Surveillance Of Hepatitis Research Articles

P-2360. Wastewater-Based Surveillance of Hepatitis A Virus Across Communities in Alberta, Canada

Abstract Background Hepatitis A virus (HAV) incident infection in Canada is rarely diagnosed (i.e. incidence of 3.6-10 cases/100,000 persons) (PMID: 18159360). Infections generally relate to imported contaminated food-products, or travelers returning from endemic countries. Due to its fecal-oral spread, possible underdiagnosis, and often-cryptic presentation, HAV is an ideal candidate for wastewater (WW)-based surveillance, a tool increasingly utilized to monitor infectious diseases globally.Figure 1.Longitudinal monitoring of HAV RNA wastewater abundance across eight Alberta municipalities over a 4-month period. Methods 24-hour composite WW was collected weekly from eight geographically disparate, and socioeconomically diverse municipal WW treatment plants in Alberta from August to December 2023. After short-term cold storage, WW was centrifuged, and RNA from the raw pellet was extracted using Qiagen’s RNeasy PowerFecal pro. HAV levels were quantified by RT-qPCR of the vp1 gene. 2021 Canadian census data was used to define population demographics for each participating site. Results HAV was detected in 18/117 (15.4%) WW samples and 5/8 (62.5%) municipalities over the 4-month period (Figure 1). RNA abundance in HAV positive WW samples was a median of 3.4 copies/mL (IQR 0.44 - 6.97). Larger population size (p=0.007), and greater density (p=0.001) were associated with increased likelihood of HAV WW detection, whereas social and economic demographics of populations within sewershed catchments did not associate with likelihood of HAV detection (Table 1). Conclusion HAV RNA is rarely detected in the wastewater of Alberta. Detection was more frequently observed in larger municipalities, which is consistent with non-endemic, imported disease. WW surveillance can potentially be adapted to monitor HAV in the context of outbreaks to reduce secondary transmission, and safeguard public health. Disclosures Mark Swain, MD MSc, Abbott: Advisor/Consultant|Advanz: Advisor/Consultant|Gilead, BMS, CymaBay, Intercept, Genfit, Pfizer, Novartis, Astra Zeneca, GSK, Celgene, Novo Nordisk, Axcella Health Inc., Merck, Galectin Therapeutics: Grant/Research Support|GSK: Advisor/Consultant|Ipsen: Advisor/Consultant|Novo Nordisk: Advisor/Consultant Carla Coffin, MD MSc, Altimmune: Grant/Research Support|Gilead: Grant/Research Support|GSK: Grant/Research Support|Janssen: Grant/Research Support Steven J. Drews, PhD FCCM D(ABMM), Abbott: Grant/Research Support|Danaher: Honoraria|Roche: Advisor/Consultant|Roche: Grant/Research Support

Wastewater-based surveillance for Hepatitis A virus, Enterovirus, Poliovirus, and SARS-CoV-2 in São Tomé and Príncipe: A pilot study

BackgroundWastewater-based surveillance is a valuable tool for monitoring pathogen transmission in communities, especially in regions where formal surveillance systems are limited. AimThe aim of this study was to implement and evaluate a wastewater-based monitoring system for viral pathogens in São Tomé and Príncipe. MethodsA total of 122 water samples were collected bi-weekly from June 2022 to July 2023 at six locations in São Tomé city and analysed for molecular detection of Hepatitis A Virus (HAV), Enterovirus (EV), Poliovirus (PV), SARS-CoV-2, as well as JC-Polyomavirus (JCPyV) and pepper mild mottle virus (PMMoV) as indicators of human contamination. Prevalence was analysed per pathogen and across sampling locations. Results for SARS-CoV-2 were assessed together with notifications from national COVID-19 surveillance. Further, we estimated resources needed to establish a wastewater-based approach to assess community-level transmission of viral pathogens. ResultsAll 122 and 117 samples were found positive for PMMoV and JCPyV, respectively, demonstrating a high level of human contamination at all sampling locations. The prevalence of HAV and EV ranged from 0 % to 59 % and 56 % respectively. Consistent with national surveillance data the highest proportion of SARS-CoV-2 positive water samples coincides with the highest number of COVID-19 cases reported during the study, demonstrating the potential of wastewater-based surveillance to identify signals. In addition, for SARS-CoV-2 this approach provided evidence of continuous circulation of the virus in the community, most importantly during weeks when no COVID-19 cases were reported. ConclusionOur findings provide evidence of high transmission of HAV and EV in communities in São Tomé and continuous circulation of SARS-CoV-2, even in weeks without COVID-19 case notifications. This study demonstrates that monitoring of viral pathogens in humanly impacted open water streams and sewage tanks is a valuable tool to complement clinical surveillance in resource-limited settings.

