HBV Immunization Research Articles

Street adolescents in low income setting exposed to hepatitis B and C, and disadvantaged by lifestyle: a Togolese cross-sectional study

BackgroundIn Togo, few data are available on viral hepatitis in street adolescents, a vulnerable population due to their lifestyle. The aim of this study was to describe the lifestyle of street adolescents (sexual practices and drug use), to estimate the prevalence of hepatitis B and C viruses, and to describe their HBV immunization profile in Togo.MethodsA cross-sectional study was conducted in Lomé (Togo) in July 2021. Street adolescents aged between 13 and 19 years were included. A questionnaire was used to document lifestyle. ELISA tests were performed for Hepatitis B surface antigen (HBsAg), Hepatitis B core and surface antibodies (anti-HBc, anti-HBs), and antibodies against hepatitis C virus (anti-HCV).ResultsA total of 299 adolescents (5.4% female) with a median age of 15 years (IQR: 14–17) were included. Of these, 70.6% (211/299) were sexually active and 70.6% (149/211) had not used a condom during their last sexual intercourse. Drug use was reported by 42.1% of the adolescents. The most used substances were cannabis (39.0%), cocaine (36.6%), glue solvents (19.5%), and tramadol (11.4%). However, cocaine use may have been overestimated due to information bias. Current HBV infection (HBsAg+) was detected in 3.7% (95%CI: 1.9–6.5) of the adolescents. Isolated anti-HBc + was present in 5.3%. All three HBV markers (HBsAg, anti-HBs, and anti-HBc) were negative in 71.6% of adolescents. Anti-HCV was detected in 4.7% of adolescents.ConclusionNearly one in 10 street adolescents has markers for HBV contact/current infection, and approximately 72% of street adolescents may still be infected with HBV, as they have no HBV markers. HCV is also circulating in this population. Given the reported high-risk sexual practices and high levels of drug use, there is an urgent need to develop integrated strategies to prevent infections, including HBV, and drug dependence in this population.

Health Care Waste Assessment in a Secondary Health Care Facility in Anambra State, Nigeria

Background: Proper management of waste generated in healthcare facilities is very important for patient safety, disease containment, and the general safety of healthcare workers in the facilities. It is important that healthcare workers have a good knowledge of healthcare waste management, develops good attitude towards healthcare waste management and practices standard health care waste management protocols as stipulated by the World Health Organization. Objectives: This study therefore assessed the knowledge, attitude and practice of health care waste management among health care workers in Borromeo Hospital, Anambra State. Methods: A cross sectional descriptive study was carried out among healthcare workers selected using multistage sampling technique in 6 categories of healthcare workers (doctors, nurses, lab scientists/technicians, pharmacists/technicians, hospital attendants) in Borromeo Hospital, Onitsha, using a pre-tested, semi-structured, interviewer-administered questionnaire. Data collected were analyzed using SPSS version 22 and associations and correlations between dependent and independent variables were tested at the bivariate level using Pearson Chi-square test and t-test as appropriate. The level of statistical significance was set at 5%. Results: A total of 73 healthcare workers were studied. Most of the respondents were female nurses with 0-5 years of working experience.58.9% of respondents had a very good knowledge of health care waste management and 37% had a relatively good knowledge. Majority of respondents (85%) agreed that HBV immunization prevents hospital transmission while 79.4% disagreed that containment of sharps does not help in safe management of hospital wastes.89% of the respondents adheres strictly to waste management regulations while only 2.7% of the respondents do not wear gloves in handling medical waste. Most of the respondents (83.6%) agreed that the number of patients in the facility was the single main factor .......

Assessing vaccine-induced immunity against pneumococcus, hepatitis A and B over a 9-year follow-up in pediatric liver transplant recipients: A nationwide retrospective study

Pediatric liver transplant recipients are particularly at risk of infections. The most cost-effective way to prevent infectious complications is through vaccination, which can potentially prevent infections due to hepatitis B (HBV) virus, hepatitis A virus (HAV), and invasive pneumococcal diseases. Here, we performed a retrospective analysis of HBV, HAV, and pneumococcal immunity in pediatric liver transplant recipients between January 1, 2009, and December 31, 2020, to collect data on immunization and vaccine serology. A total of 94% (58/62) patients had available vaccination records. At transplant, 90% (45/50) were seroprotected against HBV, 63% (19/30) against HAV, and 78% (18/23) had pneumococcal immunity, but immunity against these 3 pathogens remained suboptimal during the 9-year follow-up. A booster vaccine was administered to only 20% to 40% of patients. Children who had received >4 doses of HBV vaccine and > 2 doses of HAV vaccine pretransplant displayed a higher overall seroprotection over time post-solid organ transplant. Our findings suggest that a serology-based approach should be accompanied by a more systematic follow-up of vaccination, with special attention paid to patients with an incomplete vaccination status at time of transplant.

