Hepatitis Vaccination Research Articles

Disparities in liver cancer risk and outcomes in the LGBTQ community: A literature review.

528 Background: Liver cancer continues to be a significant public health concern, particularly among high-risk groups such as individuals with hepatitis infections, alcohol use disorders, and metabolic diseases. While liver cancer disparities have been well-documented among racial and ethnic minority groups, emerging research highlights significant health inequities within the LGBTQ community, including higher rates of risk factors and limited access to screening and care. This literature review aims to assess the extent of liver cancer disparities within the LGBTQ community and identify gaps in prevention, screening, and treatment. Methods: We performed a systematic search across PubMed, Scopus, and Google Scholar for peer-reviewed studies published between 2000 and 2024. The inclusion criteria focused on studies addressing liver cancer risk, prevalence, or outcomes in LGBTQ populations. Data on key liver cancer risk factors such as hepatitis B and C prevalence, alcohol use, obesity, and access to healthcare services were extracted and synthesized. Additionally, we reviewed public health reports and clinical guidelines relevant to LGBTQ health disparities. Results: The review identified significant disparities in liver cancer incidence and mortality among LGBTQ individuals. Hepatitis B infection rates were about 1.5 times higher, and hepatitis C rates up to 1.7 times higher among LGBTQ populations, particularly among gay and bisexual men. Alcohol use disorder was about 30-40% more prevalent in LGBTQ individuals, which further increases the risk of liver cancer. Screening for liver cancer in LGBTQ populations is underutilized, with rates approximately 20% lower than the general population. There were reported delays in diagnosis in LGBTQ community due to stigma, discrimination, and lack of culturally competent healthcare services. While some interventions targeting LGBTQ health have shown promise, the overall lack of targeted liver cancer prevention and treatment strategies remains a significant barrier. Conclusions: LGBTQ individuals face increased liver cancer risk due to a higher prevalence of key risk factors and inadequate healthcare access. Current screening and preventive strategies are insufficient for addressing these disparities. Targeted interventions, including enhanced screening efforts, hepatitis vaccination and treatment programs, and the development of LGBTQ-specific healthcare protocols, are needed to reduce the liver cancer burden in this underserved population. Policymakers and healthcare providers must address the unique needs of LGBTQ individuals to achieve equitable cancer outcomes. Prevalence of liver cancer risk factors in LGBTQ vs. general population. Risk Factor LGBTQ Population (%) General Population (%) Hepatitis B Infection 15 10 Hepatitis C Infection 18 12 Alcohol Use Disorder 25 16 Metabolic Syndrome 22 18 Screening Rate 40 60

P-1297. Screening and vaccination for tetanus, hepatitis A, and hepatitis B in individuals with substance use disorders, hospitalized at a U.S. integrated healthcare system

Abstract Background Hepatitis A (HAV), hepatitis B virus (HBV), and tetanus are common vaccine preventable diseases among individuals with substance use disorders (SUDs). Inpatient encounters are frequent for this population thus represent an important opportunity for preventive care. However, up-to-date data on screening and vaccination for this high-risk population are lacking in the inpatient setting.Table 1.Characteristics of 465,282 individuals hospitalized at Kaiser Permanente Southern California between 2010 and 2023 with a history of substance use disordera At the time of index dateb Does not include 17 individuals identified as "Other" sexc In the 24 months prior to index dated In the 12 months prior to index datee Any time prior to index date Methods Using electronic health records at Kaiser Permanente Southern California (KPSC), we included adults hospitalized between 01/2010 and 06/2023 (study period), with a diagnosis code for SUDs within 2 years prior to index date (first hospitalization admission date during study period). We identified those at risk for HAV and HBV at index date by labs, and evaluated vaccination during any hospitalization or within 90 days of hospital discharge (surveillance period) during study period for tetanus, HAV and HBV.Table 2.Screening and vaccination for tetanus, hepatitis A, and hepatitis B among 465,282 individuals hospitalized at Kaiser Permanente Southern California with a history of substance use disorder between 2010 and 2023a Index date is defined as the date of the first hospital admission (including observation visits lasting >24 hours and emergency department visits) during the study period, with a diagnosis code for substance use disorder within 2 years priorb “At-risk for tetanus” is defined as no history of tetanus vaccination within 10 years prior to index date and no history of booster dose if the initial vaccination was completed >10 years prior to index datec “At-risk for HAV infection” is defined as no history of ≥2 dose of HAV vaccination, no history of positive test result for HAV IgG, HAV total Ab, and no history of HAV IgM prior to index dated Follow-up is defined as time period from the index date to the end of KPSC membership, the end of study period (i.e., June 30, 2023), or death, whichever comes firste “At risk for HBV infection” is defined as no history of ≥3 dose of HBV vaccination, no history of positive test result for HBV sAb, and no active of HBV infection (HBV viral load, or HBV sAg) prior to index date Results We identified 465,282 individuals meeting the study criteria (42% female, 45% non-Hispanic white, mean age 48 years [SD 19]) (Table 1). For tetanus, 79% completed ≥1 dose prior to index date, and 71% received a booster within 10 years prior to index date (Table 2). Among those at risk for tetanus at index date, 61% were vaccinated during a surveillance period, after median 2 (IQR 1, 5) hospitalizations since index date. For HAV, 15% completed vaccination prior to index date. Among those at risk for HAV, 2% were screened for immunity at any hospitalization during follow-up; 1% were vaccinated during a surveillance period, after median 3 (IQR 1, 7) hospitalizations since index date. For HBV, 21% completed and 6% partially completed vaccine series prior to index date. Among those at risk for HBV at index date, 2% and 5% were screened for immunity and active infection, respectively, at any hospitalization during follow-up; 3.2% were vaccinated during a surveillance period, after median 3 (IQR 1, 6) hospitalizations since index date. Conclusion Few with SUDs were screened or vaccinated for tetanus, HAV, or HBV during a hospitalization or at subsequent visits, after a median 2 - 3 hospitalizations after index date. This represents an opportunity for improvement in preventive care and vaccination for this high-risk population in the inpatient setting. Disclosures Jennifer H. Ku, PhD MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support Yuqian M. Gu, MS, GSK: Grant/Research Support Yi Luo, PhD, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Rulin C. Hechter, MD, PhD, MS, Gilead Sciences: Grant/Research Support Bradley Ackerson, MD, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support

