HBV Immunization Research Articles

HBV Infection Trend in Iranian Disabled Children; Is It really Worrying?

We read with a great interest the article written by Davoodbeglou and colleagues entitled “Evaluation of Hepatitis B Infection Prevalence in Institutionalized Intellectually Disabled Children” which is recently published in your prestigious journal 1 . The authors concluded that HBV infection is more prevalent among institutionalized disabled children and that we should change our health policies for HBV infection management in this population. They have conducted a valuable study with an important subject in a high risk population for hepatitis. Despite our interest to the findings of Davoodbeglou et al. study there are some challenging points about their work; so we think that some comments may be of benefit. The first, authors have claimed a higher prevalence of HBV infection among vaccinated children in comparison with those with no or undetermined vaccination history. While there are studies in which the efficacy of neonatal HBV immunization has been proven 2 . How the authors justify this finding? In addition the authors have not mentioned the sampling method of their study which is the crucial factor of prevalence studies. This may seriously affect the results of study. Also the time period in which the study was conducted has not been determined by the authors. Was it after or before distribution of national vaccination program for hepatitis B? In this regard we should be aware of the maximum age of disabled individuals included in the study. In conclusion we appreciate the valuable effort of the authors; however we were wondering if we could kindly ask them to interpret better our concerns.

Prevention of blood-borne infections among nurses at Dr. Ivan Seliminski hospital, Sliven

INTRODUCTION : The occupational activities of nurses entail a daily exposure to infectious and non-infec­tious factors that can affect their health. Blood-transmitted pathogens caused by occupational exposure pose the most serious threat. Prevention strategies include vaccinations and universal precaution measures. AIM : The aim of this study is to assess vaccinations and other precautionary measures against blood-borne in­fections: HBV, HCV, HIV, and the attitude towards those among nurses at Dr. Ivan Seliminski Hospital, Sliven. MATERIALS AND METHODS : We used an individual anonymous survey among 55 nurses working in dif­ferent wards of the Hospital. RESULTS AND CONCLUSION : A large number of nurses at the hospital have had an HBV immunisation (69%). A significant proportion have also had serologic status testing for HCV and HIV (58%). Most nurses in­dicated they have had immunisation and testing as a precautionary measure.

Hepatitis B and C serologic profiles of Canadian organ donors and recipients: retrospective 10-year review at a single center.

Hepatitis C virus (HBV) and hepatitis C virus (HCV) are important causes of hepatitis and can be transmitted from organ donor to recipient. This study aimed to determine HBV and HCV serologic profiles of a population of Canadian solid organ transplant (SOT) donors and recipients, including prevalence of recipient HBV immunity. Data on age, gender, organ transplanted, and pre-transplant HBV and HCV serology for SOT donors and recipients at a Canadian hospital from 2001 to 2011 were obtained from a transplant database. There were 2455 recipients (2205 adults, 250 children), and 1559 donors. Over 50% of adult and 44% of pediatric recipients were HBV non-immune pre-transplant. Pediatric recipients were more likely to have HBV vaccine immunity than were adult recipients (48.8% vs. 28.9%, P < 0.001). Prevalence of HBV vaccine immunity was highest in renal recipients (48.3% in adult, 63.2% in pediatric recipients). Recipient HBV vaccine immunity increased from 5.8% in 2001 to 44.5% in 2011 (P < 0.001). Of 134 adult recipients with prior HBV infection, 59 (44%) were co-infected with HCV. Only 0.6% of adult non-liver recipients had acute or chronic HBV infection and 3.2% were anti-HCV positive. Only 2 donors had acute or chronic HBV infection, 29 had prior HBV infection, 9 were isolated hepatitis B core antibody positive, and 15 were anti-HCV positive. The prevalence of HBV vaccine immunity in SOT candidates is low, but increased from 2001 to 2011. Opportunities for quality improvement in pre-transplant HBV immunization exist. HCV co-infection is common in recipients with prior HBV infection. Prevalence of HCV infection in non-liver transplant recipients is low.

Immune responses to hepatitis B immunization 10-18 years after primary vaccination: a population-based cohort study.

