Doses Of HBV Vaccine Research Articles

Low HBV knowledge is associated with low HBV vaccination uptake in general adult population despite incentivization of HBV vaccination

BackgroundHepatitis B virus (HBV) vaccination in Vietnamese adults remains low and unequally distributed. We conducted a study on HBV-naïve adults living in Ho Chi Minh City, Viet Nam, to determine barriers associated with HBV vaccination uptake after removing the financial barrier by providing free coupons for HBV vaccination.MethodsAfter being screened for HBsAg, anti-HBs, and anti-HBc, 284 HBV-naïve study participants aged 18 and over (i.e., negative for HBsAg, anti-HBs, and anti-HBc total) were provided free 3-dose HBV vaccine coupons. Next, study participants’ receipt of 1st, 2nd, and 3rd doses of HBV vaccine was documented at a pre-specified study healthcare facility, where HBV vaccines were distributed at no cost to the participants. Upon study entry, participants answered questionnaires on sociodemographics, knowledge of HBV and HBV vaccination, and related social and behavioral factors. The proportions of three doses of HBV vaccine uptake and their confidence intervals were analyzed. Associations of HBV vaccine initiation with exposures at study entry were evaluated using modified Poisson regression.Results98.9% (281 of 284) of study participants had complete data and were included in the analysis. The proportion of participants obtaining the 1st, 2nd, and 3rd doses of HBV vaccine was 11.7% (95% Confidence Interval [95% CI] 8.0-15.5%), 10.7% (95%CI 7.1–14.3%), and 8.9% (95%CI 5.6–12.2%), respectively. On the other hand, participants were more likely to initiate the 1st dose if they had adequate knowledge of transmission (adjusted relative risk [aRR] = 2.58, 95% CI 1.12–5.92), adequate knowledge of severity (aRR = 6.75, 95%CI 3.38–13.48), and annual health-checking seeking behavior (aRR = 2.04, 95%CI 1.07–3.87).ConclusionWe documented a low HBV vaccination uptake despite incentivization. However, increased vaccine initiation was associated with better HBV knowledge and annual health check-up adherence. When considering expanding HBV vaccination to the general adult population, we should appreciate that HBV knowledge is an independent predictor of vaccine uptake.

Assessment of Knowledge, Attitude and Practices among Healthcare Professionals Regarding Hepatitis B Infection and Vaccination in a Tertiary Care Hospital

Background: Hepatitis B infection is an occupational risk for Healthcare workers (HCWs).[3] They have a greaterrisk of acquiring HBV infection due to exposure to blood or bodily fluids. Compared to the general population, therisk is four times higher for this group of professionals. The present study was carried out to know the vaccinationstatus of Hepatitis B; assess knowledge and attitude towards Hepatitis B vaccination; and to assess the awarenessabout Hepatitis B infection among health care professionals.Methods and Materials: A cross sectional study was conducted in the MY Hospital, Indore for a period of 6months after getting approval from institutional ethics committee. The sample size of 210 healthcare professionalswas selected using simple random sampling technique. The data was collected by using a pre-designed, validatedsemi-structured questionnaire. Data collected through the questionnaires were coded, entered into a database andanalysed using a statistical software SPSS version 25(trial version).Results: 63.81% of HCWs knew about HBV infection. 43.81% were aware about its spread through saliva. 77.36%doctors, 74.78% nurses and 80.95% of the other health care workers never used PPE while handling blood andbody fluids. All the doctors, 54.78% nurses and 21.43 of others knew about the HBV vaccine (p-value<0.00001).88.68% doctors and 41.27% nurses and only 33.33% of the other staff knew that there were three doses of HBVvaccine. Majority of the doctors (83.02%) and nurses (53.04%) had received HBV vaccine, while 69.05% of otherhealth care workers did not receive any dose of HBV vaccine.Conclusion: The study shows that complete knowledge regarding the hepatitis B infection, its mode of transmission,preventive measures and screening is still lacking among the health care workers. Although doctors seem to be themost knowledgeable, there is a need to improve the knowledge and practices among the other workers as well.

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.

Hepatitis B Immunity Status among Healthcare Sciences Students, 20 Years after the Infantile Vaccination: The Most Appropriate Policy to Confer Full Protection.