Thrombospondin 2 as a Predictive Biomarker for HCC inHepatitis C Patients: A Longitudinal Study Following DAA Therapy.

This multicentre study investigated the dynamics of thrombospondin 2 (TSP2) levels during direct-acting antiviral (DAA) therapy in hepatitis C virus (HCV) infected patients and evaluated TSP2's potential as a predictive marker for hepatocellular carcinoma (HCC). All 134 participants achieved sustained virological response at 12 weeks (SVR12) with DAA therapy, and serum TSP2 levels significantly decreased from before and after treatment (p < 0.001). During the median follow-up period of 6.0 years, HCC after DAA therapy was observed in 16 patients (11.9%). Patients with serum TSP2 High (≥ 32 ng/mL) at SVR12 had a significantly higher cumulative occurrence of HCC than did those without (26.5% vs. 7.0%, p = 0.0033). A multivariate Cox proportional hazards model identified male gender (HR 4.84, p = 0.005), HCC history (HR 4.61, p = 0.017) and TSP2 High (HR 3.93, p = 0.009) as significant independent predictors of HCC occurrence after DAA therapy. The model had a high concordance index of 0.878. Additionally, combining TSP2 High and FIB-4 High (≥ 3.538) at SVR12 yielded high specificity and negative predictive value (0.941 and 0.917, respectively) for predicting HCC. Kaplan-Meier analysis showed a higher HCC incidence in the TSP2 High + FIB-4 High group (log-rank p < 0.0001). In conclusion, TSP2 may be a promising biomarker for personalised HCC surveillance in DAA-treated hepatitis C patients.

Widespread hepatitis C virus transmission network among people who inject drugs in Kenya

ObjectivesHepatitis C virus (HCV) disproportionately affects people who inject drugs (PWID) worldwide. Despite carrying a high HCV burden, little is known about transmission dynamics in low- and middle-income countries. MethodsWe recruited PWID from Nairobi and coastal cities and towns of Mombasa, Kilifi, and Malindi in Kenya at needle and syringe programs. Next-generation sequencing data from HCV hypervariable region 1 were analyzed using Global Hepatitis Outbreak and Surveillance Technology to identify transmission clusters. ResultsHCV strains belonged to genotype 1a (n = 64, 46.0%), 4a (n = 72, 51.8%) and mixed HCV/1a/4a (n = 3, 2.2%). HCV/1a was dominant (61.2%) in Nairobi, whereas HCV/4a was dominant in Malindi (85.7%) and Kilifi (60.9%), and both genotypes were evenly identified in Mombasa (45.3% for HCV/1a and 50.9% for HCV/4a). Global Hepatitis Outbreak and Surveillance Technology identified 11 transmission clusters involving 90 cases. Strains in the two largest clusters (n = 38 predominantly HCV/4a and n = 32 HCV/1a) were sampled from all four sites. ConclusionsTransmission clusters involving 64.7% of cases indicate an effective sampling of major HCV strains circulating among PWID. Large clusters involving 77.8% of clustered strains from Nairobi and Coast suggest successful introduction of two ancestral HCV/1a and HCV/4a strains to PWID and the existence of a widespread transmission network in the country. The disruption of this network is essential for HCV elimination.