Characterization of innate immune response to hepatitis B virus genotype F acute infection in tree shrew (Tupaia belangeri) model

Abstract Introduction/Objective Hepatitis B virus (HBV) infection is a global public health problem. The clinical outcomes of HBV infections are influenced by the host as well as viral factors, including viral genotypes and subgenotypes. The interplay between HBV and host innate immunity remains unclear because of the lack of a suitable small animal model. Tree shrews (Tupaia belangeri) have been utilized as a useful animal model for hepatitis viruses such as hepatitis B and C viruses. Methods/Case Report In this study, we characterized acute infections by HBV genotype F (HBV-F) wild type (Wt) and mutant type (Mt) viruses in adult tree shrews. Serum alanine aminotransferase levels were measured before and post-infection 7 and 14 dpi. Both HBV-F-Wt and Mt were detected in the HBV-F-infected tree shrew serum and liver tissue at 7 and 14 dpi. Results (if a Case Study enter NA) We examined the intrahepatic expression patterns of Toll-like receptors (TLRs) (TLR1–9 mRNAs), cGAS, several transcription factors such as STAT1, STAT2, IRF7, HNF4, PD-L1, and cytokines, including IFN-β, IFN-γ, IL-6, and TNF-α in HBV-F Wt/Mt-infected tree shrews. When compared with an uninfected animal group, significant suppression of TLR8 in HBV-F-Wt infected animals and significant suppression of PD-L1 in both HBV-F-Wt and Mt infected animals were observed. Conclusion Thus, tree shrew can be a useful animal model to characterize HBV-F pathogenesis.

Syrian Women Knowledge and Attitudes Towards Hepatitis B Prevention

Abstract Background Globally, mother-to-child transmission during childbirth is the most prevalent transmission method of hepatitis B (HBV). However, early immunization following birth is a safe and effective method of preventing this disease. This study evaluates Syrian mothers’ and pregnant females’ knowledge, attitude, and practice regarding HBV prevention and immunization. Methods This online cross-sectional study was performed in Syria between 2 October and 12 November. The inclusion criteria for this study were Syrian pregnant women who visited obstetrics and gynaecologist clinics for prenatal care, delivery, and postpartum checkups. The survey was adapted from a previous study, which contains 33 items divided into three sections. Data were analyzed using descriptive and multivariate logistic regression. Results This study enrolled 419 participants with a mean age of (28.4±5.9). More than half of the participants agreed that HBV could be transmitted from mother to her child at birth, and about two-thirds of them agreed that HBV vaccination is necessary for their infant (87.4%). Among participants with a university education degree, 35.7% revealed good knowledge, while only 12.3% of respondents with a primary school education level have good knowledge. More than half of housewife participants have shown positive attitudes (52.4%). Females with academic careers have a higher probability of good knowledge and positive attitudes than housewife women (OR = 107.09, P value<0.05) and (OR = 16.31, P value<0.05), respectively. Conclusions Syrian women have a moderate knowledge level about HBV prevention, with gaps in knowledge and attitudes among low-educated women. Performing local awareness campaigns about HBV and its vaccination for women can increase their knowledge and attitudes about this topic. Obstetric care providers should provide more information for pregnant females about HBV prevention for their children which may limit the occurrence of this phenomenon. Key messages • Syrian women have moderate knowledge of HBV prevention for their children, while lower-educated women have gaps in knowledge and attitudes. • Local awareness campaigns about HBV and its vaccination for women can improve their knowledge and attitudes.

Expanding the donor pool: Kidney transplantation from serum HBV DNA or HBeAg-positive donors to HBsAg-negative recipients.

