Hepatitis A Virus Vaccination Research Articles

Sexual and preventive behaviors associated with HAV, HBV, and HPV vaccine hesitancy among men who have sex with men in France

ABSTRACT Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomaviruses (HPV) is insufficient among men who have sex with men (MSM), partly because of their high prevalence of vaccine hesitancy (VH) specific to these vaccines. This study aimed to investigate determinants of specific VH in MSM, focusing on characteristics of their sexual activity, propensity to use prevention tools and medical care, disclosure of sexual orientation to health care professionals (HCPs), and perceived stigmatization. A cross-sectional electronic survey (February – August 2022) collected perceptions of HBV, HAV, and HPV, and of their respective vaccines among 3,730 French MSM and enabled the construction of a specific VH variable. Using agglomerative hierarchical cluster analysis, we constructed a typology of MSM sexual and prevention practices. We identified three MSM clusters (low- (C1, 24%), moderate- (C2, 41%), and high- (C3, 35%) “sexual activity/medical engagement”) that showed an increasing gradient in the use of medical prevention with regular medical care and exposure to high-risk sexual practices. A multiple ordinal logistic regression showed that overall specific VH was higher in the C1 cluster and in men who had not informed their physician of their sexual orientation. This typology could usefully help to adapt vaccination communication strategies for MSM prevention program according to patients’ profiles. HCPs should be encouraged and trained to ask men about their sexual practices and to provide appropriate vaccination recommendations nonjudgmentally.

Assessing Immunity to Hepatitis A and Hepatitis B Among Individuals in Custody Living With HIV.

Screening upon entry into prison for hepatitis A virus (HAV) and hepatitis B virus (HBV) provides an ideal public health opportunity to offer vaccination to individuals who are nonimmune. We conducted a retrospective review of HAV and HBV immunity among adults living with HIV in the Illinois Department of Corrections between January 1, 2019, and December 31, 2019. The primary objective was to assess rates of HAV and/or HBV immunity in individuals with HIV. In total, 436 people were included in the study. Of 425 patients who had data for HAV vaccination, 335 were immune. Of 421 patients who had data for HBV vaccination, 272 were immune. Of the 149 patients who were nonimmune to HBV, 22 had active HBV and 6 had an equivocal HBV surface antibody and negative HBV surface antigen. In total, 212 (52%) were immune to both HAV and HBV, and 31 (8%) had no immunity to either HAV or HBV. These data demonstrate an important opportunity to discuss and provide vaccination while in custody.

Inactivated TZ84 strain hepatitis A vaccine and its impact: A narrative review

Hepatitis A (HepA) represents a significant global public health challenge. At present, there is no definitive treatment available for managing HepA. Before the availability of HepA vaccines, hepatitis A virus (HAV) infection had emerged as a leading cause of fulminant hepatic failure and a significant indication for liver transplantation in children living in Argentina, Brazil, the Republic of Korea, and India. Inactivated HAV vaccines have demonstrated a high level of immunogenicity. In addition, there is evidence supporting the use of inactivated HepA vaccines in immunocompromised individuals and as post-exposure prophylaxis. Recently, the inactivated TZ84 strain hepatitis A vaccine, which has shown superior immunogenicity for up to 30 years and fewer adverse reactions when compared with other inactivated HepA vaccines, has become available in India. Moreover, the TZ84 strain of the inactivated HAV vaccine has the potential to control community-wide outbreaks. This narrative review offers an overview of the existing evidence concerning immunization against HepA in India, with a particular emphasis on the TZ84 strain of the inactivated HAV vaccine.

Inactivated TZ84 strain hepatitis A vaccine and its impact: A narrative review

Hepatitis A (HepA) represents a significant global public health challenge. At present, there is no definitive treatment available for managing HepA. Before the availability of HepA vaccines, hepatitis A virus (HAV) infection had emerged as a leading cause of fulminant hepatic failure and a significant indication for liver transplantation in children living in Argentina, Brazil, the Republic of Korea, and India. Inactivated HAV vaccines have demonstrated a high level of immunogenicity. In addition, there is evidence supporting the use of inactivated HepA vaccines in immunocompromised individuals and as post-exposure prophylaxis. Recently, the inactivated TZ84 strain hepatitis A vaccine, which has shown superior immunogenicity for up to 30 years and fewer adverse reactions when compared with other inactivated HepA vaccines, has become available in India. Moreover, the TZ84 strain of the inactivated HAV vaccine has the potential to control community-wide outbreaks. This narrative review offers an overview of the existing evidence concerning immunization against HepA in India, with a particular emphasis on the TZ84 strain of the inactivated HAV vaccine.