We evaluated the immune response to neonatal HBV immunization in children of infected parents 10-18 years after primary vaccination. Healthy individuals immunized with an infantile course of three doses of HBV vaccine were tested for persistence of anti-HB surface antibody (HBsAb). Those with an HBsAb level of <10 IU/mL received a booster dose of the vaccine with subsequent doses to those without protective titres. HBsAb concentrations were determined 4 weeks after each dose of the booster vaccine. The data were analysed separately for three age groups: 10-11, 12-14 and 15-18 years old. A total of 541 healthy individuals were studied. The highest seroprotection rate of 48% was observed in the youngest vaccinees (10-11 years old). This declined to 26.5% in the oldest (15-18 years old) group (P = 0.008). The youngest vaccinees showed the highest rate of anamnestic immune responses (96%). However, 25% of oldest individuals failed to mount an anamnestic immune response in challenge with a booster dose of the vaccine (P = 0.005), suggesting waning immunity with increasing age. Age (OR: 0.80; P = 0.01) and prebooster HBsAb levels (OR: 0.37; P = 0.01) identified responders to first booster doses of the vaccine by logistic regression analysis. The majority of high-risk vaccinees showed anamnestic immune response 10-11 years after primary immunization. However, we found a significant proportion (25%) of older individuals with no anamnetic response, which suggests a waning of immune memory. Detailed long-term follow-up studies are necessary to determine the risk of natural infection among these individuals before a booster schedule can be recommended.

Low prevalence, low immunization and low adherence to full hepatitis B vaccine scheme and high-risk behaviors among crack cocaine users in central Brazil.

Crack cocaine users represent a target group for hepatitis B vaccination. We evaluate the HBV epidemiology, immunization status and compliance with a super-accelerated vaccination schedule among in-treatment crack cocaine users in central Brazil. Six hundred in-treatment crack cocaine users were interviewed, and serum samples were tested for HBV markers. A super-accelerated vaccination schedule of HBV vaccine was offered to all susceptible crack cocaine users. In total, 7.0% of those tested had at least one positive marker of HBV exposure. Age, use of crack cocaine through improvised pipe, exchange of sex for money/drugs and previous sexually transmitted infections (STIs) were predictors of HBV exposure. One hundred six (17.7%) individuals showed a serological profile of hepatitis B vaccination. Of these, 54.7% were less than 25 years old, and only 13% of individuals were more than 35 years old. Although 91.8% of crack users accepted the first vaccine dose, only 21.7% received all three doses. Of the 23 crack cocaine users who agreed to have their vaccine response evaluated, 78.3% developed protective anti-HBs titers. Premature termination of treatment was the most common reason for not receiving the full vaccine series. Despite the low prevalence of HBV exposure among in-treatment crack cocaine users in central Brazil, the low rate of immunization and the high frequency of high-risk behaviors highlight the potential for crack users to acquire and disseminate this infection and therefore maintain the viral reservoir. Health practitioners need to keep this in mind, taking advantage of all opportunities to access this population and vaccinate against HBV.

A cross-sectional serosurvey on hepatitis B vaccination uptake among adult patients from GP practices in a region of South-West Poland.

BackgroundHepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection. Therefore, HBV vaccination is widely recommended for those not covered by the national immunisation program. Objective: To assess the coverage and influencing determinants of HBV vaccination among adult patients attending GP clinics as well as to establish serological status in terms of HBV infection.MethodsPatients who were seen consecutively in March 2013 at four randomly selected GP practices located in Zgorzelec county, in south-western part of Poland, were invited to participate and complete questionnaires on socio-demographic data and other factors related to vaccination. A pilot study was done in one urban GP practice in the city of Gryfino (Gryfino county), the results have been included in the study. Patients’ immunisation status was assessed basing on vaccination cards and anti-HBs titer with the use of third-generation testing methods. In addition, serum samples were assayed for anti-HBc total.ResultsResponse rate: 99.3 %. Of 410 participants (66.1 % females, median age 56 years), 55.4 % (95%CI:50.5-60.1 %) were previously vaccinated; in those 11.5 % took 2 doses, 66.1 % - 3 doses,18.1 % – 4 doses. Elective surgery was the main reason (57.7 %) for HBV immunization, 4.8 % - were vaccinated due to recommendations by GPs. The multivariable logistic regression model revealed that living in a city (OR 2.11), and having a surgery in the past (OR 2.73) were each associated with greater odds of being vaccinated. Anti-HBc total prevalence among those unvaccinated was 13.6 % (95%CI:9.3 %-19,5 %), and 7.2 % (95%CI:4.4-11.8 %) among those vaccinated.ConclusionsLow HBV immunization coverage among adult patients from GP clinics and the presence of serological markers of HBV infection among both - those unvaccinated and vaccinated call for comprehensive preventative measures against infection, including greater involvement of family doctors. Although interventions should cover the whole population, inhabitants living in the rural areas should be a group of special interest. Preoperative immunization for HBV seems to be an efficient public health tool to increase the vaccination uptake.