HBsAg-positive (HBsAg[+]) donors are rarely accepted for kidney transplantation (KT), especially when the donor is also HBV DNA-positive (HBV DNA[+]) or HBeAg-positive (HBeAg[+]) serologically. This study aimed to report kidney transplant outcomes from HBsAg(+) donors to HBsAg(-) recipients. Consecutive cases were retrospectively identified from 1 July 2017 to 31 December 2020. KTs from HBsAg(-)/HBcAb-positive (HBcAb[+]) donors to HBcAb(-) recipients were selected as the control group. The primary outcomes were de novo HBV infection (DNH), graft and patient survival. We identified 105 HBsAg(-) recipients who received HBsAg(+) kidneys and 516 HBcAb(-) recipients who received HBcAb(+) kidneys. A higher DNH rate was observed after receiving HBsAg(+) kidneys than after receiving HBcAb(+) kidneys after a median follow-up of 23.0 months (4/105[3.8%] vs. 2/516[0.4%], p = .009). All four infected recipients receiving HBsAg(+) kidneys had HBsAg clearance after treatment. Graft and patient survival were comparable between the groups (p = .630, p = .910). The DNH rates were 0/22(0%), 3/70(4.3%) and 1/13(7.7%) after receiving HBsAg(+), HBV DNA(+) and HBeAg(+) kidneys, respectively (p = .455). The DNH rate was lower if the donor had received antiviral treatment (4/42[9.5%] vs. 0/63[0%], p = .023). HBsAb(-) recipients had a higher DNH incidence than HBsAb(+) recipients (3/25[12.0%] vs. 1/80[1.3%], p = .041). The use of HBsAg(+) donors contributed to comparable graft and patient survival, but HBV DNA(+) or HBeAg(+) donors and HBsAb(-) recipients maybe associated with a higher risk of HBV infection. These findings help expand the donor pool and emphasize the role of donor antiviral treatment and recipient HBV immunity in establishing optimal prophylactic regimens.

Hepatitis B vaccination coverage and associated factors among medical students: a cross-sectional study in Bosaso, Somalia, 2021

BackgroundHepatitis B virus (HBV) is a leading cause of liver cancer and remains a global public health concern. The risk of acquiring HBV is higher in HCWs than in non-HCWs. Medical students are considered a high-risk group because similar to HCWs, they tend to be exposed to body fluids and blood during training in clinical settings. New infections can be effectively prevented and eliminated with an increased coverage of HBV vaccination. The purpose of this study was to evaluate HBV immunization coverage and associated factors among medical students attending universities in Bosaso, Somalia.MethodologyAn institutional-based cross-sectional study was conducted. A stratified sampling method was employed to draw a sample from four universities in Bosaso. From each university, participants were selected using a simple random sampling technique. Self-administered questionnaires were distributed among 247 medical students. The data were analysed with SPSS version 21, and the findings are presented in tables and proportions. The chi-square test was used to measure statistical associations.ResultsAlthough 73.7% of the respondents had an above-average knowledge level of HBV and 95.9% knew that HBV can be prevented by vaccination, only 2.8% were fully immunized, while 5.3% were partially immunized. The students reported six main reasons for not being vaccinated: unavailability of the vaccine (32.8%), high vaccine cost (26.7%), fear of vaccine side effects (12.6%), lack of trust in vaccine quality (8.5%), lack of awareness about where to get vaccinated (5.7%), and lack of time (2.8%). Occupation and the availability of HBV vaccination in the workplace were associated with HBV vaccine uptake (p values of 0.005 and 0.047, respectively).ConclusionHBV immunization coverage among medical students was extremely low (2.8%), indicating the urgent need for increased vaccination coverage in this population. This should start with evidence-based advocacy for the development of a clear national HBV elimination policy, followed by implementing effective, large-scale immunization strategies and interventions. Future studies should expand the sample size to include multiple cities for increased representativeness and conduct HBV titre tests among participants.