Viral Hepatitis

Background: The primary goals of conducting surveillance for viral hepatitis are to direct prevention and control activities for these diseases and to evaluate the impact of these activities. Any person with a hepatitis virus infection is a potential source of infection to others. Surveillance would help accomplish the goals by providing information on:
 
 Creating a network of laboratories for diagnosis of viral hepatitis. 2. Monitor trends in incidence of and risk factors for disease.
 Assess burden of disease 4. Identify infected persons requiring counseling and /or post exposure prophylaxis. 5. Identify and control outbreaks.
 
 Methodology: Laboratory based targeted sousveillance in sentinel geographical regions/population. Clinical Case Definition: An acute illness with discrete onset of symptoms (e.g., fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting), and jaundice. (sourcewww.cdc.gov.in) NCDC will be the nodal agency for implementation of the project.
 Results: HBV, HCV and HDV are transmitted through contaminated blood or blood components or through the use of contaminated needles and syringes. In several populations, a common route of transmission of HBV infection is from infected pregnant women to their infants around the time of delivery. In many people with HBV or HCV infection, no route of transmission can be identified. In addition, specific vaccines and/or passive immune prophylaxis (use of specific immunoglobulin products) are also useful in preventing transmission of some infections. and also HAV vaccine is the most effective method for specific pre-exposure prophylaxis. and two different vaccines based on inactivated cell culture are available. Both vaccines are highly antigenic, especially in adults, and induce protective antibody levels in more than 95% of recipients after the first dose of vaccine. Individuals at high risk of repeated exposure to HBV, such as personnel Health Care Anti-HBs titer should be evaluated one month after the third dose. An Anti-HBs titer of 10 IU/L (or 10 mIU/mL) is protective. After reaching this titer, there is no need for further booster doses.
 Conclusion: Viral hepatitis is a systemic infection affecting predominantly the liver and causing its inflammation. It may be acute (recent infection, relatively rapid onset) or chronic. Viral hepatitis is caused by infection with one of the five known hepatotropic viruses, which are named as hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV), respectively. These viruses are quite divergent in their structure, epidemiology, routes of transmission, incubation period, clinical presentations, natural history, diagnosis, and preventive and treatment options.

Fixing a Hole: a retrospective cohort study evaluating HAV, HBV, tetanus screening, and vaccination during hospitalization in persons who use substances.

Rates of serious injection-related infections in persons who use drugs have increased. Resulting admissions are an opportunity for screening and vaccination of preventable infections such as hepatitis A virus (HAV), hepatitis B virus (HBV), and tetanus. We conducted a retrospective review of adults with documented substance use admitted for bacterial infection between July 2015 and March 2020. We evaluated HAV, HBV, and tetanus vaccination status at admission, along with screening for HAV and HBV infection and immunity. We identified the proportion of patients at risk for infection who received HAV, HBV, and tetanus vaccines during admission and patient-level factors associated with vaccination. We identified 280 patients who met our inclusion criteria. Of the 198 (70.7%) patients at risk for HAV, infectious disease providers recommended vaccination for 21 (10.6%) and 15 (7.6%) received HAV vaccine. Of the 174 (62.1%) patients at risk for HBV, infectious disease providers recommended vaccination for 32 (18.3%) and 25 (14.4%) received HBV vaccine. A large proportion of patients (31.4%, 88) had no documentation of prior tetanus vaccination, and infectious disease providers recommended tetanus vaccination for three (1.1%) and five patients (1.8%) received a tetanus booster. Infectious disease consult vaccine recommendations were statistically significantly associated with HAV or HBV vaccination prior to discharge. Over 70% of our population is at risk for one or more of these preventable infections. Efforts are needed to maximize inpatient screening and vaccination for HAV, HBV, and tetanus in patients with barriers to care.