Reply to L’Huillier et al

We thank L’Huillier and colleagues for their letter and thoughtful review of our Brief Communication (1.L’Huillier AG McLin VA Posfay-Barbe KM Hepatitis B virus immunization before and after pediatric liver transplantation: Check, catch-up, and check again!.Am J Transplant. 2015; 15: 2275-2276Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,2.Leung D Ton-That M Economides J Healy CM High prevalence of HBV non-immunity in vaccinated pediatric liver transplant recipients.Am J Transplant. 2015; 15: 535-540Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar). We agree and support their statement that although antibody waning may be unavoidable after liver transplantation, close monitoring of serological markers for protection is likely beneficial in ensuring optimal protection. This is one of the conclusions of our study. However, although we are aware of the previously published recommendations referenced (3.Danziger-Isakov L Kumar D Vaccination in solid organ transplantation.Am J Transplant. 2013; 13: 311-317Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar,4.Danzinger-Isakov L Kumar D Guidelines for vaccination of solid organ transplant candidates and recipients.Am J Transplant. 2009; 9: S258-S262Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar) we note that our study was a point prevalence study of patients performed during 2011–2012. The majority of our cohort had also been transplanted some years prior to our study (mean time since transplant was 4.6 years). Prior to the release of these recommendations, we instituted a protocol of regular serological monitoring for both pre– and post–liver transplant patients with administration of booster doses of vaccine when titers are nonprotective, and look forward to analyzing short and long-term outcomes of HBV immunity in this cohort of children. One of the acknowledged limitations of our study is the inability of our design to determine primary immunization failure versus antibody waning. This distinction, however, will be apparent under our current monitoring schedule. However, one could postulate that our cohort is similar in that regard with the cohort reported from the national reference center in Switzerland (5.L’Huillier AG Wildhaber BE Belli DC Diana A Rodriguez M Siegrist CA Successful serology-based intervention to increase protection against vaccine-preventable diseases in liver-transplanted children: A 19 year review of the Swiss national reference center.Pediatr Transplant. 2012; 16 (et al): 50-57Crossref PubMed Scopus (29) Google Scholar) who have had pre- and posttransplant serological monitoring incorporated as standard of care since 2003. In both studies, more than 60% of patients were nonimmune posttransplant although many of our cohort were longer posttransplant than the 1-year data reported from the Swiss cohort. It is also encouraging that so many Swiss patients responded to booster vaccination. Nevertheless, defining clinical factors, markers of functional cellular, humoral immunity that may predict poor immune function, suboptimal response to immunization, rapid antibody waning in transplant recipients merits further study, ideally in a multicenter fashion. The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Dr. Healy has received research grants from Sanofi Pasteur and Novartis Vaccines and served on Scientific Advisory Boards for Novartis Vaccines and Pfizer, Inc. Other authors have no conflicts of interest to disclose.