Up to Date in Pregnancy: Assessing Vaccination Status in Hepatitis C-Positive Pregnant Persons [ID: 1372896

INTRODUCTION: Hepatitis C virus (HCV) is the most commonly reported bloodborne infection in the United States. Over 65% of infections are among people of childbearing age leading to increased perinatal transmission. The American College of Obstetricians and Gynecologists recommends HCV screening for all pregnant persons. Prior to HCV treatment, the hepatitis B (HBV) vaccination series is recommended. Per recommendations from the Centers for Disease Control and Prevention, the HBV vaccination series should be given to unvaccinated pregnant persons. This study aims to assess the frequency of HCV-positive pregnant persons who are screened for HBV immunity. METHODS: A quality improvement project through retrospective chart review was performed at a single institution from October 2020 to October 2022. Patients identified as HCV positive in pregnancy were included. Data collected included patient demographics and infectious variables such as HCV viral load, HBV antigen/antibody testing, and whether patients underwent HCV treatment. RESULTS: From October 11, 2020, to October 11, 2022, 113 pregnant patients were noted to be HCV positive. Of this population, 95% were also screened with HBV antigen. Only 13 patients had a HBV surface antibody checked to assess vaccination or previous infection status, of whom 9 were previously immunized. In total, only 74% of patients had a HCV viral load checked, half of whom had a viral load present. Of the patients with a positive viral load, only 51% had planned or participated in HCV treatment. CONCLUSION: Pregnancy offers a unique opportunity to complete complex vaccination series for previously unimmunized individuals who are positive for HCV. This quality improvement project indicates a lack of screening and assessment for further HBV immunization in a vulnerable population.

Sero-prevalence of hepatitis B virus and compliance with hepatitis B vaccination schedules among outpatient clinic attendees in Nairobi.

Hepatitis B is becoming a growing public health problem in Kenya. To combat the threat, HBV vaccination should be recommended, particularly for individuals who are not covered by the national immunization program. Vaccination provides sero-protection rates approaching 95% among healthy adults after completing the three-dose vaccination course, but decreases to 87% among those who receive only two doses, emphasizing the importance of completing the three-dose vaccination course. However, data on adult adherence to HBV multi-dose vaccines in Sub-Saharan Africa are limited, despite the fact that this information is critical for prevention. As a result, more research on HBV vaccine dose completion is required. The purpose of this study is to estimate the prevalence of hepatitis B virus infection among out-patient clinic attendees in Nairobi, Kenya, as well as to identify beneficiaries of free vaccination and barriers to completing the recommended vaccine doses. Between July 30th and September 30th, 2015, 2644 outpatient clinic attendees aged ≥ 4 were recruited from three hospitals in Nairobi County, Kenya: Mama Lucy, Riruta, and Loco. Self-administered questionnaires were used to collect socio-demographic information, and blood samples were tested for hepatitis B surface antigen (HBsAg) using the KEMRI HEPCELL Rapid® (Hepatitis B Detection kit) test kit. Individuals who tested negative for HBsAg were given a free course of three doses of HBV vaccine. The vaccination register provided information on the number of doses administered. The average age of the study population was 31.4 years (range: 4-66), with females accounting for 59.2%. 1.82% (48/2644) of the participants tested positive for HBsAg. Among the 2596 individuals eligible for vaccination, 66% (1720/2596) received at least one dose, and 51.8% (1345/2596) received all three doses. Vaccination acceptance increased with age, with older patients more likely to return for subsequent dose (OR>1 for second and third dose). Unavailability and failure to contact client were cited as significant (p<0.0001) barrier to vaccination completion by 53.7% (666/1226, 95% CI 0.5-0.6) and 37% (454/1226, 95% CI 0.3-0.4) of respondents respectively. The prevalence of HBV infection among outpatient clinic attendees highlights the importance of expanding HBV immunization programs in Kenya. However, given the low vaccination completion rate, there is a need for public awareness of the vaccine's importance in preventing HBV and HBV-related complications.

Impact of hepatitis B vaccination programs in Vietnam evaluated by estimating HBsAg prevalence

BackgroundVietnam introduced a 3-dose hepatitis B (HBV) immunization program comprising 1 dose immediately after birth and 2 or 3 in infancy in the past 20 years, but the impact of the vaccine has not been systematically evaluated. Thus, we conducted this survey aiming to estimate the age-specific chronic HBV prevalence in the general population and to evaluate HBV immunization effectiveness. MethodsPopulation-based, four-stage cluster sampling was used in the South Central Coast region of Vietnam. The point-of-care Determine rapid test was used to assess hepatitis B surface antigen (HBsAg) positivity. ResultsA total of 2,075 samples were included in the study. HBsAg prevalence was significantly higher among adults aged 20–39 years than in the population aged 1–19 years (8.0% [95% confidence interval 5.0–12.0] vs. 2.0% [95% confidence interval 1.0–6.0], p<0.01). HBsAg prevalence decreased after implementation of the 3-dose vaccination schedule during infancy from 1997 to 2002, whereas the change in prevalence after implementation of the birth dosing was not significant. A slight increase in HBsAg prevalence was observed for the cohort born in 2011, 2012, and 2013, when there was a vaccine shortage and media reports of immunization resistance. ConclusionsThis is the first population-based assessment of the introduction of the HBV vaccine in Vietnam performed by estimating the HBsAg prevalence across a wide range of ages. The results showed that the HBV immunization policy effectively reduces HBsAg prevalence in general, although birth dosing of the vaccine and low immunization coverage should be carefully monitored.