Delays in Hepatitis A vaccination in people with HIV in Houston, Texas between 2010 and 2018

BackgroundStudies have demonstrated low hepatitis A virus (HAV) vaccination rates among persons with HIV (PWH). MethodsWe conducted a retrospective study of persons entering HIV care at two clinics in Houston, Texas between 2010 and 2018. We defined those eligible for HAV vaccination as those who had no history of HAV vaccination and had a negative anti-HAV IgG at entry to care. Kaplan-Meier curves summarized time to receipt of HAV vaccines. The proportions of patients who received 1 and 2 HAV vaccines at 6, 12, and 24 months were estimated. Cox proportional hazards regression evaluated associations between patient characteristics and vaccination. Significant factors were included in a multivariable Cox proportional hazards model. ResultsOf 6,515 patients, 1372 were eligible for HAV vaccination. Of eligible patients, 29.2 % received 1 HAV vaccination at 6 months, 37.1 % at 12 months, and 47.8 % at 24 months. At 6 months, 10 % received 2 HAV vaccinations, 21.1 % at 12 months, and 33.4 % at 24 months. In multivariable analysis, men who have sex with men (adjusted HR 1.35, 95 % CI 1.06, 1.73) or those who had CD4 count ≥ 200 cells/µl (adjusted HR 2.52, 95 % CI 1.89, 3.37) had their second vaccination sooner than those who were not men who have sex with men or who had CD4 counts < 200 cells/µl, respectively. Patients > 50 years of age had their second vaccination sooner than those aged 30–50 years (adjusted HR 1.47, 95 % CI 1.08, 1.99). Those with active substance history had a longer time to second vaccination compared to those with no substance use history (adjusted HR 0.57, 95 % CI 0.40, 0.82). ConclusionsHAV vaccination rates were low and highlight the need for effective solutions to address HAV immunization gaps in PWH, especially among young patients, those with active substance use disorders, and those with significant immunocompromise.

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% (48/62) 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.

1801. About Damn Time: HAV, HBV, and Tetanus Screening and Vaccination during Hospitalization in Persons who Use Drugs

Abstract Background Rates of serious injection related infections (SIRI) in persons who use drugs (PWUD) have increased over the past two decades. Admissions for SIRI are an opportunity for screening and vaccination of preventable infections like hepatitis A virus (HAV), hepatitis B virus (HBV) and tetanus given significant barriers to preventive care in the outpatient setting for this population. The purpose of this study was to evaluate rates of screening and subsequent vaccination for hepatitis A, hepatitis B, and tetanus for PWUD admitted to the hospital for treatment of serous bacterial infection. Methods We conducted a retrospective review of adult patients admitted for a bacterial infection requiring &amp;gt; 2 weeks of antibiotics with both infectious disease (ID) and addiction medicine consults. Data on patient demographics, screening recommendations, and testing and vaccination administration were collected via chart review. Results 280 patients were eligible for inclusion. Of the 198 (70.7%) patients determined at risk for HAV, ID recommended vaccination for 21 (10.6%) and 15 (7.6%) received HAV vaccine during the admission. Of the 174 (62.1%) patients at risk for HBV, ID recommended vaccination for 32 (18.3%) and 25 (14.4%) received HBV vaccine prior to discharge. 88 patients (31.4%) had no documentation of prior tetanus vaccination and ID recommended tetanus vaccination for 3 (1.1%). 5 patients (1.8%) received a tetanus booster during admission. In univariable analysis, the strongest factor associated with HAV (Odds Ratio 142.19, 95% Confidence Interval: 27.34-739.44) and HBV (Odds Ratio 18.98, 95% Confidence Interval: 7.02-51.37) vaccination during admission was ID recommendation for vaccine. Conclusion Screening and vaccination for HAV and HBV remains low in the inpatient setting, as does tetanus vaccination in high-risk patients. A large proportion of our population (70%) were at risk for one or more of these preventable infections. Given the limited access and significant barriers to healthcare in this vulnerable population, efforts should be taken to maximize inpatient screening and vaccination for HAV, HBV, and tetanus. Disclosures Monica K. Sikka, MD, F2G: Grant/Research Support

Hepatitis A outbreak in a refugee shelter in Kiel, northern Germany.

In the spring of 2023, three Ukrainian war refugees from a municipal community shelter and a volunteer caregiver at an affiliated daycare center in Kiel, Germany, were diagnosed with infectious jaundice attributable to a single hepatitis A virus (HAV) subgenotype IA strain. Similar HAV sequences have been observed in Germany and other European countries for several years. One refugee and the volunteer required hospitalization. Four children were asymptomatically infected but excreted high levels of HAV ribonucleic acid in the stool. The infections were probably acquired in Germany, but a source could not be determined. The outbreak was contained through vaccination, increased hygiene, and education. The existing HAV vaccination recommendation for refugee shelter staff and volunteers should be consistently implemented.