Economic evaluation of hepatocellular carcinoma surveillance in chronic hepatitis B patients with virological remission

BackgroundSubsequent risk of hepatocellular carcinoma (HCC) persists in chronic hepatitis B (CHB) patients with virological remission. We aimed to assess the cost-effectiveness of HCC surveillance in those patients and determine appropriate age to commence or discontinue surveillance.MethodsWe developed an individual-based state transition model, simulating the advancement of HCC in CHB patients with virological remission. We used this model to compare the incremental cost-effectiveness ratio (ICER) and long-term health outcomes of biannual or annual HCC surveillance for varying durations with no surveillance.ResultsFor compensated cirrhosis patients with CHB, biannual surveillance was not cost-effective for all age groups, while annual surveillance was cost-effective for patients aged 55 to 70 (ICER USD 28,076 / quality-adjusted life years [QALY] gained), which detected 176 additional early HCC cases in a 100,000-person cohort compared to no surveillance. In CHB patients with advanced fibrosis, annual surveillance for patients aged 40 to 75 was the most cost-effective strategy (ICER USD 4,984/QALY gained), which detected 289 additional early HCC per 100,000 patients.ConclusionsAnnual surveillance for patients with compensated cirrhosis or advanced fibrosis was a more cost-effective option that demonstrated substantial economic benefits, being slightly less effective than biannual surveillance at a significantly lower cost, providing insights for professionals in evaluating HCC surveillance among high-risk patients in China.

Estimating the Prevalence of Injection Drug Use Among Acute Hepatitis C Cases From a National Surveillance System: Application of Random Forest-Based Multiple Imputation.

Injection drug use (IDU) is a major contributor to the syndemic of viral hepatitis, human immunodeficiency virus, and drug overdose. However, information on IDU is frequently missing in national viral hepatitis surveillance data, which limits our understanding of the full extent of IDU-associated infections. Multiple imputation by chained equations (MICE) has become a popular approach to address missing data, but its application for IDU imputation is less studied. Using the 2019-2021 National Notifiable Diseases Surveillance System acute hepatitis C case data and publicly available county-level measures, we evaluated listwise deletion (LD) and 3 models imputing missing IDU data through MICE: parametric logistic regression, semi-parametric predictive mean matching (PMM), and nonparametric random forest (RF) (both standard RF [sRF] and fast implementation of RF [fRF]). The estimated IDU prevalence among acute hepatitis C cases increased from 63.5% by LD to 65.1% by logistic regression, 66.9% by PMM, 76.0% by sRF, and 85.1% by fRF. Evaluation studies showed that RF-based MICE imputation, especially fRF, has the highest accuracy (as measured by smallest raw bias, percent bias, and root mean square error) and highest efficiency (as measured by smallest 95% confidence interval width) compared to LD and other models. Sensitivity analyses indicated that fRF remained robust when data were missing not at random. Our analysis suggested that RF-based MICE imputation, especially fRF, could be a valuable approach for addressing missing IDU data in the context of population-based surveillance systems like National Notifiable Diseases Surveillance System. The inclusion of imputed IDU data may enhance the effectiveness of future surveillance and prevention efforts for the IDU-driven syndemic.

Active surveillance of hepatitis E: a 10-year epidemiological analysis in a city in eastern China

ABSTRACT Hepatitis E virus (HEV) is an important cause of acute hepatitis, however, is highly neglected and largely underreported. This study aimed to describe the detailed epidemiology of hepatitis E (HE) through a 10-year surveillance. A community-based active hepatitis surveillance was conducted between November 2007 and October 2017 in 11 townships of Dongtai City in China, involving 355,673 residents. Serum samples were obtained from patients presenting with hepatitis symptoms for more than 3 days. Serum alanine aminotransferase (ALT) levels greater than 2.5 times the upper limit of normal (ULN) were considered acute hepatitis. Samples were subsequently tested for IgG and IgM anti-HEV antibodies, HEV RNA, and hepatitis B surface antigen (HBsAg). The data indicated the incidence of HE fluctuated downward from 2007 to 2017, with an average annual age-standardized incidence of 17.50 per 100,000, exceeding the 10.26 per 100,000 in the National Notifiable Disease Report System (NNDRS). The incidence was notably higher among males (20.95 per 100,000) and individuals aged 50–69 years (37.47 per 100,000). Genotype 4 (HEV-4) was the predominantly circulating genotype during the study period. Furthermore, the study revealed the incidence of hepatitis with HEV and hepatitis B virus (HBV) co-infection was 4.99 per 100,000. The active surveillance system identified a higher incidence of HE compared to NNDRS, with a decreased prevalence over a 10-year period. While efforts are still needed to prevent HE in high-risk populations, including individuals with hepatitis B and the elderly.