S1431 Hepatitis B Vaccination Rates in Ambulatory Patients With Chronic Liver Disease Before and After the Onset of the COVID-19 Pandemic

Introduction: Hepatitis B (HBV) is one of the most prevalent infectious diseases worldwide. It is preventable with vaccination and experts recommend screening for HBV immunity in all patients with chronic liver disease. The 2019 novel coronavirus (COVID-19) pandemic disrupted ambulatory care clinics throughout the United States, interfering with normal vaccination screening and administration. In the subsequent years after the pandemic began, clinicians and patients alike have had to play catch up on healthcare maintenance. This study was done to determine if the rate of screening and vaccination of patients with chronic liver disease for Hepatitis B changed in the subsequent years after the onset of the COVID-19 pandemic at our single institution. Methods: A retrospective study was performed from January 2000 to January 2019 and from February 2022 to April 2022 on patients seen in the ambulatory clinic of our community-based hospital. The criteria to be vaccinated for Hepatitis B was patients with chronic liver disease (defined as cirrhosis, nonalcoholic fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and transaminitis (ALT or AST >2x ULN) not immune to HBV. Seven-hundred-and-ninety patients were selected from the first period and eighty-six patients were selected from the second period. Results: We found that there were increases in the rate of screening for HBV immunity as well as the rate of vaccination against HBV in the post-COVID onset years compared to the pre-COVID onset years. (Table) Conclusion: We believe that the increases in both screening rates and subsequent vaccination are due to both patient and physician driven motives. Our patients are requesting re-evaluation of vaccination history with increased compliance in vaccination course. We have also noticed a more thorough review of patient history by our physicians, focusing on what was missed during the years since the onset of the pandemic. Further studies qualifying these observations are underway, however, we believe it is important to present these results now to demonstrate that we can continue to improve the care we provide in the outpatient setting despite the pandemic. In fact, the COVID-19 pandemic itself may have improved the overall care we provide for patients. Table 1. - Rates of Screening and Subsequent Vaccination Against Hepatitis B Virus in Patients With Chronic Liver Disease Before and After the Onset of COVID-19 Pre-COVID Onset Post-COVID Onset Percent Change Screening for HBV Immunity 88.5% 94.2% +6.4% Rate of 1st HBV Vaccine Given 46.1% 63.5% +37.7% Rate of 2nd HBV Vaccine Given 37.5% 48.3% +28.8% Rate of 3rd HBV Vaccine Given 27.5% 28.8% +4.7%

Survey on HBV Immunisation Status among the Dental Practitioners

Introduction: There are more than 2 billion people worldwide who have evident recent or past HBV infection and chronic cases. Hepatitis B, C and D are transmitted by parental contact with infected body fluids including blood, semen, saliva , sweat and tears , invasive medical procedures using equipment which are contaminated with the virus , vertical transmission. Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with immunisation such as from AIDS/HIV and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people routine immunisation results in more than 96% of the people being protected.&#x0D; Aim: The aim of this study is to know the immunisation status and knowledge and awareness among dental practitioners.&#x0D; Materials and Methods: A survey was designed to analyse the result. The questionnaire was prepared in Google Forms (online survey link) and was distributed to 100 dental practitioners. The responses were then collected and statistically analysed using SPSS software.&#x0D; Results and Discussion: After discussing the results of the present study, it was seen that many were aware of hepatitis B vaccine. Limitations of this are that the population is small. Limitations seen in this study can be included in future research for better spread of awareness among the general public.&#x0D; Conclusion: From the study we can conclude that the majority of the dental practitioners are aware of hepatitis B vaccine and are aware of their vaccination status of hepatitis B.