Seroprevalence of hepatitis A virus antibodies among children and adolescents living in Northern Thailand: an implication for hepatitis A immunization

This cross-sectional study aimed to assess seroprevalence of hepatitis A virus (HAV) antibodies and identify factors associated with HAV seropositivity among children and adolescents aged 1–18 years who resided in Chiang Mai, Thailand. Sociodemographic characteristics, sanitation/hygiene, and history of HAV vaccination were collected. Anti-HAV IgG antibody was determined, and a level ≥ 1.0 S/CO defined HAV seropositivity. We enrolled 300 participants; median age 8.7 years, 54% male, and 13% overweight (BMI z-score: + 1 to + 2 standard deviation [SD]). Sixty-five participants (22%) were vaccinated against HAV. Overall, 84/300 participants (28%) demonstrated HAV seropositivity, of whom 55/65 (85%) and 29/235 (12%) were among vaccinated and unvaccinated participants (P < 0.001), respectively. Previous HAV vaccination (adjusted odds ratio [aOR] 47.2; 95% CI 20.0–111.8) and overweight (aOR 4.4; 95% CI 1.7–11.3, compared with normal weight [BMI z-score: − 2 to + 1 SD]) were significantly associated with seropositivity of HAV. In the stratified analyses, crowded bedroom (aOR 3.2; 95% CI 1.3–7.8, per one person increase) and overweight (aOR 5.0; 95% CI 1.8–13.7) were factors associated with HAV seropositivity among vaccinated and unvaccinated participants, respectively. Seroprevalence of HAV antibodies in healthy Thai children and adolescents was relatively low. Recommendation of HAV vaccination for these populations, particularly those with high-risk conditions, should be considered.

Durability of serologic responses to inactivated hepatitis A virus vaccination among people living with HIV following acute hepatitis A outbreak: a 5-year follow-up study

ABSTRACT Serologic responses to hepatitis A virus (HAV) vaccination may wane among immunocompromised populations. To evaluate the long-term seroresponses to 2-dose HAV vaccination, we retrospectively included people living with HIV (PLWH) who had achieved seroconversion within 12 months after vaccination at a university hospital during an outbreak of acute hepatitis A between 2015 and 2017. PLWH included in the study received either Havrix or Vaqta. The seroresponses were evaluated 60 months after the second dose of vaccination and estimated by the intention-to-treat (ITT) with last-observation-carried-forward (LOCF) and per-protocol (PP) analyses. Overall, 986 PLWH (median age, 34 years and CD4 count, 587 cells/µL) were included. The rates of PLWH with persistent seroprotection at month 60 of vaccination were 90.7% (894/986) and 97.4% (748/768) in the ITT with LOCF and PP analyses, respectively. PLWH with persistent seroprotection had achieved higher peak anti-HAV IgG titers after vaccination and had a slower decline in antibody levels compared with those with seroreversion. In the multivariable analysis, seroreversion at month 60 was associated with a higher body-mass index (per 1-kg/m2 increase, AOR, 1.10; 95% CI, 1.04-1.17), lowest-ever CD4 count (per 10-cell/µL increase, AOR 0.98; 95% CI, 0.97-1.00), plasma HIV RNA <200 copies/ml at vaccination (AOR, 0.28; 95% CI, 0.14-0.59), and having received Vaqta as the first dose of HAV vaccination (AOR, 0.44; 95% CI, 0.27-0.70). The seroprotection against HAV remained high in the long-term follow-up among PLWH on antiretroviral therapy after 2-dose HAV vaccination. Regular monitoring of seroresponses and timely administration of HAV vaccines are warranted to maintain seroprotection.

Hepatitis A seroprevalence and demographic risk factors in the susceptible population: a cross-sectional study.