P079: Hepatitis B and C among people who inject drugs in Germany: High HCV prevalence, low HBV immunization rates, and urgent need for prevention

Journal of Viral HepatitisVolume 22, Issue S2 p. 59-60 Poster PresentationFree Access P079: Hepatitis B and C among people who inject drugs in Germany: High HCV prevalence, low HBV immunization rates, and urgent need for prevention First published: 25 June 2015 https://doi.org/10.1111/jvh.75_12425AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, IssueS2Special Issue: 15th International Symposium on Viral Hepatitis and Liver Diseases (ISVHLD) held from June 26th to 28th, 2015, in Berlin, GermanyJune 2015Pages 59-60 RelatedInformation

Prevalence of hepatitis B and C virus infections among military personnel

BackgroundData regarding Hepatitis B and C viruses (HBV and HCV) prevalence among military personnel in Brazil are lacking, but the work-related risk of exposure can be high. The objective of this study was to estimate the seroprevalence of HBV and HCV and the risk factors associated to HBV exposure among Brazilian military personnel. MethodsA cross-sectional study was conducted and included 433 male military adults aged 18–25 years old working in Rio de Janeiro during October 2013. All individuals completed a questionnaire to assess their risk of exposure and provided a blood sample to HBV and HCV testing. ResultsNone of the participants presented HBsAg or anti-HBc IgM, 18 (4.1%) were positive for total anti-HBc, 247 (57.0%) were positive for anti-HBs, and 3 (0.7%) were anti-HCV reactive. The majority of military personnel with past HBV infection (anti-HBc reactive) and HBV immunity (anti-HBs reactive) had a history of prior dental procedures (88.9% and 77.3%), consumption of alcohol at least once a week (50% and 55.9%), and practiced oral sex (61.1% and 58.3%, respectively). In addition, anti-HBc positivity was common among individuals with a history of surgery (44.4%) and practice of anal sex (50%). At univariate analysis, age group was associated to anti-HBc and anti-HBs positivity. ConclusionsLow rates of HBV and HCV infection were observed among Brazilian military personnel in comparison to the general Brazilian population. HBV immunity rates were relatively low indicating the need for vaccination campaigns in this group.

Knowledge of Hepatitis B Virus Infection, Immunization with Hepatitis B Vaccine, Risk Perception, and Challenges to Control Hepatitis among Hospital Workers in a Nigerian Tertiary Hospital

Background. Studies had reported high rate of hepatitis B infection among hospital workers with low participation in vaccination programmes, especially those whose work exposes them to the risk of HBV infection. The study assessed knowledge of hepatitis B virus infection, risk perception, vaccination history, and challenges to control hepatitis among health workers. Methods. A descriptive cross-sectional study. Consenting health care workers completed a self-administered questionnaire that assessed respondents' general knowledge of HBV, vaccination history and HBsAg status, risk perception, and challenges to control hepatitis. Data was analysed using descriptive and inferential statistics. Results. Three hundred and eighty-two health care workers participated in the study. There were 182 males and 200 females. The respondents comprised 94 (25%) medical doctors, 168 (44%) nurses, 68 (18%) medical laboratory technologists, and 52 (14%) pharmacists. Over 33% had poor knowledge with 35% not immunized against HBV. Predictors of good knowledge include age less than 35 years, male sex, being a medical doctor, previous HBsAg test, and complete HBV immunisation. Identified challenges to control hepatitis include lack of hospital policy (91.6%), poor orientation of newly employed health workers (75.9%), and low risk perception (74.6%). Conclusion. Hospital policy issues and low risk perception of HBV transmission have grave implications for the control of HBV infection.

Prevalence of hepatitis B infection in women delivering at a community health centre in Dili, Timor-Leste and discussion of programmatic challenges.

Limited data regarding prevalence of hepatitis B virus infection in Timor-Leste exist. An observational study of hepatitis B surface antigen (HBsAg) results of women delivering at Bairo Pite Clinic in Dili, Timor-Leste was carried out. Of the 781 women included in the study, 80.5% (626/777) of women who had accessed antenatal care had been tested for HBsAg, of whom 2.2% (14/626) were positive. Of the remaining women, 83.2% (129/155) received a test at the time of delivery, of whom 5.4% (7/129) were positive. Overall prevalence of HBsAg positivity was 2.8% (21/755). Further studies are urgently needed to establish the prevalence of HBV infection in Timor-Leste, particularly in pregnant women. Findings from this study suggest that routine HBV immunisation of newborns should be instituted promptly.