Abstract 
 Background. During recent years, an increasing number of previously vaccinated children against hepatitis B (HBV) may begin activities as healthcare sciences students (HSS), so, at the higher risk of HBV infection. Therefore, documenting their immunity at before training was recommended. To evaluate their immunity status, as well as measuring the presence of immunological memory and protection through administering 1-to-3 additional doses of HBV vaccine among HSS who have been immunized at childhood, this study was conducted.
 Subjects and Methods. The vaccination status of the accepted HSS was documented by reviewing their vaccination record card. HBV infection markers at before, and following 1-to3 dose of HBV vaccine were measured using ELISA. Simple descriptive statistical methods were used to analyze collected data.
 Results. Totally, 274 HSS, 59.1% female, with mean age 23.8 years were included. Of those, 228 in infancy, and 46 within last 12-years have been immunized. From 228 infantile immunized students,103 with 1-to-3 doses of HBV vaccine were vaccinated. Of 125 non-boosted HSS, 64 preserved their protective antibody titers. The proportion of protected students and their antibody levels were increased significantly and approached to 96.8% following 3-doses of booster injection.
 Conclusion. Nearly half of the vaccinated students had lost their protective antibody titers, but, the majority of them preserved their immunological memory, detected through anamnestic response to booster vaccination. To provide appropriate protection, universal vaccination with one-doses of HBV vaccine followed by serological monitoring to identify non-protected students for further management seems reasonable.

Protective Anti-HBs Antibodies and Response to a Booster Dose in Medical Students Vaccinated at Childhood.

The immune system in humans is regulated by the circadian rhythm. Published studies have reported that the time of vaccination is associated with the immune response to vaccine for some pathogens. Our study aimed to evaluate the association between time of dose administration of challenge HBV vaccine and seroconversion for anti-HBs in medical students vaccinated at birth who were found to be unprotected at pre-training screening. Humoral protection for HBV was assessed in 885 medical students vaccinated during childhood. In total, 359 (41.0%) of them showed anti-HBs titer < 10 UI/mL and received a challenge dose of HBV vaccine followed by post-vaccination screening 30-60 days later. The challenge dose elicited a protective immune response (anti-HBs IgG titer > 10 UI/mL) in 295 (83.8%) individuals. Seroconversion was significantly associated with female gender and time of vaccination after controlling for age group and nationality at logistic regression analysis. Students who received the booster dose in the morning had a higher response rate than those who received the vaccine in the afternoon (OR 1.93; 95% C.I. 1.047-3.56: p < 0.05). This finding suggests that morning administration of the HBV booster may result in a better immune response in susceptible individuals.

Perceived risk factors and preventive practices of Hepatitis B viral infection among pregnant women in Nigerian hospitals: A cross-sectional study

ObjectiveThe study assessed the perceived risk factors and prevention practices of HBV infection among pregnant women in Nigerian hospitals. Study DesignA descriptive cross-sectional study was conducted among 343 pregnant women attending antenatal clinics at two purposefully selected primary health care centers in Ile-Ife. Women were included in the study using systematic sampling. A structured researcher-administered questionnaire was used for data collection. Descriptive and inferential (Chi-square test and Logistic regression) statistical analysis were carried out. ResultsMore than half (53%) of the respondents had a low perceived risk for hepatitis. Majority (73.5%) had been screened for HBV during the index pregnancy but only 30% received complete doses of HBV vaccine. Respondents who underwent HBV screening during pregnancy (OR = 2.06, 95% CI = 0.94 – 4.5), who had completed Hepatitis B vaccination had reduced odds ratios for perceiving risk factors for Hepatitis B Viral Infection (OR = 0.224, 95% CI = 0.94 – 4.5). ConclusionPregnant women had a low-risk perception of HBV infection. The low level of risk perception can serve as a basis for developing preventive interventions aimed at educating and empowering expectant mothers in order to prevent HBV infection and its transmission to their children.

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.

Abstract B067: Trend and factors associated with mothers’ refusal of HBV birth dose to their infants, 2018-2020, Washington metropolitan areas