Australian vaccine preventable disease epidemiological review series: Hepatitis B, 2000-2019.

Hepatitis B vaccination was nationally funded for adolescents in 1996, with inclusion of universal infant immunisation under the National Immunisation Program (NIP) in May 2000. This study describes hepatitis B epidemiology in Australia in the two decades since 2000. This article analyses newly-acquired (within the prior 24 months) and unspecified (all other) hepatitis B notifications (2000-2019) from the National Notifiable Diseases Surveillance System; acute hepatitis B hospitalisations (2001-2019) from the National Hospital Morbidity Database; and acute (2000-2019) and chronic (2006-2019) hepatitis B deaths from the Australian Bureau of Statistics and Australian Coordinating Registry. Rates over the reporting period were described overall, and by age group, sex, and Aboriginal and Torres Strait Islander status (Aboriginal and/or Torres Strait Islander versus other [neither Aboriginal nor Torres Strait Islander, unknown or not stated]). Trend analyses were performed using Poisson or negative binomial regression. Additional analyses were performed for the cohort born after May 2000. The annual all-age notification rate per 100,000 per year declined (p < 0.001) from 2.13 in 2000 to 0.65 in 2019 for newly-acquired hepatitis B and from 38.3 to 22.3 for unspecified hepatitis B (likely to predominantly represent chronic hepatitis B). Newly-acquired and unspecified hepatitis B notification rates were lowest among children aged < 15 years. The most substantial reductions in notification rates of newly-acquired hepatitis B were among adolescents aged 15-19 years and young adults aged 20-24 and 25-29 years (respectively 17-, 11-, and 7-fold); these age groups also recorded the most substantial reductions in unspecified hepatitis B notifications (respectively 5-, 3.5-, and 2-fold). Newly-acquired hepatitis B notification and acute hepatitis B mortality rates were two- to threefold higher in males than females. The all-age newly-acquired hepatitis B notification rate in Aboriginal and Torres Strait Islander people decreased twofold between 2000 and 2019, but remained threefold higher than in other people. Acute hepatitis B hospitalisations also declined over the study period (p < 0.001) and followed similar patterns. There were no acute or chronic hepatitis B deaths among people born after May 2000; this cohort featured 52 newly-acquired and 887 unspecified hepatitis B notifications. Due to lack of data on country of birth (and hence eligibility for infant vaccination under the NIP or overseas programs), vaccination status and likely transmission routes, we were unable to assess factors contributing to these potentially preventable infections. Adolescent and infant immunisation under the NIP has led to significant reductions in notification rates of newly-acquired hepatitis B, and in acute hepatitis B hospitalisation rates, both overall and in Aboriginal and Torres Strait Islander people. Unspecified hepatitis B notification rates have also greatly decreased in children and young adults, likely largely due to the impact of overseas infant immunisation programs on prevalence in child and adolescent migrants. Work to improve completeness of variables within national datasets is crucial, along with enhanced surveillance of both newly-acquired and unspecified hepatitis B cases to investigate transmission routes, vaccination status and factors contributing to acquisition of hepatitis B, in order to optimise the impact of immunisation programs and ensure linkage with care.

Comparison of Autolumo A2000 Plus and Architect i2000 for detection of hepatitis B virus serological markers

Serological detection of hepatitis B virus markers plays a vital role in the diagnosis, treatment, prognosis, and therapeutic surveillance of hepatitis B. To compare the diagnostic performance of Autolumo A2000Plus and Abbott Architect i2000 systems in the detection of hepatitis B infection markers. A total of 6 HBV seroconversion panels and 743 participants were enrolled in this study, including 383 HBV-infected patients and 360 healthy adults. Clinical diagnostic information, laboratory results, and HBV genotyping were collected to evaluate the diagnostic performance of the A2000Plus and i2000 systems in detecting HBV infection markers. The results showed that the total percent agreement of HBV markers was all >90 % in both detection systems among the six seroconversion panels and 743 serum samples from the population. The χ2 values of the Chi-square test among hepatitis B virus serological markers in both analyzers were between 550.7 and 743.0, p < 0.0001. HBV marker consistency test results show perfect consistency between the two analyzers, with Kappa values ranging from 0.854 to 1.000. For specific samples, including Hepatitis B patients with Genotype C, chronic hepatitis B, hepatitis B-related cirrhosis, and hepatocellular carcinoma, spearman correlation analysis showed HBsAg correlation coefficients ranging from 0.8532 to 0.9745, p < 0.001 in both analyzers. In conclusion, Autolumo A2000Plus diagnostic performance in consistency and correlation is comparable to Abbott Architect i2000 when detecting markers of hepatitis B infection. The Autolumo A2000Plus system can be used as a reliable instrument for HBV marker detection.