S1084 Single Center Study for Improving Hepatitis A and B Immunity in Veterans With Cirrhosis

Introduction: Patients with cirrhosis should be immunized against hepatitis A (HAV) & hepatitis B (HBV) as they are high risk for decompensation if infected. Baseline data at the Atlanta VA hepatology clinics demonstrated 75% of veterans with cirrhosis were immune to HAV and 44% to HBV. One fourth of visits failed to address hepatitis vaccines, and 60% of missed opportunities were from providers not discussing it. Our aim was to reduce missed opportunities to initiate HAV and HBV vaccination to <and to confirm immunity with serologies to < over 6 months in the Atlanta VA hepatology clinics. Methods: A process map identifying steps to obtain a vaccine and Pareto charts quantifying rates of commonly identified barriers were used to implement Plan-Do-Study-Act (PDSA) cycles. Approximately every 10th chart was sampled, and P charts were created to assess the average missed opportunity rate before and after our QI initiatives. Results: PDSA 1 focused on educating providers on the importance of vaccination, sharing the baseline data, and instructing how to order vaccines. For PDSA 2, the liver pharmacist monitored the vaccine queue daily to ensure that orders remained active. PDSA 3 involved a “quality inspection” by the attending hepatologist, who alerted the provider if vaccination was not addressed but was warranted. The last PDSA included creating a “Liver Passport” for the veteran that had personalized vaccination, hepatocellular screening, and esophageal variceal screening recommendations. The overall average missed opportunities for HAV & HBV vaccination and serologic confirmation testing decreased from 41% to 29% after four PDSA cycles. Separately, mean missed opportunities for initiating HAV & HBV vaccination decreased from 25% to 19% and assessing immunity with HAV & HBV serologies declined from 16% to 10%.Conclusion: Lack of in-person visits during the COVID-19 pandemic was a significant study limitation early on. Nevertheless, the national discussion surrounding COVID-19 vaccines provided a springboard for our QI initiatives to increasingly address HAV & HBV vaccines and immunity within a short time frame. Future aims are ≥HAV and HBV immunity and addressing all other vaccines recommended in patients with cirrhosis.

Prevalence of Hepatitis B Virus Infection Markers among Patients of the Ibn Sina University Hospital Center (Rabat, Morocco)

Introduction: Viral hepatitis B is a global scourge affecting millions of people worldwide. In Morocco, hepatitis B is considered a public health problem, and available data converge to consider Morocco as a country with intermediate endemicity. In the present study, we have planned to evaluate the HBV prevalence in Morocco on a large scale and to assess the prevalence of different serological markers for better management of this infection in Morocco. Methods: This study was conducted on 18,877 patients referring to the Ibn Sina University Hospital Center of Rabat, Morocco. HBV serological markers including HBsAg, HBsAb, HBeAg, HBeAb, and total HBcAb were assessed by immune-enzymatic assays. The quantification of HBV DNA was performed by real-time PCR. Results: The overall prevalence of positive cases for HBsAg, HBsAb, and total HBcAb was 2.47%, 27.66%, and 21.2%, respectively. From 141 patients with an isolated HBcAb serological profile (HBcAb+/HBsAb−/HBsAg−), HBV DNA was detected in 10 patients, representing a rate of 7.09%. In the present study, up to 95.78% of HBV chronic carriers were negative for HBeAg. Conclusion: This study highlights a higher prevalence of HBsAg in the hospital-based population than the general population reported previously in Morocco and a very low HBV immunization coverage. Of particular interest, detectable HBV DNA levels in isolated HBcAb patients show that exclusive HBsAg screening cannot eliminate the risk of HBV transmission in certain cases. Many efforts are then mandatory to promote serological testing and increase the vaccination rate to limit viral dissemination for better management of this disease in Morocco.

Assessing Hepatitis B Knowledge Among Native Hawaiians and Pacific Islanders in San Diego

BackgroundAsian-Americans and Pacific Islanders comprise 6% of the U.S. population, but 50% of chronic hepatitis B cases and have a cancer mortality that is 60% higher than non-Hispanic Whites. The objective of this study was to assess knowledge of HBV transmission, symptoms/sequelae and treatment among NHPIs in San Diego.MethodsSelf-administered surveys were distributed using convenience sampling at the 24th Annual Pacific Islander Festival in San Diego in 2018.ResultsOverall knowledge scores were low (mean: 9.8 out of 28) among participants. Compared to U.S.- born (mean: 11.6), participants born in Pacific Island countries and territories (mean: 8.5) had lower knowledge scores (p = 0.017) and lower self-reported vaccination rates (50% vaccinated vs 27%, respectively, p = 0.025).DiscussionLack of HBV knowledge, low vaccination rates and the discordance between knowledge and behavior regarding HBV vaccination elicits an urgent need to collaborate with NHPI communities for HBV education, screening, immunization and treatment.