Abstract Background. Vertical transmission of HBV is the leading mode of acquisition of the infection worldwide. Prevention of vertical transmission is possible in the majority of cases through the correct administration of the birth dose of HBV vaccine to the neonate. The purpose of this study to examine the trend and factors associated with mothers’ refusal of HBV birth dose to their infants in 2018-2020 in the targeted region. Methods. We performed a retrospective analysis of electronic birth dose vaccination of newborns in the 2018-2020. Six birthing facilities and home delivery records sent the birth dose data to the DC Health Department, representing 40,269 newborns. This data from the DC health department has mother’s race and ethnicity, health insurance type, birthing facilities, and mother’s refusal to give her newborn birth dose. Descriptive analysis and multivariable logistic regression analysis were conducted. Results. A total of 34,509 (85.7%) received hepatitis B birth dose within 12 hours or discharge from the facility. Mother’s refusal rate to give her newborn has been significantly decreased from 2018 to 2020 (11.5% in 2018, 8.6% in 2019, and 4.2% in 2020, p&amp;lt;.001). There were racial/ethnic differences in the HepB birth dose rates: Asian newborns (90.4%) had the highest vaccination rate followed by Hispanics (88.7%), Whites (86.1%), and African Americans (84.4%). In multivariate logistic regression analysis, race, birthing facility, and health insurance were associated with mother’s refusal. African American mothers (aOR=1.26, 95% CI: 1.15-1.39) and those with home birth (aOR=4.12, 95% CI: 2.96-5.74) had high likelihood to refuse having birth dose. Those with Medicaid were less likely to refuse than those with private insurance (aOR=0.90; 95% CI: 0.82-0.99). Discussion. Our study indicated that the overall mother’s refusal to give HepB birth dose vaccination rate has decreased in the past 3 years. A policy for universal vaccination of all newborns (regardless of mother’s HBsAg status) should be implemented to prevent unrecognized perinatal transmission. Citation Format: Hee-Soon Juon, Donna Sheler, Jane Pan, Daisy Le, Tony Yang. Trend and factors associated with mothers’ refusal of HBV birth dose to their infants, 2018-2020, Washington metropolitan areas [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B067.

Long-term immunity after HBV vaccine: shall we consider a change? A 20-year-follow-up study

Abstract Introduction Although vaccines against HBV have been available since the 1980s, the long-term immunity is still debated. When assessing immune persistence, a number of clearly defined variables must be taken into account. Often the expression ‘infant vaccination’ means the administration within the first year of life at any age, but a difference of a few months may imply a different antibody persistence over the years. This study assessed the anti-HBs titre 20 years after the primary vaccination course and estimated the effect of age at 1st dose and time interval between doses on long-term protection. Methods Data on age, sex and date of administration were collected. Inclusion criteria: born to negative mother, 3-dose schedule, no previous HBV infection, age at enrolment 18-24 years; age at 1st dose 2-12 months. Titres ≥10IU/l were considered protective. A logistic regression was performed, adjusting for sex, follow-up time and date of 1st dose and analysis. Results We included 5,485 participants (64% female). The mean anti-HBsAg increased from 46, 52, 85 to 193IU/l when the 1st dose was administered in the I, II, III or IV trimester of life, respectively. Similarly, the proportion of individuals with titre &amp;lt;10IU/l decreased from 51 to 18% between the two extreme quarters. The risk of a titre &amp;lt;10IU/l decreased with age at the 1st dose (AOR: 0.84; 95%CI: 0.78-0.91 per one-month increase) and time between the 2nd and 3rd doses (AOR: 0.89; 95%CI:0.85-0.94). Conclusions The mere presence of a titre &amp;lt;10IU/l does not equate lack of protection. However, antibody levels are very different depending on the actual age of vaccination. One-month delay within the first year is associated with a -18% chance of a titre &amp;lt;10IU/l 20 years later. Although this information needs to be combined with local epidemiology and surveillance to obtain an informed risk-benefit balance, the implications from a public health and economic perspective may be diverse and worth considering. Key messages • Still within the first year of life, a delay in the administration of the 1st dose of HBV vaccine and a longer time between the 2nd and 3rd dose imply a higher antibody persistence even 20 years later. • Considering the local circulation of HBV and surveillance, this result could be taken into account to obtain an informed risk-benefit balance.

Implementation Approaches for Introducing and Overcoming Barriers to Hepatitis B Birth-Dose Vaccine in sub-Saharan Africa.

In sub-Saharan Africa (SSA), chronic viral hepatitis B (HBV) affects more than 60 million people. Mother-to-child transmission is a major contributor to the ongoing HBV epidemic and yet only 11 of 54 (20.3%) SSA countries have introduced the birth dose of HBV vaccine (HepB-BD) into their regular immunization schedule. As more African countries adopt HepB-BD, implementation approaches must be targeted to ensure effective and timely HepB-BD delivery, especially in rural and under-resourced settings. We conducted a systematic literature review of published literature using PubMed. We included 39 articles published from January 2010 to August 2020, as well as gray literature, case studies, and research performed in SSA. We describe barriers to the uptake of HepB-BD in SSA at the policy, facility, and community levels and propose solutions that are relevant to stakeholders wishing to introduce HepB-BD. We highlight the importance and challenge of reaching infants who are born outside of health care facilities (i.e., home deliveries) with HepB-BD in partnership with community health workers. We also discuss the critical role of maternal education and community engagement in future HepB-BD scale-up efforts in SSA.