Seroprevalence and molecular characterization of viral hepatitis and HIV co-infection in the Central African Republic.

The Central African Republic (CAR) is one of the countries with the highest prevalence of viral hepatitis infection in the world. Coinfection with HIV increases the morbidity and mortality beyond that of mono-infection with either hepatitis or HIV. The present study describes the geographic distribution of viral hepatitis infections and molecular characterization of these viruses in the CAR. Out of 12,599 persons enrolled during the fourth Multiple Indicator Cluster Survey of 2010 in the CAR, 10,621 Dried Blood Spot (DBS) samples were obtained and stored at -20°C. Of these DBS, 4,317 samples were randomly selected to represent all regions of the CAR. Serological tests for hepatitis B, D, and C viruses were performed using the ELISA technique. Molecular characterization was performed to identify strains. Of the 4,317 samples included, 53.2% were from men and 46.8% from women. The HBsAg prevalence among participants was 12.9% and that HBc-Ab was 19.7%. The overall prevalence of HCV was 0.6%. Co-infection of HIV/HBV was 1.1% and that of HBV/HDV was 16.6%. A total of 77 HBV, 6 HIV, and 6 HDV strains were successfully sequenced, with 72 HBV (93.5%) strains belonging to genotype E and 5 (6.5%) strains belonging to genotype D. The 6 HDV strains all belonged to clade 1, while 4 recombinants subtype were identified among the 6 strains of HIV. Our study found a high prevalence of HBV, HBV/HDV and HBV/HIV co-infection, but a low prevalence of HCV. CAR remains an area of high HBV endemicity. This study's data and analyses would be useful for establishing an integrated viral hepatitis and HIV surveillance program in the CAR.

Forecasting Hepatitis C Virus Status for Children in the United States: A Modeling Study.

Virtually all cases of hepatitis C virus (HCV) infection in children in the United States occur through vertical transmission, but it is unknown how many children are infected. Cases of maternal HCV infection have increased in the United States, which may increase the number of children vertically infected with HCV. Infection has long-term consequences for a child's health, but treatment options are now available for children ≥3 years old. Reducing HCV infections in adults could decrease HCV infections in children. Using a stochastic compartmental model, we forecasted incidence of HCV infections in children in the United States from 2022 through 2027. The model considered vertical transmission to children <13 years old and horizontal transmission among individuals 13-49 years old. We obtained model parameters and initial conditions from the literature and the Centers for Disease Control and Prevention's 2021 Viral Hepatitis Surveillance Report. Model simulations assuming direct-acting antiviral treatment for children forecasted that the number of acutely infected children would decrease slightly and the number of chronically infected children would decrease even more. Alone, treatment and early screening in individuals 13-49 years old reduced the number of forecasted cases in children and, together, these policy interventions were even more effective. Based on our simulations, acute and chronic cases of HCV infection are remaining constant or slightly decreasing in the United States. Improving early screening and increasing access to treatment in adults may be an effective strategy for reducing the number of HCV infected children in the United States.

The Effectiveness of National Expanded Program on Immunization With Hepatitis A Vaccines in the Chinese Mainland: Interrupted Time-Series Analysis.