Seroprevalence, Immunostatus and Factors Associated with Blood Borne Viral Infections Among Egyptian Municipal Solid Waste Workers

Abstract Objectives Waste collectors have a potential risk of infectious diseases. The high prevalence of viral hepatitis B and C in Egypt has elevated the concern regarding the potential for disease transmission among municipal solid waste workers (MSWWs) from solid waste stream sources. Such transmission has never been epidemiologically demonstrated. This study aimed to explore the occurrence of HIV, Hepatitis B and C and to describe possible ways of virus transmission among MSWWs in Egypt. Methods A descriptive cross-sectional study was conducted among 346 MSWWs recruited from the main municipality in Alexandria, Egypt. Study procedure entailed interviews using a predesigned questionnaire and blood testing for the blood borne viral markers. Analytical statistics were used to identify independent factors correlated with HCV and HBV infections. Results: Overall seroprevalences were: hepatitis B; 36.1%; hepatitis C; 8.4%; and HIV; 0.0%. About 50% of the participants were at risk of HBV infection. Subjects were characterized by a predominance of males with low educational and economic levels. HBV infection was found to be significantly associated with younger age, folk circumcision, and the presence of genital complains suggestive of STDs while HCV infection was primarily associated with past history of parenteral anti-schistosomal therapy, intravenous infusion and direct exposure to solid waste. Conclusion The present work provides a strong evidence of increased occupational risk of blood borne viral infections among MSWWs. This mandates the need of compulsory HBV immunization proph.

Circumventing failed antiviral immunity in chronic hepatitis B virus infection: triggering virus-specific or innate-like T cell response?

Therapeutic vaccination for the treatment of chronic hepatitis B has thus far been unsatisfactory. In this review, we discuss potential new therapeutic vaccination strategies and other immunotherapeutic approaches that aim to achieve efficient restoration of HBV immunity in chronically infected patients.

Epidemiology of sharp instruments injuries at a dental school in Sudan

Dental practice represents an occupational hazard for injuries and transmission of serious infections and dental students are generally considered at a higher risk because they undertake exposure prone techniques during their training years. No published literature is available on sharp injuries among dentists in Sudan. The aim of this survey was to describe the epidemiology of sharp instruments injuries in dental students at a dental school in Sudan. An anonymous self-administered questionnaire was used to collect data on prevalence, protective strategies, hepatitis B immunization, health status following injuries and post-exposure prophylaxis. The response rate was 100% and females constituted 89.1% (41) of the sample. Thirty-two (69.6%) students reported being exposed to a sharp instruments injury and most injuries (22, 68.8%) occurred in the conservative dentistry department. The main tools causing injury are the syringe needle (16, 50%) and endodontic file (16, 50%). Endodontic treatment was the principle procedure causing injury (15, 46.9%). Twenty-five (78.1%) of students did not report their injury. None have tested for a blood borne virus after injury. Anxiety and stress was reported by 19 (59.4%) students. Thirty-five (76.1%) students were fully vaccinated against hepatitis B. Seven (15.2%) were aware of full details on standard precautions. Forty-two (91.3%) students practiced needle re-capping. The findings of this survey indicate the need for efficient training of dental students that encourages prevention of sharp injuries; compliance with standard precautions; preclinical HBV testing, immunization and efficacy testing; reporting of injuries and follow-up with provision of PEP.

Risk Factors of Changes in Hepatitis B Antibody Status after Allogeneic Hematopoietic Stem Cell Transplantation in Chinese Children with Thalassemia Major

