the four domestic quantity assay reagents and with ARCHITECTi2000 immunoassay system. 185 weak-reactive serum samples and standard materials of different concentrations were tested by four domestic quantity assay reagents for HBsAg test and ARCHITECTi2000 immunoassay system. The coincidence, the precision and the correlations between different systems were analyzed. The coincidence rates of the results of 0.05-1.00 IU/ml samples between the four domestic quantity assay reagents and ARCHITECTi2000 immunoassay system were 25.93%, 35.19%, 51.85% and 18.52% respectively, and for those results of more than 1.00 to 10.00 IU/ml samples the coincidence rates were 71.76%, 87.79%, 95.42% and 69.47% respectively. The samples of 0.05 to 0.80 IU/ml weak-reactive serum samples detected by the i2000 system were all negative detected by the four domestic systems. The coincidence rates of more than 7.93 IU/ml serum samples detected by i2000 system were 100% detected by the four domestic systems. The correlations of the four domestic quantity assays were around 0.8629 to 0.9265. The analysis sensitivity of the four domestic quantity assay reagents were below the i2000 system. The results of under 0.80 IU/ml samples detected by i2000 system were disaccord with the results detected by the four domestic systems, whereas for the sapmples over 7.93 IU/ml the results were consistent.

Development of an economic and efficient strategy to detect HBsAg: Application of “gray-zones” in ELISA and combined use of several detection assays

BackgroundELISA and CMIA are commonly used for detection of HBsAg. However, few investigations have been performed to evaluate their value in clinical practice, especially when jointly used. A reasonable and economic HBsAg testing algorithm is in great need. MethodsA total of 161,426 specimens in China were tested for 5 serum HBV markers with commonly used ELISA kits. 498 of these specimens were further tested for HBsAg by another ELISA kit, a CMIA kit and an HBsAg confirmatory assay. ResultsThe sensitivities of the 2 ELISA kits were 76.21% and 88.42%, respectively. However, when using “gray-zones”, the sensitivities were significantly improved to 97.43% and 96.43%. Furthermore, the combined use of the 2 ELISA kits and their “gray-zones” improved the sensitivity to 99.04%. Nevertheless, 2.91% of the samples with S/CO values below the lower “gray-zone” limits were reactive by the CMIA kit and then confirmed as HBsAg positive. However, 71.43% of the samples with HBsAg values within 0.05 and 0.10IU/ml detected by the CMIA kit could not be confirmed. ConclusionsAs a rational and economic strategy, combined use of “gray-zones” in ELISA and several different detection assays can significantly increase the efficiency of HBsAg detection.

A Intervention Study to Improve HBsAg Testing and Preventive Practices for Hepatitis B in an Obstetrics Hospital

Objectives: This study was conducted to determine the effectiveness of a multicomponent intervention in Sanliurfa Gynecology and Obstetrics Hospital (SGOH), which is designed to overcome the obstacles encountered in the application of HBsAg testing to all delivering women, the administration of hepatitis B vaccine and Hepatitis B Immunglobulin(HBIG) to newborns of HBsAg positive pregnant women. Methods: This is an intervention study, conducted between December 15, 2007 and December 30, 2008. Intervention procedure is composed of four methods; namely, motivation of all parties through academic leadership, implementation of workshops to determine the obstacles, provision of administrative commitment, and training of healthcare personnel. Results: In 2007, a total of 18,709 deliveries were realized in SGOH; HBsAg testing was performed in only 16.5% of the pregnant women and 0.8% of these women were found to be HBsAg positive. It was determined that HBIG was administered to 28.2% of newborns of HBsAg positive mothers and hepatitis B vaccine was given to 71.4% (n=13349) of all newborns. After the intervention, the increase in HBsAg test application status, HBsAg positivity, HIBG administration and hepatitis B vaccination was 6.0, 5.8, 2.0 and 1.2 fold, respectively (P

Hepatitis B and the surgeon

Hepatitis B virus is the most transmissible virus and is very resistant to heat and chemicals, because of its unique structure. Blood has the maximum concentration of the virus among all the body fluids and the risk of transmission is related to the presence of HBeAg and the Hepatitis B virus DNA level in the blood. In India, about 1-10% of the healthcare workers are HBsAg positive. Healthcare workers, especially surgeons, and laboratory technicians are at a high risk of developing Hepatitis B infection. Transmission from Hepatitis B positive surgeons to patients has been well-documented. However, the risk of transmission from a patient to a surgeon is higher - about 30% - following a needle stick injury from an HBeAg positive individual. In India, there is low awareness among healthcare personnel about Hepatitis B vaccination and its related issues, and there is no health policy in this regard. In relation to the healthcare workers, there is an urgent need to formulate guidelines on HBsAg testing, hepatitis B vaccination, restriction of exposure-prone procedures that have to be performed, the extent to which their serological status can be revealed to patients, implementation of universal precautions, and post-exposure prophylaxis.