The high prevalence of hepatitis A delivered a blow to public health decades ago. The World Health Organization (WHO) set a goal to eliminate viral hepatitis including hepatitis A by 2030. In 2008, hepatitis A vaccines were integrated into the Expanded Program on Immunization (EPI) in China to alleviate the burden of hepatitis A, although the effectiveness of the EPI has not been well investigated. We aimed to evaluate the intervention effect at both provincial and national levels on the incidence of hepatitis A in the Chinese mainland from 2005 to 2019. Based on the monthly reported number of hepatitis A cases from 2005 to 2019 in each provincial-level administrative division, we adopted generalized additive models with an interrupted time-series design to estimate province-specific effects of the EPI on the incidence of hepatitis A among the target population (children aged 2-9 years) from 2005 to 2019. We then pooled province-specific effect estimates using random-effects meta-analyses. We also assessed the effect among the nontarget population and the whole population. A total of 98,275 hepatitis A cases among children aged 2-9 years were reported in the Chinese mainland from 2005 to 2019, with an average annual incidence of 5.33 cases per 100,000 persons. Nationally, the EPI decreased the hepatitis A incidence by 80.77% (excess risk [ER] -80.77%, 95% CI -85.86% to -72.92%) during the study period, guarding an annual average of 28.52 (95% empirical CI [eCI] 27.37-29.00) cases per 100,000 persons among the target children against hepatitis A. Western China saw a more significant effect of the EPI on the decrease in the incidence of hepatitis A among the target children. A greater number of target children were protected from onset in Northwest and Southwest China, with an excess incidence rate of -129.72 (95% eCI -135.67 to -117.86) and -66.61 (95% eCI -67.63 to -64.22) cases per 100,000 persons on average, respectively. Intervention effects among nontarget (ER -32.88%, 95% CI -39.76% to -25.21%) and whole populations (ER -31.97%, 95% CI -39.61% to -23.37%) were relatively small. The EPI has presented a lasting positive effect on the containment of hepatitis A in the target population in China. The EPI's effect on the target children also provided a degree of indirect protection for unvaccinated individuals. The continuous surveillance of hepatitis A and the maintenance of mass vaccination should shore up the accomplishment in the decline of hepatitis A incidence to ultimately achieve the goal set by the WHO.

Incidental Zinner Syndrome in Nigeria: A Case Report

Zinner syndrome (ZS) is a rare urogenital condition characterised by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction, resulting from malformation during early embryogenesis of the mesonephric (Wolffian) duct. The authors present a 35-year-old male who was being evaluated for chronic hepatitis B virus infection. He was referred to the urology outpatient clinic on account of incidental ultrasound finding of solitary right kidney. General physical examination revealed a healthy-looking young male with a flat abdomen and no palpable enlarged organs. Digital rectal examination revealed normal sized prostate with no palpable pararectal masses. MRI of the pelvis revealed a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. The clinical diagnosis was asymptomatic ZS. He is on yearly follow-up at the urology outpatient clinic for lower urinary tract symptoms, pelvic pain, painful ejaculation, features of infertility, and pelvic ultrasound. If any of these symptoms occur, he will be treated with an α-adrenergic receptor blocker, drainage of the seminal vesicle cyst, and appropriate treatment for infertility. He is also on active surveillance for viral hepatitis by the gastroenterology team. In conclusion, prompt referral and comprehensive radiological imaging investigations of patients with unilateral agenesis of the kidney will lead to increased identification and report of patients with ZS. There is paucity of literature reports on ZS in the authors’ environment, and this case report, to the best of the authors’ knowledge, is the first from Nigeria.

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:&#x0D; &#x0D; Creating a network of laboratories for diagnosis of viral hepatitis. 2. Monitor trends in incidence of and risk factors for disease.&#x0D; Assess burden of disease 4. Identify infected persons requiring counseling and /or post exposure prophylaxis. 5. Identify and control outbreaks.&#x0D; &#x0D; 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.&#x0D; 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.&#x0D; 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.

Development of a data dictionary on viral hepatitis for the Philippines

Abstract The considerable difference between the reported number of actual and estimated viral hepatitis cases in the Philippines can be attributed to the lack of reliable data. Since viral hepatitis is endemic in the country, efficient disease control depends on access to quality data. The rapid adoption of electronic medical records in different facilities in the country offers opportunities for access to such data but raises concerns about its standardization for analysis. This study presents the steps taken toward the adoption of a standardized data dictionary for viral hepatitis, referencing existing international terminology standards. A series of workshops were conducted to gain consensus among subject matter experts such as epidemiologists, hepatologists and informaticists. These workshops provided context to the different stakeholders through a shared understanding of viral hepatitis care processes and transforming these into computable representations. Using Department of Health-approved paper forms for viral hepatitis surveillance, a multidisciplinary team mapped the 125 unique data elements to various international standard code sets. The output was a draft Philippine Viral Hepatitis Data Dictionary—a prerequisite for the semantic interoperability of data from different electronic medical records.