Objective: This retrospective study evaluated the risk factors involved in the changes in HBsAb status in patients with thalassemia major at a single center in China.Methods: A total of 104 children who underwent allo-HSCT, using NF-08-TM transplant protocol in our center, between January 2010 and June 2012 were recruited.Hepatitis B markers, including HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc were examined by TRFIA (time-resolved fluoroimmunoassay) or ELISA (Enzyme-Linked Immunosorbent Assay) for recipients before and after allo-HSCT (at least up to 6 months) and for donors prior to transplantation. HBsAg positive recipients and donors received lamivudine antiviral therapy before allo-HSCT and the treatment was continued in recipients up to 6 months post transplantation.The demographic and clinical characteristics of the patients and their donors were summarized by descriptive statistics. For identification of risk factors that influenced the post-transplant anti-HBs loss and HBV reactivation, both univariate and multivariate logistic regression was used, and odds ratio (OR) and 95% confidence interval (CI) were determined for the covariates that were shown to be statistically significant. All tests were 2-sided, with the type I error rate fixed at 0.05. Statistical analyses were performed using IBM SPSS 20 (SPSS Statistics V20, IBM Corporation, Somers, New York).Results: Of the 104 patients, 2（1.9%） recipients were positive for HBsAg and 102（98.1%） recipients were negative for HBsAg. Of the 102 patients negative for HBsAg before transplantation, the proportion of positive anti-HBs was 69.6% (71 of 102 patients). Of the 104 donors, 99 (95.2%)were negative for HBsAg and 5 (4.8%)were positive for HBsAg. Of the 99 donors negative for HBsAg before transplantation, 72 donors (72.7%) had anti-HBs. After transplantation, of the 69 patients, 27 (39.1%) patients lost their HBV immunity in a median follow-up period of 30 months (range: 21–45); the remaining 42 (60.9 %) patients maintained the immunity against HBV after a median follow-up period of 28.5 months (range: 19–46). 33 patients were anti-HBs negative before the allo-HSCT. The 33 patients included 11 patients with donors who had no anti-HBs and 22 patients with donors who had anti-HBs. After the allo-HSCT, 15 of the 33 patients were found to have newly gained HBV immunity, as represented by the presence of anti-HBs. While 14 of them who developed adoptive immunity had immunized donors (63.6%; 14 out of 22), 1 of them (9.1%; 1 out of 11) with a non-immunized donor (donors without anti-HBs) also had developed HBV immunity.Multivariate logistic regression analysis of 104 patients who underwent allo-HSCT revealed that, patients with pre-HSCT titer of HBsAb < 257.47mIU/mL (adjusted odds ratio, 10.5, 95% CI, 2.1–53.3) and HBsAb-immunized donors (51.3, 2.8–938.6) were significant risk factors for post allo-HSCT HBV loss and acquisition, respectively. In addition, the post-transplant HBV reactivation rate was 11.1%.Conclusions: Current results indicate that pre-transplant HBsAb titer is a key determinant in the loss of HBV immunity after allo-HSCT and HBsAb negative patients with immunized donors are more likely to gain HBV immunity after allo-HSCT than those with non-immunized donors. Further, preemptive antiviral treatment with lamivudine significantly reduces HBV reactivation. This is the first study to have indicated the significant predictors of changes in HBsAg status in children with thalassemia major. DisclosuresNo relevant conflicts of interest to declare.

A Reality Check on the Quality of NASH Care

Introduction: Non-alcoholic steatohepatitis (NASH) is becoming pandemic. The management of this chronic liver disease is often frustrating. Here, we undertake a quality improvement project to explore potential gaps in NASH management within our clinical practice. Methods: In our tertiary care teaching hospital, new NASH patients in the gastroenterology (GI) clinic from April 1st, 2010 to June 30th, 2011 were reviewed. They were seen by 2 types of providers: those with a mixed GI/hepatology background (mixed GI), or those with purely hepatology background (hepatology). The patients were followed over the next 3 years. Demographics, patient characteristics, labs such as AST, ALT, platelet, etc., and relevant medications were recorded. The number of clinic visits was counted. NAFLD fibrosis scores (FS) were calculated from the initial visit and the patients were then identified as low (FS <-1.455), intermediate (FS -1.455 to 0.676), and high risk (FS>0.676). Results: During the 14 months from April 1st, 2010 to June 30th, 2011, a total of 72 and 65 new NASH patients were seen by hepatology and mix GI providers, respectively. About half of the patients were male. Median age was 54.6 and 49.3, respectively. According to NAFLD FS, the majority are at least of intermediate risk (77.7 and 57.4%, respectively). Most had dyslipidemia (76.4% and 81%, respectively); however, only 46% in mixed GI practice are on statins compared to 69% in pure hepatology practice. 69.4% checked for fasting insulin in the pure hepatology practice, while only 13.8% did so the mixed GI practice. 72.2% were on Vitamin E in the hepatology practice, compared to 31.1% in mixed GI practice. Fifty percent were seen in the GI clinic for 3 or more times in the 3-year period in the hepatology practice, compared to only 27% with mixed GI. Furthermore, 76.4% and 99% were checked for HAV and HBV immunity in the hepatology practice, while only 41.5% and 23% in the mixed GI practice. Finally, a relatively small number had a liver biopsy (18.1% and 23%, respectively, in the pure hepatology versus mixed GI practice). Conclusion: NASH patients who are referred to the GI clinic in a tertiary teaching hospital are mostly of high risk according to NAFLD fibrosis scores. In general, these patients did not get satisfactory long-term care for the chronic steatohepatitis. The appropriate use of vitamin E and statins is suboptimal, especially among the providers with a mixed GI population. A more standardized care model might help close the gaps and improve quality of care in the NASH patient population.