Liver function tests as indicators of metabolic syndrome

Liver function tests as indicators of metabolic syndrome

Hepatitis B, hepatitis C, HIV, and VDRL seroprevalence of blood donors in Mersin, Turkey

The aim of this study was to determine the seroprevalence and affecting factors of Hepatitis B surface antigen (HbsAg), hepatitis C virus antibody (anti-HCV), anti human immunodeficiency virus (anti-HIV), and VDRL in blood donors in Mersin. Materials and methods: This was a retrospective, descriptive study. All blood centers in Mersin were included in the study. The medical records of 30,716 blood donors were evaluated. The data were analyzed using descriptive analysis, linear-by-linear association test, and the Pearson chi-square significance test. Results: Of the donors, 691 (2.2%) had positive HbsAg, 125 (0.4%) had positive anti-HCV, and 46 (0.1%) had positive VDRL test. The confirmation test was positive in 1 participant out of 54 (0.2%), whose anti-HIV test was positive. Of the participants, 862 (2.8%) showed at least 1 positive test result. In one participant, both HbsAg and anti-HCV tests were positive. Conclusion: There was at least 1 blood-borne disease seropositivity in 2.8% of the donors. Seroprevalence increased with age in males.

Mantle Cell Lymphoma Superimposed on Multicentric Castleman's Disease

In August 2010, a 51-year-old man was transferred to our Hematology & Oncology Department from another hospital with a 1-month history of unknown fever, anasarca, and lymphadenopathy of bilateral neck, bilateral axilla, and bilateral inguen. Chest X-ray showed bilateral pleural effusion and swellings in the lymph nodes of the neck, axilla, mediastinum, paraaorta, and inguen ; furthermore, ascites and pleural effusion were detected on computed tomography. Positron emission tomography indicated the abnormal uptake in these lymph nodes. Laboratory tests indicated the presence of neutrophilia (white blood cells 13900/mL : band 4.0%, segmented 71.8%, eosinophils 1.0%, lymphocytes 19.2%, monocytes 3.0%, atypical lymphocytes 1.0%), and the increase of lactate dehydrogenase (286 IU/L), serum immunoglobulin (IgG 2,527 mg/dL, IgA 203 mg/dL, IgM 178 mg/dL), soluble interleukin-2 receptor (2,320 U/mL), and interleukin-6 (14.9 pg/mL). Viral tests for HBsAg, HCV antibody, and HIV antibody were negative. The patient underwent biopsy via the right inguinal lymph node. Numerous follicles with atrophic germinal centers were scattered throughout the cortex and medulla in the lymph node, and the small vessel network in the interfollicular area and proliferation of small vessels in follicles were consistent with hyaline-vascular variant Castleman’s disease (Figs. 1 & 2). The cytology of pleural effusion and bone marrow (BM) indicated an increase in plasma cells. Two-color flow cytometry using anti-k and-l antibody did not confirm the clonality of B cells in the inguinal lymph node, pleural effusion, and BM. However, rearrangement of the IgH gene was detected in these samples by polymerase chain reaction (data not shown). On the other hand, chromosomal analysis using Gbanding showed the translocation t(11;14)(q13;q32) in one of 20 cells with metaphase cells in pleural effusion; however, Bcl1/IgH gene was not detected in these samples. Lymphocytes from lymph node were found to be negative for human herpes virus-8 by polymerase chain reaction. Subsequently, immunohistochemical staining performed on sections of lymph node sample revealed that some broad mantle zones consisted of cells positive for CD20, CD5, and cyclin D1 (Figs. 3 & 4). Epstein-Barr virus-encoded RNA (EBER)-positive cells were not detected in lymph node or BM (data not shown). These findings were consistent with mantle cell lymphoma (MCL) superimposed on multicentric Castleman’ s disease (MCD). After one cycle of hyperCVAD/high-dose MTX + Ara-C therapy (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone combined with high-dose methotrexate and cytarabine), the pleural effusion and ascites diminished, and the enlarged lymph nodes were reduced in size. With regard to the occurrence of non-Hodgkin’s lymphoma (NHL) and Castleman’s disease (CD) in the same patient, diagnosis of NHL is concurrent with CD or follows the diagnosis of CD. In these cases, various histological features of NHL have been reported. According to the study reported by Larroche et al., the histology of NHL in 3 of 6 CD patients with NHL was MCL, and all three patients died after treatment. Furthermore, the type of CD in 5 of the 6 patients was MCD. On the other hand, we had to differentiate this case from MCL resembling the plas-