Prospective clinical trial of hepatitis B vaccination for children with hematological malignancies: a study on the safety and immunogenicity efficacy

ABSTRACT Children with hematological malignancies are at increased risk of hepatitis B virus infection. This study assessed the immunogenicity and safety profile of HBV vaccination in pediatric hemato-oncological children. A nonrandomized interventional study was conducted from January 2017 to February 2020 in Shanghai, China. Seventy-three pediatric hemato-oncological children with hepatitis B surface antibody (anti-HBs) titers <10 mIU/ml were recruited. The participants received three doses of recombinant HBV vaccine according to the 0-, 1-, and 6- month immunization schedule. Adverse events following immunization and anti-HBs titers (at baseline, 1 month, and 6 months after inoculation) were recorded. Forty-three males and thirty females with median ages of 9.12 and 9.60 years, respectively, were included. The mean anti-HBs titer was 4.88 ± 2.61 mIU/ml, 893.12 ± 274.12 mIU/ml, and 711.45 ± 337.88 mIU/ml at baseline, one month, and six months after inoculation, respectively (P< .001). A total of fourteen adverse events following immunization were reported, and among them, 5 (6.85%), 5 (6.85%), and 4 (5.48%) events were reported after the first, second, and third inoculation, respectively (P= .927). In conclusions, the HBV vaccine is immunogenic and safe in children with hematological malignancies. It is worth noting that the anti-HBs titer was decreased at the 6-month follow-up, and periodic monitoring of the anti-HBs titer accompanied by timely booster vaccination should be carefully considered. Abbreviations: AEFI: Adverse events following immunization; HBV: Hepatitis B virus; Anti-HBs: Antibody against hepatitis B surface antigen; HBsAg: Hepatitis B surface antigen; APC: Antigen-presenting cell; HSCT: Hemopoietic stem cell transplantation; COVID-19: Corona Virus Disease 2019

Three vs Four Dose Schedule of Double Strength Recombinant Hepatitis-B Vaccine in HIV-infected Children: A Randomized Controlled Trial

To compare seroprotection rates and the anti-HBs titers following primary immunization with double strength (20 µg) recombinant hepatitis B virus (rHBV) vaccine administered intramuscularly (IM) in a 3-dose (0, 1 and 6 months) vs 4-dose (0, 1, 2 and 6 months) schedule in HIV-infected children receiving antiretroviral therapy (ART). An accelerated 3-dose schedule (0, 1, 2 months) within the 4-dose group was also compared. Randomized controlled trial. Pediatric ART clinic of a tertiary hospital in Delhi from November, 2017 to April, 2019. Fifty (25 per group) HIV-infected children aged 18 months - 12 years receiving ART for at least 6 months who had not received any prior dose of HBV vaccine, and were anti-HBs negative. Group 1 received 20 µg of rHBV vaccine IM (in deltoid muscle) at 0, 1, and 6 months, and group 2 received 20 µg the same vaccine at 0, 1, 2 and 6 months. Anti-HBs titers and proportion of responders in 3-dose vs 4-dose group at seventh and twelfth month and at third month after an accelerated 3-dose schedule. Median (IQR) anti-HBs titers at the seventh month were significantly higher in group 2 [225.7 (151-300) IU/L] compared to group 1 [138.2 (35.2-250) IU/L], but were comparable at the 12th month. Seroprotection rates were comparable between group 2 and group 1 at 7th month (96% vs 80%; P=0.19) and 12th month (96% vs 88%; P=0.61). The proportion of good responders were also comparable between the groups at 7th month and 12th month (both P=0.29). Accelerated 3-dose schedule achieved comparable anti-HBs titers [179.9 (130.6-250) IU/L] and seroprotection rate (92%) one month after completion of schedule to the standard 3-dose + schedule. A 3-dose double strength recombinant HBV vaccine schedule offers comparable seroprotection to 4-dose schedule for HIV-infected children receiving ART.

Adherence to pregnancy hepatitis B care guidelines in women and infants in the United States and evaluation of two interventions to improve care: A multicentre hospital-based study.