1804. A Hospital System Utilization of EMR towards New Jersey’s Goal of Viral Hepatitis and HIV Elimination

Abstract Background New Jersey plans to reduce 75% of new HIV infections and promote access to testing and linkage-to-care (LTC) to end the HIV epidemic by 2025. In the US, CDC 2020 hepatitis surveillance report indicated cases of hepatitis C in 2020 corresponded to a 124% increase from 2013. Globally, if the HBV effort remains unchanged, the annual deaths from HBV are projected to increase by 39% from 2015 to 2030. We implemented an electronic medical record (EMR) based screening algorithm to scale up HBV, HCV, and HIV screening and provide LTC. Methods In March 2018, the EMR was modified at Cooperman Barnabas Medical Center in the Emergency Department (ED) to start automated screening, we expanded the screening criteria to boost identifying the undiagnosed. Subsequently, the program expanded to Somerset Medical Center and Rahway Hospital. Patient Navigators receive a real-time alert of positive results to contact patients and arrange LTC, the multidisciplinary team offers evaluation and treatment.Figure 1.Expanding Automated Screening Program Results We found HIV prevalence in CBMC is 1.5%, close to 5 times the NJ statewide 397.2 per 100,000 population. HBV infection rates varied in three hospitals, representative of the diverse population in their service areas. The HBV patients we confirmed came from more than 170 countries with different insurance statuses, the majority are immigrants from endemic countries or with high-risk behaviors identified. From Aug 2022, new HbsAg + cases reflex to HDVAb test, where 5% resulted HDVAb+ and no HDVRNA+. HCV prevalence rates are more consistent among the three sites, however, the percentages of the birth cohort (1945-1965) are varied. LTC rates are higher in HBV patients than HCV, thus far, 41 patients were cured of HCV from our team.Figure 2.Total Numbers of HBV, HCV &amp; HIV Tested, Prevalence &amp; LTC Conclusion EMR automated screening significantly scales up the diagnosis of HBV, HCV and HIV, as well as identifying HIV at-risk patients to receive comprehensive preventative services. HBV, HCV and HIV share similar risks, LTC is crucial to treat current infections and is beneficial to prevent transmission and potential exposure. In summary, automated screening and LTC work robustly toward elimination. Disclosures All Authors: No reported disclosures

Project Hep-ØN: A comprehensive approach to reduce chronic viral hepatitis in Portugal

Abstract Issue The World Health Organization considers viral hepatitis a public health problem and aims to eliminate it as a threat by 2030, reducing incidence by 90% and mortality by 65%. To achieve these goals, the National Program for Viral Hepatitis recommends the screening of viral hepatitis at least once in a lifetime. However, this is not a widespread practice. Description of the problem Micro-elimination is an effective, efficient, and cost-effective intervention in addressing chronic hepatitis in specific geographic areas. The ‘Hep-ØN’ project aims to reduce the incidence, mortality, and morbidity of viral hepatitis in the area of influence of Oeste Norte. The project has three strategic axes: screening, patient follow-up, and liver disease literacy, with the support of several partners. Results The goal is to implement viral hepatitis screening at least once in a lifetime for all adult users, improve referral networks, ensure treatment and post-treatment surveillance of viral hepatitis, and empower healthcare professionals. The project aims to cover the 180,000 users registered in Oeste Norte (municipalities of Alcobaça, Bombarral, Caldas da Rainha, Óbidos, Peniche, Nazaré), of which more than 150,000 are over 18 years old. The pilot project is taking place in Peniche until September 2023, and covers more than 27,000 users, of which more than 22,000 are adults. The project's strategies can be applied to other areas, allowing for the rapid identification and treatment of viral hepatitis. Lessons The success of the pilot project in Peniche will demonstrate the importance of integrated and localized interventions in preventing and eliminating chronic viral hepatitis, first in ACES ON and then in other regions of the country. Replication should be adapted to local characteristics, leveraging synergies with local and national partners. Integrated care models are an effective strategy to address the challenges of preventing, treating, and controlling chronic viral hepatitis. Key messages • ‘Hep-ØN’ project aims to screen all adults, treat viral hepatitis, and empower healthcare professionals in Oeste Norte to eliminate chronic hepatitis. • Success of the pilot project in Peniche will show localized interventions’ importance in identifying and treating viral hepatitis rapidly and how integrated care models are an effective strategy.