A Rare Case of Kimura's Disease with Superior Vena Cava Syndrome and Biatrial Masses

AbstractAbstract 5068A 33-year-old man of Asian descent was admitted to our hospital 3 years ago with a main complaint of palpitations for 7 months. There was no fever, no cough, no gain or loss of weight, no night sweats, no medical history of allergic diseases or contact with parasites. Physical examination showed marked edema in the neck and upper chest, and the hepatojugular reflux was positive. There was no change in skin appearance or hepatosplenomegaly. A soft rubbery, non-tender lymph node (1×2cm) was palpated in the left axillary area. The laboratory data showed mild eosinophilia (leukocyte count 6000 /ul with eosinophils 582/ul). The serum IgE concentration was increased (1,250 U/ml). Serological tests for HBsAg, anti-HCV, anti-HIV, and antibodies for distoma pulmonala, distoma japonicum, schistosome, bladder worm, sparganum, trichina cystica and filarial were negative, however toxoplasma gondii antibody IgG was positive, while the IgM was negative. Antinuclear antibodies were all negative. Echocardiogram revealed a mass (7.1×7.0×5.5cm) displacing the base of the heart and involving both atria. CT showed enlarged biaxillary lymph nodes and a large mediastinal mass extending into both atria and obstructing the superior vena cava with right ventricular hypertrophy (Fig.1a, b). Positron emission tomography (18F-FDG-PET) scan indicated negative fluorodeoxyglucose (FDG) uptake in the lymph nodes, spleen and liver. Biopsy of an enlarged right axillary lymph node was performed and the pathology revealed a normal preserved nodal architecture with proliferation of lymphoid follicles infiltrated by abundant eosinophils partially forming eosinophilic microabscesses. CD20 staining was positive. The bone marrow examination indicated normal cellularity except a little increase of eosinophils at 7.5%. Biopsy of the cardiac mass was not performed due to technical challenges related to its anatomical location. Based on the clinical and laboratory findings, a diagnosis of Kimura disease was established. Treatment was started with a low dose of oral prednisone 20–30mg/d. After treatment, the enlarged lymph nodes diminished gradually. However, 4 months later, echocardiogram showed the mediastinal mass remained, with two new masses (left 5.4×3.2cm, right 4.3×2.6cm) attached to the atrial septum respectively (Fig2). Prednisone was gradually increased to 50mg/d. 3 months later, the patient was admitted to hospital with chest pain and shortness of breath. Thoracic CT showed severe obstruction of the right middle lobe bronchus by the enlarged mediastinal mass. A bone marrow smear and flow cytometric analysis did not show any clonal hematopoietic abnormality. The echocardiogram remained unchanged. Prednisone (40mg/d) was re-administered but the patient's situation was getting worse quickly. He developed dyspnea and hypoxemia, apparent SVCS, edema of the inferior extremities and recurrent arrhythmia. CHOP chemotherapy was initiated (CTX 1.0 dl, VDS 4mg dl, EPI-ADM 60mg dl, DXM 10mg dl-2) but he died due to cardiac and respiratory failure. Kimura's Disease is a distinct clinicopathological entity accompanied by peripheral blood eosinophilia and elevated serum IgE level. Though rare, KD with cardiovascular involvement has been reported in several cases. This kind of involvement is also named as Eosinophilic Myocarditis (EM), occurs in up to 60% of patients diagnosed with hypereosinophilic syndrome (HES). However, this patient only has partial response of prednisone, and relapsed after 9 months therapy with prednisone 20–50 mg/d. Although chemotherapy was added, it was too late to control the progression of disease. This instructive case demonstrates that although Kimura's disease is a benign process, infiltration of eosinophils in multiple organs may result in critical illness and can be fatal. Early intervention and frequent close followup appears essential for controlling disease in KD patients with cardiac or other critical complications. [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Screening for Hepatitis B Surface Antigen before Chemotherapy: Current Practice and Opportunities for Improvement