There has been an increase in hepatitis B (HBV) detection during pregnancy in the United States and an emphasis on measures to decrease mother-to-child transmission of HBV. We performed a multicentre retrospective study (2015-2018) evaluating care among all women with HBV during pregnancy. We determined rates and predictors of adherence to key maternal care measures including: (1) referral to HBV specialty care, (2) assessment of HBV DNA, and (3) initiation of antiviral therapy, and (4) rates of HBIG and HBV vaccine completion in infants. We evaluated two interventions to improve HBV care: (1) clinical decision support with best practice alert and (2) co-location of HBV care in obstetrics department. We identified 372 women with HBV during pregnancy. Patients had a median age of 33 (IQR 29, 36), were mostly of Asian (49%) or Black (36%) race, HBeAg-negative (83%) with HBV DNA ≤2000 IU/mL (65%) and maximum ALT ≤25 (66%). Regarding care measures, 62% were referred to an HBV specialist, 85% had HBV DNA checked during pregnancy and 68% with HBV DNA ≥200,000 were initiated on antiviral therapy. Co-located obstetric-liver diseases clinics appeared to improve adherence to maternal care measures. All infants received HBIG and the first HBV vaccine dose, 106 (81%) received the second, 94 (74%) received the 3rd dose, but fewer at the recommended time intervals. We identified clear gaps in adherence to HBV care measures for both mothers and infants. Co-location of HBV care in the obstetrics department shows promise in improving adherence to maternal care measures.

Adherence and Effectiveness of HBV Vaccination among Healthcare Workers in Egypt.

Context:Healthcare workers (HCWs) face a potential risk of acquiring different bloodborne pathogens, by occupational exposure to contaminated blood and body fluids. Hepatitis B vaccine is a safe, effective method of conferring long-term protection against HBV infection.Aims:The study aimed to assess the adherence and effectiveness of HBV vaccination among HCWs at Gastrointestinal Surgical Center, Mansoura University, Egypt.Settings and Design:A prospective descriptive study was carried out between June 2019 and December 2019 at Gastrointestinal Surgical Center, Mansoura University, Egypt.Methods and Material:All HCWs with anti-HBs levels below 10 mIU/mL were advised to receive 3 doses of recombinant HBV vaccine, at 0, 1, and 6 months. The anti-HBs levels were checked 3 months after the third dose of the HBV vaccine.Statistical Analysis Used:Data was analyzed using the Statistical Package of Social Science (SPSS) program for windows (version 16).Results:A total of 442 healthcare providers were included. Most of them completed the 3 doses of the vaccine (81.7%), 10.2% refused the vaccine, while 0.9% and 7.2% received 1 and 2 doses, respectively. Odds of vaccination were the highest (88.1%, 273/310) among nurses (OR, 4.7; 95% CI, 2.6–5.2; P ≤ 0.001). The overall anti-HBs positivity of 97% (350/361) was observed. The main reasons for not being vaccinated included the fear of vaccine side effects 25/81 (30.9%) and lack of trust in the vaccine effectiveness 18/81 (22.2%).Conclusions:The outcome of the present study emphasizes the need to apply alternative and innovative measures to build a positive attitude toward the HBV vaccine among HCWs.

Hepatitis B in Poland in 2018.

Evaluation of the epidemiological situation of hepatitis B in Poland in 2018 compared to the situation in previous years. The epidemiological situation was assessed based on the results of the analysis of individual data on hepatitis B cases and HBV infections registered by Local Sanitary- Epidemiological Stations in the central database using Epidemiological Interview Registration System (SRWE). Aggregate data published in the annual bulletins "Infectious Diseases and Poisonings in Poland" and "Vaccinations in Poland" were also used. In 2018, a total of 3 196 hepatitis B cases were registered, which corresponds to an incidence of 8.3 cases per 100,000 population. Acute hepatitis B cases accounted for about 1.3 % of total. The incidence of acute hepatitis B was lower by 33% than in 2017 and lower by 44% than median of the years 2012-2016. No acute cases were reported among children and adolescents aged 0-19 years and in the age group 20-24. The incidence of chronic and unknown (in terms of the stage) was lower by 4.5% than in the previous year however, in comparison to median incidence of chronic hepatitis B in 2012-2016 an increase of 17% was noted. As in the previous years, acute, chronic and unknown stage (UNK) hepatitis B were more often detected in men and in urban residents. The dominant route of transmission of HBV infections still remains procedures performed in medical settings - 86% of cases with a known transmission route. The coverage with the third HBV vaccine dose in children aged two years was 91 % and remains ( since 2017) below the 95% required in the elimination strategy. In 2018 three people died due to acute hepatitis B and 35 people due to chronic hepatitis B. In 2018 decrease in the incidence of acute and chronic hepatitis B was observed. In group of persons born after 1994 covered by obligatory hepatitis B vaccinations as newborns no acute cases have been reported, however, a progressive decline in children's vaccination coverage poses a risk for new HBV infection also among people subjected to mandatory vaccinations. Maintenance of a low incidence of acute hepatitis B requires improvement in carrying out of mandatory vaccination among newborns and further recommendation of vaccination for all persons previously unvaccinated. A slight decline in the detection of chronic and UNK cases may be related to the number of tests performed in a given year.