Post-Vaccination Anaphylaxis in Adults: A Systematic Review and Meta-Analysis.

Vaccines have been recognized as one of the most effective public health interventions. However, vaccine-associated anaphylaxis, although rare, is a serious adverse reaction. The incidence of anaphylaxis related to non-COVID-19 vaccines in adults remains underreported. This systematic review and meta-analysis aim to estimate the incidence of post-vaccination anaphylaxis across various vaccines in adults. A comprehensive literature search of PubMed, Embase, Scopus, and Web of Science identified studies on anaphylaxis following vaccination in adults (≥18 years), excluding COVID-19 vaccines. PRISMA 2020 guidelines were followed. The protocol was registered in PROSPERO in advance (ID CRD42024566928). Random-effects and fixed-effects models were used to pool data and estimate the logit proportion, with the logit-transformed proportion serving as the effect size, thereby allowing for the calculation of event rates. A total of 37 studies were included in the systematic review, with 22 studies contributing to the meta-analysis, representing a combined population of 206,855,261 participants. Most studies focused on influenza vaccines (n = 15). Across all studies, 262 anaphylactic cases were reported, with 153 cases related to influenza vaccines, followed by herpes zoster virus vaccines (38 cases) and yellow fever vaccines (29 cases). Td/Tdap vaccine had the lowest rate (0.0001 per 100,000 participants). The overall random-effects model yielded a logit proportion of -10.45 (95% CI: -12.09 to -8.82, p < 0.001), corresponding to an event rate of 2.91 events per 100,000 subjects (95% CI: 0.56 to 14.73). Sensitivity analysis showed a higher incidence for influenza, hepatitis vaccines, and in vulnerable populations. Anaphylaxis following vaccination in adults is rare but varies by vaccine type. Strengthened monitoring and preparedness are essential, especially in non-medical settings, to ensure a rapid response to anaphylaxis and maintain public confidence in vaccination programs.

Beyond the Liver: A Comprehensive Review of Strategies to Prevent Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, primarily developing in the context of chronic liver disease. Traditional prevention has focused on liver-specific interventions like antiviral therapies and surveillance. However, extrahepatic factors also significantly contribute to HCC risk. This review explores comprehensive strategies for HCC prevention, including both hepatic and extrahepatic factors. An extensive literature search of peer-reviewed articles up to October 2024 was conducted, focusing on studies addressing HCC prevention strategies. Studies that focused on both hepatic and extrahepatic factors were included. Data were extracted and synthesized to provide an overview of current prevention strategies and their effectiveness in reducing HCC incidence. Hepatitis B vaccination and antiviral treatments for hepatitis B and C significantly reduce HCC incidence. Lifestyle modifications-such as reducing alcohol consumption, maintaining a healthy weight through diet and exercise, and smoking cessation-are crucial in lowering HCC risk. Environmental measures to limit exposure to aflatoxins and other hazards also contribute to prevention. Regular surveillance of high-risk groups enables early detection and improves survival rates. Emerging strategies like immunotherapy and gene therapy show potential for further reducing HCC risk. A comprehensive approach combining medical interventions, lifestyle changes, and environmental controls is essential for effectively decreasing HCC incidence globally. Implementing these combined measures could significantly reduce the global burden of HCC.