Low rates of transfusion-transmitted infection screening in chronically transfused adults with sickle cell disease.

Adults with sickle cell disease (SCD) on chronic transfusion therapy are exposed to a large volume of blood products, thus increasing their risk of transfusion-associated human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV). We performed a systematic chart review of chronically transfused SCD subjects at the Johns Hopkins Sickle Cell Center for Adults between October 2014 and September 2019 to determine our Center's adherence to the 2014 National Heart, Lung and Blood Institute (NHLBI) SCD guidelines for annual screening for Transfusion Transmitted infections (TTI) and assessed HBV immunity and HBV vaccination rates. The study included 85 subjects with a median age of 34 years (23-63); 52% were female. No subject received annual screening; 68 subjects (80%) were screened for HIV, 60 subjects (71%) for HCV and 53 subjects (62%) for HBV infections at least once in the study period. Of those screened, one patient was newly diagnosed with HCV infection, and none with HIV or HBV infection. Among 31 subjects tested for anti-Hepatitis B surface antibody, 16 subjects (52%) tested negative. Nineteen (20%) subjects had HBV vaccination documented. Low adherence to the NHLBI TTI screening guidelines, especially for HBV, highlights the resource intensiveness of this patient population. The low rates of anti-Hepatitis B surface antibody positivity highlight the need to confirm vaccination, provide boosters as indicated, and investigate the adults with SCD's immune response to HBV vaccination.

Prevalence and Determinants of Vaccine Hesitancy and Vaccines Recommendation Discrepancies among General Practitioners in French-Speaking Parts of Belgium.

General practitioners (GPs) play a critical role in patient acceptance of vaccination. Vaccine hesitancy (VH) is a growing phenomenon in the general population but also affects GPs. Few data exist on VH among GPs. The objectives of this analysis of a population of GPs in the Belgian Wallonia-Brussels Federation (WBF) were to: (1) determine the prevalence and the features of VH, (2) identify the correlates, and (3) estimate the discrepancy in vaccination’s behaviors between the GPs’ children and the recommendations made to their patients. An online survey was carried out among the population of general practitioners practicing in the WBF between 7 January and 18 March 2020. A hierarchical cluster analysis was carried out based on various dimensions of vaccine hesitancy: perception of the risks and the usefulness of vaccines as well as vaccine recommendations for their patients. A total of 251 GPs answered the survey. The average percentage of moderate to high vaccine hesitancy was 50.6%. Three factors were independently associated with increased risk of vaccine hesitancy: an age <50 years old, having no children, and having no contact with selected vaccine-preventable disease (measles, complicated influenza, chronic hepatitis B (HBV), bacterial meningitis, or cervical cancer) in the past 5 years. VH was associated with controversies on vaccines’ safety. GPs who had vaccinated their children against six diseases (MMR, meningococcus C (MenC), HBV, and HPV) tended not to recommend the same vaccines to their patients. Among GPs with all children vaccinated against HBV, only 37.5% recommended catch-up HBV immunization to their patients. In this small cohort of GP, moderate to high VH was associated with controversies on vaccines’ safety and with specific personal characteristics (age <50, no children, and no recent experience with a serious VPD). As previously reported, GPs have different vaccine prescription attitude toward their patients and children. These findings should be confirmed in larger cohorts.

Serum HBV pregenomic RNA exhibited opposite associations with NKdim and NKbright cell immunity in treatment-naïve chronic hepatitis B patients.