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

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

Introduction of birth dose of hepatitis B virus vaccine to the immunization program in Ethiopia: an economic evaluation

BackgroundHepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia.MethodsWe constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities.ResultsIn Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs.ConclusionsBased on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia’s essential health services package.

Seroprevalence of HBV, HCV and HIV-1 and Correlation with Molecular Markers among Multi-Transfused Thalassemia Patients in Western India.

BackgroundMultitransfused β-thalassemia major patients are always at high risk of having Transfusion Transmitted Infections (TTIs). This study was aimed to determine the seroprevalence of HBsAg, Anti-HIV-1/2, and Anti-HCV among these patients and to correlate the same with NAT testing.MethodsA total of 196 patients with β-thalassemia were included in the study. Patients were screened for the presence of viral markers by third-generation ELISA test as well as for viral DNA/RNA by NAT test.ResultsAmong 196 multi-transfused Beta-thalassemia patients, the seroprevalence of anti-HCV was very high 100 (51.1%), however, anti-HIV1/2 was 6 (3.1%), and HBsAg were 3 (1.5%). Surprisingly similar patterns were observed in the prevalence of molecular markers, as HCV-RNA were 66 (33.7%) of the patients along with HIV-1 RNA were 8 (4.1%), and HBV-DNA were 5 (2.5%) patients. Overall eight (4.1%) patients were found to have coinfections, where two were positive for HBsAg/anti-HCV by ELISA along with 3 (1.5%) were positive for HBV-DNA/ HCV-RNA, 1 (0.5%) was positive for HIV-RNA/HBV-DNA, and 2 (1%) had coinfection of HIV-RNA/ HCV RNA by NAT testingConclusionThe prevalence of HCV infection among multi-transfused β-thalassemia patients is significantly higher than that of the HBV and HIV infections. This scenario should be controlled and monitored by doing regular follow-up testing schedules of such patients and also the administration of the booster dose of the HBV vaccine along with HCV treatment with antiviral DAAs.

Evaluation of the Immune Memory Response to Routine Hbv Vaccine in Egyptian Patients With Type 1 Diabetes

We aimed to evaluate the immune memory response to HBV vaccine in diabetic patients who had received the full HBV vaccination during infancy and to assess the need for booster doses. Blood samples were collected from children (93 diabetics and 105 controls) and university students (22 diabetics and 20 controls). Anti-HBs titer in serum and after in vitro stimulation of peripheral blood mononuclear cells with HBV vaccine was measured by ELISA. Diabetic groups had significantly lower anti-HBs levels after 10 years of the last HBV vaccine dose. The percentage of diabetic patients having protective anti-HBs titers was significantly lower than controls. In conclusion, diabetic patients had lower immune response to HBV vaccine over time, emphasizing the need for a booster dose.

Serum levels of anti-hepatitis B surface antibodies among vaccinated children aged 1 to 12 years in a rural community in Fars Province, southern Iran

ABSTRACTThe present study aimed to find out the levels of anti-HBsAb among vaccinated children in a rural community in Fars Province, Southern Iran. Blood samples were taken from 550 children, aged 1–12 years (mean 6.4 ± 3.5), in 2017 from three villages in the area. A structured questionnaire was used to get the sociodemographic data of the subjects along with determinants concerning the Hepatitis B. Sera samples were examined for anti-HBsAb, using an ELISA commercial kit. Anti-HBsAb were detected in 468 (85.1%) of the subjects. Of the seropositive subjects, 37 (45.1%) were female and 45 (54.9%) were male. In the age group of 0–5 years, 88.7% of the subjects were seropositive. This rate was 84.3% and 78.1% in the age group of 6–10 years old and older than 10 years, respectively. There was a significant association (p < .05) between the anti-HBsAb and age. Findings of the current study revealed that children living in a rural community in southern Iran have appropriate protection against HBV even more than 10 years after being vaccinated. The decline in seropositivity rate of anti-HBsAb with age may further point out the need for a booster dose of HBV vaccine.