Hepatitis B virus (hbv) reactivation is a recognized complication of chemotherapy. The U.S. Centers for Disease Control and Prevention recommend that all patients be screened for the hbv surface antigen (hbsag) before chemotherapy. We sought to determine the frequency of hbsag testing before chemotherapy at our hospital and to increase the frequency of testing to more than 90% of patients starting chemotherapy. Using a retrospective electronic chart review, we identified the frequency of hbsag testing for patients initiated on intravenous chemotherapy at out institution between March 2006 and March 2007. The frequency of left ventricular function testing in the subgroup of patients receiving potentially cardiotoxic chemotherapy was identified as a comparator. An educational intervention was developed and delivered to the multidisciplinary oncology team. The frequency of hbsag testing was determined post intervention. Qualitative interviews were conducted with the members of the oncology team to identify risk perception and barriers to testing. Of 208 patients started on intravenous chemotherapy between March 2006 and March 2007, only 28 (14%) were tested for hbsag. All 138 patients scheduled for cardiotoxic chemotherapy (100%) underwent left ventricular function testing. In the post-intervention phase, of 74 patients started on intravenous chemotherapy, 24 (31%) underwent hbsag testing, with 1 patient testing positive. The frequency of testing for hbsag before chemotherapy was very low at our institution. An educational intervention resulted in only a modest improvement. Potential barriers to routine screening include lack of awareness about existing guidelines, controversy about the evidence that supports hbsag testing guidelines, and a perception by physicians that hbv reactivation does not occur with solid tumours.

1454 Hepatitis B Vaccination Effectiveness in Greenland

Background and aims: Greenland is a hepatitis B (HBV) high-endemic country, but the only preventive measure against HBV is routine HBsAg testing of pregnant women and HBV vaccination of children born to HBsAg positive mothers. Methods: This national wide study evaluated the effectiveness of the Hepatitis B vaccination program in Greenland by examine the frequency of HBsAg testing during pregnancy of all live-births from 1992 to 2000. Secondly we followed-up children born to HBsAg positive mothers in Greenland in the period 1992 to 2007 and determined their vaccination- and HBV status. Results: The survey revealed more challenges in the Greenlandic HBV vaccination program. Firstly, only 65% of all live births were preceded by HBV testing of the mother during pregnancy. Secondly in the follow up study of children born to HBsAg positive mothers, we found that 20% had received no vaccination at all, and that only 58% of the children had received three or four vaccinations. Thirdly, 3% of the children born to HBsAg positive mothers were immune and 3% were chronically infected. Fourthly, the HBsAb level of immunized children was unexpectedly low indicating non responders or an ineffective vaccine. Conclusions: Based on the results in this study we therefore urgently recommend changing the HBV vaccination strategies in Greenland. HB vaccination should be included in the childhood vaccination program and the procedures in the general screening programme of pregnant women should be evaluated and there should be an attenuated awareness of atrisk children born to HBsAg positive mothers.

Sequence analysis of the S gene region in HBV DNA from patients positive for both HBsAg and HBsAb tests

To study the characteristics of mutation in the amino acids coded by the S gene region in the HBV DNA sequence and to comprehensively explore and analyze the cause of the double positive result phenomena in both HBsAg and HBsAb tests. Specimens collected from 43 cases of chronic hepatitis B patients with positive results for both HBsAg and HBsAb tests were used as the experimental group; specimens collected from 43 cases randomly picked from all patients with chronic hepatitis B with a single positive result for HBsAg test were used as the control group. In HBV DNA, the S gene region was amplified and sequenced. Amino acid sequences were grouped, and mutations were analyzed based on the sequencing results. The patients were infected with HBV of the genotype B and C and those who with genotype C show more mutations than genotype B carriers. Compared with the control group, the experimental group had a marked increase in S gene amino acid mutations; a higher amino acid mutation rate was observed in the first loop (aa124-137) of the a-determinant (aa124-147) and there was a statistical difference (genotype B: 2.68% vs. 0.00%, P = 0.041; genotype C: 7.14% vs. 2.01%, P < 0.001). The first loop in a-determinant of S gene sequence possesses a large numbers of mutated amino acids, leading to changes of antigenicity and simultaneous positive results in both HBsAg and HBsAb tests finally.