Hepatitis B and C Serologic Profiles of Organ Donors and Recipients Over a 10 Year Period at a Canadian Transplant Center.

Purpose: Determine the Hepatitis B (HBV) and Hepatitis C (HCV) serologic profiles of a population of Canadian solid organ donors and recipients, including prevalence of recipient HBV immunity. Methods: Data on the age, gender, organ transplanted and pre-transplant HBV and HCV serology for all solid organ donors, whose organs were transplanted, and recipients at a Canadian hospital from January 2001 through December 2011 were obtained from a transplant database. Results: There were 2533 transplant events with 1559 unique donors. Recipient HBV and HCV serology is summarized in Table 1.Table 1: Recipient HBV & HCV Serology by OrganRenal transplant recipients were more likely to have HBV vaccine immunity than were heart, lung or liver recipients (p<0.001 for all). Median age of recipients with HBV vaccine immunity was younger than non-immune recipients and those with prior HBV infection (p<0.001 for both). Recipient HBV vaccine immunity increased from 5.7% in 2001 to 45.2% in 2011. Of the 145 recipients with evidence of prior HBV infection, 61 (42%) were co-infected with HCV. Only 3 (0.2%) donors had acute or chronic HBV infection, 28 (1.8%) had prior HBV infection, and 9 (0.6%) were isolated anti-HBc positive. Compared to HCV negative recipients, recipients with HCV infection had an older median age, were more likely to be male, and were more likely to have evidence of prior HBV infection or be isolated anti-HBc positive (p<0.001 for all). Only 15 (1.0%) donors were HCV infected. Conclusions: Over 50% of recipients were HBV non-immune. Prevalence of HBV vaccine immunity increased from 2001-2011 and is expected to increase due to routine childhood HBV immunization in Canada; opportunities for quality improvement in catch-up pre-transplant immunization exist. HCV co-infection is common in recipients with evidence of prior HBV infection; prevalence of HCV infection in non-liver transplant recipients is low.

Low prevalence of hepatitis B and C virus markers among children and adolescents.

This study aimed to determine the prevalence of HBV and HCV among children and adolescents attending schools and daycare centres in Rio de Janeiro State, located in southern Brazil. Serum samples from 1,217 individuals aged 0 to 18 years were collected from 1999 to 2012 and tested for HBsAg, total anti-HBc, anti-HBs, and anti-HCV by ELISA. Reactive HBsAg and anti-HBc samples were tested for HBV DNA. Reactive anti-HCV samples were tested for HCV RNA and genotyped by RFLP. HBsAg was detected in 1.8% of individuals, and total anti-HBc was detected among 3.6% of individuals. Anti-HBs reactivity was found among 25.3% (322/1,217) of the individuals and increased from 6.28% in the years 1999-2000 to 76.2% in the years 2001–2012 (P < 0.0001). HBV DNA was detected in 18 of 51 individuals who presented with HBsAg or isolated anti-HBc, and nine were considered occult hepatitis B cases. Three individuals were anti-HCV- and HCV RNA-positive: two of them were infected with genotype 1, and the other was infected with genotype 3. Low levels of HBV and HCV markers were observed in children and adolescents. HBV immunity increased during the period of study, indicating that childhood universal HBV vaccination has been effective for controlling HBV infection in Brazil.