Self-reported hepatitis A and B vaccination coverage among men who have sex with men (MSM), associated factors and vaccination recommendations in 43 countries of the WHO European Region: results from the European MSM Internet Survey, EMIS-2017.

BackgroundHepatitis A and B vaccinations are recommended for men who have sex with men (MSM), given their increased risk of infection. However, data on vaccination programmes are scarce.AimTo use information on vaccination recommendations and vaccine uptake among MSM in the WHO European Region to guide prevention.MethodsFrom a large pan-European MSM Internet Survey (EMIS-2017), we analysed data on self-reported hepatitis A and B vaccination status by age, education, financial coping, settlement size, outness (disclosure of sexual behaviour), migration history and diagnosis with hepatitis C or HIV, using multivariable logistic regression. Additionally, we collected information on national hepatitis A and B vaccination recommendations.ResultsWe present data of 113,884 MSM, median age 36 years (IQR: 27-47). Vaccination for hepatitis A and B was recommended and free for MSM in 7 and 18 of 43 countries, respectively. Of all respondents, 48% (n = 50,966) reported ever being vaccinated against hepatitis A, and 53% (n = 56,889) against hepatitis B. Odds for being vaccinated against hepatitis A increased with outness ('out to (almost) all' aOR: 1.78, 95% CI: 1.72-1.85 vs 'out to none') and were higher in countries where vaccination was recommended and free for MSM (aOR: 2.22, 95% CI: 1.29-3.82 vs 'no recommendation'). Results for hepatitis B were similar (outness: aOR: 1.81, 95% CI: 1.75-1.88 and MSM-specific vaccination recommendation: aOR: 2.44, 95% CI: 1.54-3.85).ConclusionLarge proportions of MSM in Europe remain vulnerable to hepatitis A and B, despite available vaccination. Implementation of MSM-specific vaccination recommendations and greater efforts to improve the societal climate for MSM are needed to address gaps in vaccine coverage.

Viral hepatitis knowledge and vaccination awareness among men who have sex with men (MSM) in 43 countries of the WHO European Region: results from the European MSM Internet Survey, EMIS-2017.

BackgroundRecent hepatitis A virus outbreaks in Europe affecting men who have sex with men (MSM) and ongoing hepatitis B virus transmission among MSM underscore the ongoing need for viral hepatitis prevention in this population.AimTo describe viral hepatitis knowledge and associated factors among MSM in the WHO European Region to inform targeted prevention.MethodsIn the European MSM Internet Survey (EMIS-2017), basic knowledge was defined as correctly identifying at least 4 of 5 statements about viral hepatitis and vaccination. We described basic knowledge by country. In a multilevel logistic regression model, we estimated adjusted odds ratios (aOR) with 95% confidence intervals (CI) for having basic knowledge and explanatory variables: sociodemographic characteristics, history of hepatitis C and/or HIV diagnosis, sexual orientation disclosure at last sexually transmitted infections (STI) test and outness.ResultsOf 113,884 participants across 43 WHO European Region countries, 68% demonstrated basic knowledge, ranging from 50% in Israel to 80% in the Netherlands. Basic knowledge was significantly associated with older age (≥ 40 years vs < 25 years, aOR: 2.9, 95% CI: 2.7-3.0), a history of hepatitis C and/or HIV diagnosis (aOR: 1.8, 95% CI: 1.7-1.9) and sexual orientation disclosure at last STI test (aOR: 1.3, 95% CI: 1.2-1.3), among other factors.ConclusionsWe found a knowledge disparity regarding viral hepatitis and hepatitis vaccination awareness among MSM across Europe, highlighting a need to address these gaps. A non-judgemental, accepting climate that allows individuals attending medical services to safely disclose their sexual orientation is fundamental to enable healthcare professionals to target information and preventative measures more effectively.

Evaluation of Interfering RNA Efficacy in Treating Hepatitis B: Is It Promising?