Hepatitis B virus (HBV) pregenomic RNA (pgRNA) is a new biomarker that reflects HBV replication, but its relationship with natural killer (NK) cell immunity in chronic hepatitis B (CHB) is unknown. We assessed serum HBV pgRNA levels in 323 CHB patients by reverse transcription-polymerase chain reaction, assessed cytokine production and activation and inhibitory markers of NK cells by flow cytometry, and measured serum cytokines by enzyme-linked immunosorbent assays (ELISAs). Among the different CHB phases, the serum HBV pgRNA level was highest in the immune-tolerant (IT) and immune-active (IA) phases. Regarding NK and NKdim cells, HBV pgRNA was negatively associated with frequencies, but positively associated with NKp44 and NKp46 expression (activation markers). Regarding NKbright cells, serum HBV pgRNA was positively associated with frequency and programmed cell death protein 1 (PD1) expression (inhibitory marker), but negatively associated with NKp44 and NKp46. Serum HBV pgRNA was not associated with NKp30 (activation marker) on NK cells or subsets. Lastly, serum HBV pgRNA was positively correlated with the levels of serum IL-7 and IL-12P40 (NK cell-promoting cytokines) and negatively correlated with serum prostaglandin E2 (PGE2) level (which negatively regulates NK cells). In conclusion, we found varied relationships between serum HBV pgRNA and NK cells and subsets, indicating that HBV pgRNA may play a complicated role in NK cell-related immunity, providing new information on HBV and host immunity.

Diagnostic Value of Ultrasonographic Portal Venous Index in the Assessment of Liver Fibrosis in Chronic Viral Hepatitis in Lagos, Nigeria

Background: Delayed intervention in chronic viral hepatitis results in progression to fibrosis and hepatocellular carcinoma. Determining the degree of liver fibrosis is invaluable in the initiation of clinical interventions, prevention of progression, and prognostication of end-stage liver disease. Considering the risks of liver biopsy (the standard for assessing fibrosis), safer methods are necessitated. Aim: The aim of this study was to determine the reliability of ultrasonographic Portal Venous Index (PVI) in assessing liver fibrosis. Subjects and Methods: Doppler Ultrasonography-determined Aspartate-Platelet Ratio Index (APRI) Score. Results: The mean age for the subjects was 35.79 ± 10.75 years and controls was 36.51 ± 11.31 years. They were sex matched. HBV was more common, with a 99:3 HBV: HCV ratio. HBV immunization compliance in both the groups was poor. The median PVI of the subjects and controls was 0.36 and 0.42, respectively, which was statistically significant (P = 0.025). There was no significant difference in median PVI between subjects with and without significant fibrosis as determined by APRI score. There was an inverse but moderate correlation between PVI and APRI score (r = −0.57, P= 0.569). The area under the receiver operating characteristic curve was 0.524 (95% confidence interval: 0.36–0.69). The cutoff for PVI was 0.34 with a sensitivity of 57.1% and a specificity of 57.4%. Conclusion: PVI is useful in distinguishing healthy individuals from virus-induced chronic liver diseases but could not adequately determine the degree of liver fibrosis.

From national HBV and HDV screenings to vaccination and treatment in healthcare workers: The Mauritanian pilot study

ObjectivesHepatitis B and D infections are highly endemic in Mauritania, with prevalences ranging from 10 to 20%. With the present prospective transversal pilot study, we aimed to evaluate the prevalences of HBV, HCV, and HDV infections in healthcare workers (HCWs), and offer treatment or vaccination as required. MethodsAt inclusion, each HCW was screened for anti-HBc Ab (followed by HBsAg assay when positive). Additional biological analyses were performed for HBsAg + cases. Depending on the results, HBV vaccination or anti-viral treatment was offered. ResultsA total of 3,857 HCWs were included, of whom 1,363 tested negative for anti-HBc Ab and received full vaccination. Of the 2,494 HCWs who were positive for anti-HBc Ab, 1,246 were positive for anti-HBs Ab and 418 were positive for HBsAg. Three HCWs were positive for HBeAg; 66 and 18 had HBV DNA levels respectively > 2,000 and > 20,000 IU/mL; and 48 were positive for anti-HDV Ab among whom 10 were positive for HDV RNA. HCV prevalence was 0.5%. Only seven HCWs fulfilled the criteria for treatment and five of them were treated. ConclusionFew HCWs in Mauritania are immunised against HBV. The prevalences of anti-HBc Ab and HBsAg observed in this work were similar to those observed in our earlier works, whereas prevalence of active HDV infection was less high. HBV and HDV infections are a serious health concern in Mauritania. New recommendations developed in accordance with WHO guidelines should include mandatory HBV screening and immunisation for HCWs.