Prevalence of Hepatitis B surface antigen in children with sickle cell anemia

Background: Hepatitis B virus is known to be endemic in Africa. The seroepidemiological studies of HBV have shown that infection commonly occurs in childhood in Africa resulting in an increased tendency to chronicity. This cross-sectional study was undertaken to determine the seroprevalence of hepatitis B surface antigen among pediatric patients with homozygous hemoglobin S. Materials and Methods: Three hundred sickle cell anemia children aged 6 months-15 years (both in steady state and in crises) attending the SCA clinic and on admission in emergency pediatrics unit and pediatrics medical ward, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, were screened for hepatitis B infection using HBsAg as marker of infection. The sensitive enzyme linked immunosorbent assay method was used for detection of the marker. Three hundred children with minor illness attending pediatrics outpatient department and on admission in EPU/PMW for various treatment in the same hospital served as gender- and age-marched controls cohorts. Results: The sero-prevalence of HBsAg seropositivity for hepatitis B virus infection among SCA children was 17.3% (52/300) compared to 10.7% (32/300) of the control (P = 0.0875). The peak prevalence age group for HBV infection among SCA children was in the age group 1.1-5.0 years (6%) compared to 10.1-15.0 years (4.7%) in the control. Risk factors for HBV infection such as blood transfusion, traditional scarification/circumcision/uvulectomy, and tattooing did not significantly affect the prevalence of HBV infection in both SCA children and controls. Conclusion: Hepatitis B infection is common in Sokoto. The need for strict adherence to HBV immunization and further community-based studies on the risk factors are recommended.

PIN83 - Mathematical Models of Hepatitis B Vaccination and Screening Programmes in the United Kingdom: A Systematic Review

PIN83 MatheMatIcal Models of hePatItIs B VaccINatIoN aNd screeNINg PrograMMes IN the UNIted KINgdoM: a systeMatIc reVIew Keeping S.T.1, Allen F.2, Patel A.2, Carroll S.M.1, Kilcoyne A.1 1Sanofi Pasteur MSD, Maidenhead, UK, 2Abacus International, Bicester, UK objeCtives: The United Kingdom (UK) has a targeted hepatitis B (HBV) vaccination programme for at-risk patient groups; however such a programme can be challenging to implement. The World Health Organisation (WHO) recommends universal HBV vaccination and this approach has been adopted by most developed countries. A systematic review was conducted to identify UK-based mathematical models for HBV to determine whether current evidence supports the use of a universal vaccination programme versus a targeted approach. Methods: Embase, Medline, Econlit and The Cochrane Library were searched for studies reporting HBV mathematical models (economic or epidemiological) in the UK population. Hand searching of Health Protection Agency and National Institute for Health and Clinical Excellence guidance documents was also performed. Economic models (cost-effectiveness, cost-utility, cost-benefit, cost-consequence) were included if they assessed HBV vaccination or screening programmes. Epidemiological studies were included if they modelled HBV immunity and infection rates. Data were independently extracted and summarised into evidence tables by two reviewers and quality appraisal of included studies was performed. Results: Electronic database searches identified a total of 649 citations resulting in 11 relevant publications. Hand searching yielded an additional two publications; a total of 13 included publications representing seven economic evaluations and six epidemiological modelling studies. Overall, there was considerable variation in model methodologies including methods of discounting used, static versus dynamic approaches and sources of model inputs. Only one epidemiological modelling study considered HBV transmission patterns across the UK. ConClusions: Current HBV vaccination policy in the UK is dependent on the demonstration of cost-effectiveness. However, this review highlights some of the limitations inherent in the models which have been used to support policy decisions. Alternative modelling approaches, as well as new data on key inputs, are desirable if the full value of a universal HBV vaccination programme in the UK is to be assessed.