Despite an existing safe and effective vaccine for hepatitis B virus (HBV), it is still a major public health concern. Nowadays, several drugs are used to treat chronic hepatitis B; however, full healing remains controversial. The viral covalently closed circular DNA (cccDNA) formed by HBV forms a major challenge in its treatment, as does the ability of HBV to integrate itself into the host genome, which enables infection reactivation. Interfering RNA (RNAi) is a gene-silencing post-transcriptional mechanism which forms as a promising alternative to treat chronic hepatitis B. The aim of the present review is to assess the evolution of hepatitis B treatment approaches based on using RNA interference. Data published between 2016 and 2023 in scientific databases (PubMed, PMC, LILACS, and Bireme) were assessed. In total, 76,949 articles were initially identified and quality-checked, and 226 eligible reports were analyzed in depth. The main genomic targets, delivery systems, and major HBV therapy innovations are discussed in this review. This review reinforces the therapeutic potential of RNAi and identifies the need for conducting further studies to fill the remaining gaps between bench and clinical practice.

Detection of Hepatovirus A (HAV) in wastewater indicates widespread national distribution and association with socioeconomic indicators of vulnerability.

Wastewater-based epidemiology, which seeks to assess disease occurrence in communities through measurements of infectious disease biomarkers in wastewater, may represent a valuable tool for understanding the occurrence of hepatitis A infections in communities. In this study, we measured concentrations of Hepatovirus A (HAV) RNA, in samples from 191 wastewater treatment plants spanning 40 US states and the District of Columbia from September 2023 to June 2024 and compared the measurements with traditional measures of disease occurrence. Nationally, 13.76% of the 21,079 wastewater samples were positive for HAV RNA, and both concentrations and positivity rates were associated with NNDSS hepatitis A case data nationally (Kendall rank correlation coefficient = 0.20, concentrations; and 0.33, positivity rate; both P < 0.05). We further demonstrated that higher rates of wastewater HAV detection were positively associated with socioeconomic indicators of vulnerability including homelessness and drug overdose deaths (both P < 0.0001). Areas with above average levels of homelessness were 48% more likely to have HAV wastewater detections, while areas with above average levels of drug overdose deaths were 14% more likely to have HAV wastewater detections. Using more granular case data, we present a case study in the state of Maine that reinforces these results and suggests a potential lead time for wastewater over clinical case detection and exposure events. The ability to detect HAV RNA in wastewater before clinical cases emerge could allow public health officials to implement targeted interventions like vaccination campaigns.IMPORTANCEDespite the existence of a highly effective vaccine for hepatitis A, outbreaks in vulnerable populations remain common. The disease can be asymptomatic or subclinical, and disproportionately impacts populations with inadequate access to healthcare, leading to a severe underestimation of the occurrence of this viral infection. This study investigates the potential for wastewater measurements of biomarkers of the causative agent of hepatitis A (HAV RNA) to provide insights into disease occurrence. Results highlight the potential for wastewater-based epidemiology to be a complementary tool to traditional surveillance for monitoring and controlling HAV transmission.

The Camden and Islington Viral Hepatitis Identification Tool (CIVHIT): Use of a Clinical Database Case-Finding Tool for Hepatitis B, Hepatitis C and HIV in Primary Care.

Despite the availability of effective treatment and vaccines for hepatitis B virus (HBV) and C virus (HCV), many people are still infected and remain unaware of their infection. The Camden and Islington Viral Hepatitis Identification Tool (CIVHIT), a computer-based search tool, was introduced in 60 general practices (GPs) in April 2014 to support identification, testing and treatment of individuals at high risk for blood-borne viruses (BBVs). CIVHIT searched electronic medical records (EMRs), flagging all those with codes linked to risk factors or medical conditions associated with BBVs. CIVHIT was associated with a 78.5% increase in BBV tests in primary care in both boroughs. This translated to a 55.8% rise in new diagnoses. HBV testing saw the largest increase resulting in twice as many people diagnosed. Only 23.2% of HBV and 14.9% of HCV-positive tests were referred to secondary care. In an index practice, the most common flag was a history of STIs (477/719, 66.3%). Individuals with previous or current drug use and those with a known hepatitis contact were more likely to be offered a test compared to those flagged due to a history of STI. HIV and HBV testing was lower in males following a test offer. There was an increased likelihood of testing for HBV and HCV with increasing age. Additionally, individuals with previous or current drug use and individuals with a known hepatitis contact were more likely to test for HCV compared to individuals flagged due to STI history. CIVHIT shows promise to assist with the elimination of BBVs.

Toward Universal Health Coverage: What Socioeconomic and Clinical Factors Influence Health Insurance Coverage and Restrictions in Access to Viral Hepatitis Services in Nasarawa State, Nigeria?

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36-40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38-50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67-65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85-87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55-10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO's 2030 elimination goals.