The epidemiology of hepatitis A virus (HAV) infection is influenced by variables such as age, sex, environmental conditions, and vaccination status. This study aimed to evaluate HAV seropositivity after the inclusion of hepatitis A vaccination in the national childhood immunization program and identify demographic risk factors of the susceptible population before routine vaccination.This cross-sectional epidemiological study was conducted by retrospectively examining the laboratory records of patients who underwent HAV serology testing in a tertiary care center in eastern Turkey between 2008 and 2019.Overall immunity to HAV was 81.6%. According to birthplace and year, the rate of anti-HAV positivity was higher among people born before 2006 in the Southeast and Eastern Anatolia regions. For those born in 2012 or later, the lowest seropositivity was among those born in the Southeast region, while it was over 60% in the other regions. When analyzed by year of birth, the lowest seropositivity was in those born between 1994 and 2011, and the frequency of seropositivity increased with age. Of those born between 1982 and 1999, the seropositivity rate was higher among men than women. Rural dwellers born before 2012 had higher seropositivity than urban dwellers. Among those born before the introduction of routine childhood HAV vaccination, female sex, urban dwelling, and each additional year of age were identified as independent demographic risk factors for HAV susceptibility.Socioeconomic development and immunization programs have altered HAV seroprevalence patterns. Planning catch-up vaccinations, especially in adolescents and young adults (born in 1994-2011) with low seropositivity and ensuring the continuity of hygiene and sanitation practices are important to protect the susceptible population.

Low rate of vaccination and risk of incident hepatitis A among HIV-infected men who have sex with men in Seville, Southern Spain

BackgroundPeriodic outbreaks of hepatitis A (HAV) infection in men who have sex with men (MSM) have been reported. Low vaccination uptake in HIV-infected individuals could drive new outbreaks. We aimed at evaluating the incidence of and risk factors for HAV infection in people living with HIV (PLWH) in our area. We also assessed the rates of HAV vaccination. MethodsThis was a prospective cohort study. 915 patients were included, 272 (30%) of them were anti-HAV seronegative at baseline. ResultsTwenty-six (9.6%) susceptible individuals became infected. Incident cases peaked in 2009–2010 and 2017–2018. Incident HAV infection was independently associated with MSM [adjusted odds ratio (95% confidence ratio): 4.39 (1.35–14.27), p=0.014]. One hundred and five (38.6%) HAV seronegative patients were vaccinated, 21 (20%) of them did not respond, and one (1%) patient lost immunity against HAV. Four (29%) non-responders to vaccination showed incident HAV 5–9 years afterwards. ConclusionsThe incidence of HAV infection in a cohort of well-controlled PLWH remains low and stable, with intermittent outbreaks involving mainly non-immunized MSM. A significant proportion of PLWH remain susceptible to HAV infection due to insufficient vaccine uptake and limited response to vaccination. Importantly, patients not responding to HAV vaccination continue at risk of infection.

Low rate of vaccination and risk of incident hepatitis A among HIV-infected men who have sex with men in Seville, Southern Spain

BackgroundPeriodic outbreaks of hepatitis A (HAV) infection in men who have sex with men (MSM) have been reported. Low vaccination uptake in HIV-infected individuals could drive new outbreaks. We aimed at evaluating the incidence of and risk factors for HAV infection in people living with HIV (PLWH) in our area. We also assessed the rates of HAV vaccination. MethodsThis was a prospective cohort study. 915 patients were included, 272 (30%) of them were anti-HAV seronegative at baseline. ResultsTwenty-six (9.6%) susceptible individuals became infected. Incident cases peaked in 2009–2010 and 2017–2018. Incident HAV infection was independently associated with MSM [adjusted odds ratio (95% confidence ratio): 4.39 (1.35–14.27), p=0.014]. One hundred and five (38.6%) HAV seronegative patients were vaccinated, 21 (20%) of them did not respond, and one (1%) patient lost immunity against HAV. Four (29%) non-responders to vaccination showed incident HAV 5–9 years afterwards. ConclusionsThe incidence of HAV infection in a cohort of well-controlled PLWH remains low and stable, with intermittent outbreaks involving mainly non-immunized MSM. A significant proportion of PLWH remain susceptible to HAV infection due to insufficient vaccine uptake and limited response to vaccination. Importantly, patients not responding to HAV vaccination continue at risk of infection.

A randomized clinical trial of one-dose versus accelerated two-dose schedule for hepatitis A virus revaccination among people with HIV who were non-responders or had seroreversion after primary HAV vaccination.