Surveillance for rat hepatitis E in wastewater networks, Italy.

Rat hepevirus is an emerging zoonotic pathogen associated with human hepatitis and distantly related to the hepatitis E virus. By using broadly reactive primers for hepevirus, we detected viral RNA in 68/155 (43.9%) of sewage specimens collected from 14 wastewater treatment plants serving about half of the population of Abruzzo, Italy. On sequence analysis, the 68 strains showed 79.0%-91.6% identities to reference sequences of rodent and human origin, segregating in different genetic groups with a clear geographic/wastewater treatment plant (WWTP)-related pattern.IMPORTANCEHepatitis E virus (HEV) infection constitutes a significant health problem worldwide. In recent years, in addition to the zoonotic HEV3 and HEV4, emerging highly divergent hepevirus of rat origin (rat HEV [RHEV]) has been associated with human acute and chronic hepatitis. As environmental surveillance can be a complementary tool to explore emerging viruses of human and rodent origin, we investigated the epidemiology and the genetic variability of RHEV targeting 14 wastewater treatment plants in an Italian geographic area considered a hot spot for HEV infection in humans. Our results revealed that RHEV is a significant component of the wastewater microbiota with viral RNA detected in 43.9% of the specimens tested, adding further evidence to the need to investigate more in depth the real burden of RHEV infections in humans.

The Effectiveness and Safety of Direct-Acting Antivirals in the Treatment of Hepatitis C Virus in Saudi Arabia: A Nationwide Study Based on the Saudi Ministry of Health Surveillance Data From 2017 to 2021.

Background and objective While the Kingdom of Saudi Arabia (KSA) has had ahepatitis C virus (HCV) elimination program in place since 2015,there have been limited studies investigating the effectivenessand safety ofdirect-acting antivirals(DAAS) based on the Ministry of Health (MOH) surveillance data. In light of this, this study was conducted to assess the effectiveness and safety of DAAS (glecaprevir/pibrentasvir, daclatasvir/sofosbuvir, or other combinations) in treating HCVcases in Saudi Arabia as per the MOH data from 2017 to 2021. Methods This was a retrospective cohort study involving recorded HCVcases in the national hepatitis surveillance database of MOHacross all regions of KSAfrom 2017to 2021. Statistical analyses were performed using IBM SPSS Statistics software (IBM Corp., Armonk, NY). Continuous variables were expressed asmean ± standard deviation (SD), and categorical variables were presented as numbers (percentages). An independent t-test was used for continuous variables, and a Chi-square analysis was used for categorical variables. A confidence interval of 95%, a margin of error of 0.05, a precision of 2%, and a 5% level of significance were employed. Results Regardingdemographic characteristics, age was significantly associated with HCVinfection (p=0.002).Similarly, nationality had a highly significant association with HCVinfection (p=0.004). Regardingclinical characteristics, creatinine levels were significantly associated with HCVinfection (p=0.009). As for effectiveness, all participantshad a positivepolymerase chain reaction(PCR) for HCVat enrolment(n=4806) and were DAAS-naïve. After the completion of the first DAAScourse, 99.5%(4781) had negative PCRs12 weeks post-treatment completion; however, the PCRremained positive for some patients (0.5%, n=25), which became negative after receiving the second DAAScourse, resulting in complete cure of HCV infection and a 100% negative PCRamong all participants. With regard to safety, noside effects were recorded in the cohort and hence the safety aspect was not analyzed. Conclusion Univariate analysis revealed that nationality (non-Saudi), age, and creatinine levels were significantly associated with HCVinfection. However, only nationality showed a significant association with HCVinfection following multivariate logistic regression adjustment. We believe that these insights will help guide the creation of clinical guidelines and promote evidence-based decision-making in the management of HCVin Saudi Arabia.

Surveillance of Hepatitis A Virus in Oysters Produced in Major Production Areas in Japan

Surveillance of Hepatitis A Virus in Oysters Produced in Major Production Areas in Japan