Can the nucleic acid amplification test (NAT) be an alternative to the serologic tests? A prospective study, the results of 18,200 blood donors from the Turkish Red Crescent

AimSerologic tests having high sensitivity and specificity are used in order to prevent contamination with infectious agents from blood and blood products for transfusion safety. The present serologic tests have problems such as low sensitivity and weak detection capacity of infectious agents in the “window period”. We aimed to test the use of NAT (Nucleic Acid Amplification Test) in routine blood screening in the Blood Bank. MethodWe used the Procleix Ultrio (Chiron Ltd., USA) test kit based TMA (Transcription Mediated Amplification) for the NAT study of serum samples from 18,200 donors who came to the Turkish Red Crescent between February 2007 and September 2008. The NAT positive samples were studied twice. The discrimination of HIV, HCV and HBV NAT positive samples was performed by the Procleix Discrimination (Chiron Ltd., USA) test. Otherwise, Micro ELISA were used in parallel for routine serological screening of Anti-HIV, Anti-HCV, and HBsAg with Vironoste HIV Uni-form, AG/Ab innotest HCV Ab and Hepanostika Ultra HBsAg test kits. ResultsThe results of serum samples with serology (+) and NAT (+) (13/18,200 and 0.05%) for anti-HIV, anti-HCV and HBsAg were higher than in other NAT studies; we also detected that a transfusion risk can occur in every 1400 transfusions.

Community-based research: cost of the tests used for anti-HBc total seropositivity only and hepatitis B screening

Our study aimed to determine anti-HBc total (IgG+IgM) seroprevalence in the adult population aged ≥15 and to compare the cost of testing for HBsAg and anti-HBs in only anti-HBc positive (+) subpopulation to that in the whole population for HBV screening. The study involved a face-to-face survey and peripheral blood sampling from 452 adult subjects for HBV tests. HBV-DNA PCR was studied only in anti-HBc(+)subjects. Of the 452 subjects anti-HBc total was positive in 192 (42.47%), of which: (a) 27 (14.06%) were HBsAg(+), anti-HBs negative (-), (b) 126 (65.62%) were HBsAg(-), anti-HBs(+), (c) 39 were HBsAg(-), anti-HBs(-). This last group (c) were tested for HBV-DNA PCR and six (15.38%) were positive. When we perform HBsAg and anti-HBs tests in all 452 subjects as in routine practice in blood banks, the cost is 3320 Euros. However, when all subjects are tested for anti-HBc total at first and then only anti-HBc total(+) ones are tested for HBsAg and anti-HBs, the cost is 2929 Euros. The cost difference between the two methods is 391 Euros for 452 subjects. Accordingly, our HBV screening algorithm brings a financial saving of 11.78% and helps to identify the isolated anti-HBc total(+) subjects who carry potential risk for spreading HBV.

Hepatitis B virus transfusion risk in China: proficiency testing for the detection of hepatitis B surface antigen

Because of the high prevalence of Hepatitis B virus (HBV), HBsAg tests play an extremely significant role in donor screening in China. In our multicentre study, the HBsAg assays used in blood screening were evaluated for their analytical sensitivity and the ability to detect mutants. A panel of eight samples was sent to 85 blood banks. The panel included four HBsAg-positive serum samples at concentrations of 0·16, 0·46, 0·9 and 1·73 IU mL(-1) ; three recombinant HBsAg mutants (G145R, T131I and K141E) with defined concentrations and one negative sample. All laboratories were required to detect the samples with their routine procedures.All the 85 blood banks reported their results before the closing date, and 170 data sets were submitted. The wild-type samples at concentrations of 1·73 and 0·9 IU mL(-1) were correctly identified as positive in all data sets, whereas the other two samples (at concentrations 0·16 and 0·46 IU mL(-1) ) were not consistently detected as positive. Regarding the mutants, significantly different results were reported among all the assays involved. All users of Hepanostika HBsAg Ultra and most users (16/17) of Abbott Murex HBsAg Version 3 detected all mutant samples, whereas some of the commercial assays failed to detect any of the three mutant samples. Some HBsAg assays with unsatisfactory sensitivities and capabilities of mutant detection were used by a large percentage of blood banks, which might lead to a high transfusion risk in China. A list of assays of high sensitivity and good ability of mutant detection should be recommended for use in blood screening.