For people with HIV (PWH) who have no serological responses to their primary hepatitis A virus (HAV) vaccination or have seroreversion after successful primary vaccination, optimal revaccination strategy remains unclear. In this open-label, randomized clinical trial, PWH who tested negative for anti-HAV antibodies after receiving a standard 2-dose series of primary HAV vaccination were enrolled and assigned in a 1:1 ratio to receive either one dose (the one-dose group) or two doses of HAV vaccine administered four weeks apart (the two-dose group). Serological response rates and the anti-HAV antibody titers at weeks 24 and 48 were compared. Of the 153 participants (77 in the one-dose group and 76 the two-dose group), the overall serological response rates at week 48 after revaccination were not statistically significantly different between the two groups (two- vs. one-dose, 80.2% vs. 71.4%, p=0.20). However, anti-HAV antibody titers were consistently higher in the two-dose group than the one-dose group. In subgroup analysis, PWH who were non-responders to their primary HAV vaccination were significantly more likely to mount a serological response after two-dose HAV revaccination (68.4% vs. 44.1%, p=0.038). No severe adverse effects were reported throughout the study. Two-doses HAV revaccination administered four weeks apart yielded similar serological responses as one-dose revaccination among PWH who were non-responders or had seroreversion after primary HAV vaccination. Two-dose revaccination schedule generated significantly higher anti-HAV antibody titers and were more likely to elicit serological responses at week 48 among PWH who were non-responders to primary HAV vaccination.

Enhancing Hepatitis A and B Vaccinations Through Electronic Clinical Decision Support Systems and Staff Education in a Correctional Facility.

Despite the prevalence and risks for hepatitis A virus (HAV) and hepatitis B virus (HBV) infection and the availability of safe and effective vaccines, HAV/HBV vaccinations are disproportionately low in jails. This quality improvement project evaluated the effectiveness of clinical decision support systems: electronic standing orders to nurses, clinical alerts to nurses and healthcare providers, and secondarily staff education in enhancing HAV and HBV vaccination and knowledge of hepatitis infection. We distributed a validated self-report hepatitis knowledge questionnaire (α = 0.7-0.8) before and after an educational presentation to nurses, nurse practitioners, and physicians ( N = 26) at a Northeastern state jail and then embedded electronic clinical alerts and standing orders in the electronic medical record. The questionnaire assessed pre- and posteducation knowledge scores. The number of vaccine status screenings and vaccinations was retrieved from the electronic medical record 3 months pre- and post-implementation. Descriptive statistics and the Wilcoxon signed-ranks test were used for data analysis. Twenty-one participants completed the pretest, 18 attended the educational intervention, and 15 completed the posttest. Vaccine status screening increased by 97.5%, and HAV and HBV vaccinations increased by 8.7%. Knowledge scores improved significantly post-intervention ( p = 0.04), with an effect size of r = 0.67). Using the Donabedian quality of care model, we showed that quality initiatives are feasible in a jail setting. Implementing a clinical decision support system and education improved the vaccination rate, which may decrease HAV/HBV incidence in the jail and prevent community spread.

Viral hepatitis A in the Voronezh region: a controlled or «self-controlled» infection?

Over the past decade, in most regions of Russia, including the Voronezh region, the epidemic process of viral hepatitis A (HAV) has been of low intensity. The aim of the study was to study the incidence of viral hepatitis A in the Voronezh region for the period 1993–2021, taking into account the results of laboratory studies conducted as part of epidemiological surveillance and preventive measures. The research materials were statistical forms approved by Rosstat, analytical reports of Rospotrebnadzor for the Voronezh region, departmental reports of regional medicaorganizations to the Regional Health Department. The data of examination for anti-HAV IgG of contact persons in the outbreaks were analyzed. The materials were processed using the methods of epidemiological analysis. A downward trend in the incidence of HAV with the properties of a «controlled» infection was established: the severity of seasonal rises, a shift in the proportion of cases to the adult population, school-age children. At the same time, coverage of HAV vaccination among the population of the region is low and cannot yet have a significant impact on reducing the incidence. Immunization is important in outbreaks to prevent group spread and during natural disasters. Against the background of improved provision of the population with quality water, the importance of water as a factor in the transmission of infection has decreased. During the study period, only one focus with a presumably waterway was noted. Complexes of preventive and anti-epidemic measures are being effectively implemented in the region. The selective vaccination used at this stage of the epidemic process is sufficient for the Voronezh region.

Viral hepatitis in persons living with HIV in the post-COVID era.

Coinfection with hepatitis viruses A to E is frequent in persons living with HIV (PLWH) and causes significant morbidity and mortality. Oro-fecal transmissible hepatitis A and E mostly produce acute self-limited episodes in poor income regions and in non-vaccinated travelers. In high-income countries, outbreaks of hepatitis A occur in men having sex with men (MSM) and chronic hepatitis E is occasionally reported among PLWH with severe immunodeficiency. Chronic hepatitis B, C, and D are frequent in PLWH in highly endemic regions and globally in persons who inject drugs (PWID) and MSM. Progression to liver cirrhosis and development of hepatocellular carcinoma (HCC) is major clinical complications in coinfected patients. Current estimates for PLWH are of 38 million worldwide. Roughly 12% have chronic viral hepatitis (5 million). Coinfection figures are of 5-10% for HBV (2-4 million), 4% for HCV (1.5 million), and 15% of HBsAg+ for HDV (0.5 million). Oral direct-acting antivirals (DAA) cure almost all treated patients with hepatitis C. However, given that there is no protective HCV immunity, PLWH with high-risk behaviors may experience HCV reinfection episodes. Tenofovir is the drug of choice in PLWH with chronic hepatitis B, given its dual effect on HIV and HBV. Lifelong oral tenofovir suppresses HBV replication and ameliorate liver damage. However, the risk of HCC persists even in the absence of cirrhosis. Finally, HDV causes the worst of viral hepatitis with faster progression to cirrhosis and HCC. An entry inhibitor, bulevirtide, has recently been approved and another drug, lonafarnib, is completing Phase 3 trials. Combination antiviral therapy for hepatitis D could improve dramatically the poor prognosis of HIV-HDV coinfected patients. The resumption of good medical practices in PLWH after the big disruption caused by COVID-19 will reduce the burden of viral hepatitis coinfections. Renewed efforts on HAV and HBV vaccination of susceptible individuals and earlier and wider prescription of antiviral therapy for HBV, HCV, and/or HDV coinfection should be prioritized in PLWH. The benefits of innovative strategies for viral hepatitis, including pre-exposure prophylaxis or use of long-acting antivirals, warrant further consideration in PLWH.

Manejo en atención primaria de las infecciones de transmisión sexual (I). Epidemiología. Síndrome secretor

These days sexually transmitted infections (STIs) are important public health problems not only due to their high prevalence, but also because they require early diagnosis and treatment to avoid complications.In recent years, there has been an exponential increase in cases of infections caused by Chlamydia trachomatis and gonococcus in the population under 25years of age. In addition, an increase in the incidence of syphilis and hepatitisC (HCV) has also been detected, especially in men who have sex with other men (MSM).Genital herpes continues to be the second most frequent STI in the world, behind condyloma acuminata, and the first cause of genital ulcer among Spain in the sexually active population.A decrease in reported HIV cases was observed during 2020, but almost half of these new cases had a late diagnosis (<350CD4cell/μL).Current guidelines recommend offering STI annual screening to populations at risk or more often depending on the risk.STIs can appear in the form of syndromes, such as secretory syndrome (urethritis, proctitis, and cervicitis) or ulcerated syndrome (ulcers). The STIs that can cause secretory syndrome are mainly caused by Neisseria gonorrhoeae and C.trachomatis, which co-infect up to 40% of cases, and also cause urethritis, cervicitis or proctitis depending on where they are located.Gonococcus has an incubation period of 2-7days and Chlamydia 2-6weeks, and they are diagnosed using PCR and/or culture (the last one only valid for gonococcus) of samples collected according to sexual activities.Empirical treatment to cover both germs will be accomplished with ceftriaxone, 1g single intramuscular dose plus doxycycline 100mg every 12h orally for 7days, or azithromycin 1g single dose orally (we will use azithromycin only if we suspect a poor compliance with treatment, difficulty in going to the control or in pregnancy).Likewise, whenever we diagnose an STI firstly, we must offer advice and health education in order to promote the adoption of safe sexual behaviours and the correct use of barrier methods. Secondly, we must also screen for other STIs (HIV, syphilis, hepatitisB, and hepatitisA andC depending on the risk), offer HBV and HAV vaccination if it is appropriate, and finally study and treat all sexual partners from the previous 3months.