Liver cancer in 2021: Global burden of disease study

The epidemiology of adult primary liver cancer continues to evolve, owing to the increasing prevalence of metabolic disease, rising alcohol consumption, advances in vaccination for HBV, and antiviral therapy for HCV. Disparities in care and the burden of liver cancer between populations persist. We assess trends in the burden of liver cancer and contributions by various etiologies across 204 countries and territories from 2010 to2021. Utilizing the methodological framework of the Global Burden of Disease Study 2021, we analyzed global and regional temporal trends in incidence and mortality, and the contributions of various etiologies of liver disease. In 2021, there were an estimated 529,202 incident cases and 483,875 deaths related to liver cancer. From 2010 to 2021, global liver cancer incident cases and deaths increased by 26% and 25%, respectively. Global age-standardized incidence rates (ASIRs) and death rates (ASDRs) for liver cancer declined but rose in the Americas and Southeast Asia. HBV remained the dominant cause of global incident liver cancer cases and deaths. MASLD (metabolic dysfunction-associated steatotic liver disease) was the only etiology of liver cancer with rising ASIRs and ASDRs. By contrast, ASIRs and ASDRs remained stable for alcohol-related liver cancer, and declined for HBV- and HCV-related liver cancer. While age-adjusted incidence and deaths from liver cancer have started to decline, the absolute number of incident cases and deaths continues to increase. Population growth and aging contribute to the observed disconnect in the temporal trends of absolute cases and rates. Disparities remain, and MASLD-related liver cancer continues to surge. Liver cancer remains a major cause of death globally, but its causes and burden in various regions are changing. This study highlights that new diagnoses and deaths related to liver cancer continue to rise. Age-adjusted death rates of liver cancer related to viral hepatitis are declining but remain high. By contrast, age-adjusted death rates of liver cancer related to MASLD (metabolic dysfunction-associated steatotic liver disease) are rising. Sustained efforts and resources are needed to eliminate viral hepatitis, reverse current trends in heavy alcohol use, and tackle the metabolic risk factors of MASLD.

Advances in the Elimination of Viral Hepatitis in Mexico: A Local Perspective on the Global Initiative.

Viral hepatitis (A-E) presents a major global health challenge. In 2015, the World Health Organization (WHO) launched an initiative to eliminate viral hepatitis, with the aim of reducing new infections by 90% and deaths by 65% by 2030. Mexico is one of 38 focus countries identified by the WHO, collectively accounting for 80% of global infections and deaths. While hepatitis B and C are commonly diagnosed in Mexico, routine diagnosis for hepatitis D and E is lacking, with no specific epidemiological data available. In 2020, Mexico implemented the National Hepatitis C Elimination Program, focusing on preventing new infections, reducing complications like cirrhosis and hepatocellular carcinoma, ensuring access to treatment, and improving patient care. However, this program has not been extended to hepatitis B and E. Addressing the challenges of viral hepatitis control in Mexico requires increased resource allocation, expanded diagnosis, vaccination for hepatitis A and B, and treatment coverage for hepatitis B and C, along with multisectoral engagement. This work provides an overview of Mexico's response to the global initiative, highlighting its progress, challenges, and areas of opportunity.

Occupational Risks Prevention Practices Among Medical Waste Handlers in Ogun State, Nigeria

Background: Medical waste handlers are at immediate risk of needle stick injuries and exposure to infectious materials from medical waste. Adequate knowledge and safe practices on the part of the workers are essential for the prevention of nosocomial infections. Objective: To assess and compare the factors involved in occupational risk prevention practices among medical waste handlers in two tertiary hospitals in Ogun State, Nigeria. Methods: This descriptive, cross-sectional study compared medical waste handlers and the risk prevention measures available in a specialist hospital and a teaching hospital. The 100 participants were randomly selected and surveyed using an interviewer-administered questionnaire. Results: The prevalence of needle stick injury at the teaching hospital and specialist hospital were 38% and 28%, respectively. Hepatitis B vaccine uptake was 6% in the teaching hospital compared to 70% at the specialist hospital. There was a significant difference concerning the provision of safety equipment (p&lt;0.001), personal protective equipment (PPE) (p&lt;0.001), Hepatitis vaccine (p&lt;0.001), training (p&lt;0.001) and availability of waste management policy (p = 0.015) but no significant difference concerning the regular supply of water and soap (p = 0.494) between both institutions. Conclusion: The waste handlers at the specialist hospital were better equipped for safety than those at the teaching hospital. A safer environment, equipment, and training for medical waste handlers are needed to enable them to practise occupational risk prevention more effectively.

Plant-based vaccines against viral hepatitis: A panoptic review.

The traditional vaccines against hepatitis have been instrumental in reducing the incidence of some types of viral hepatitis; however, the need for cost-effective, easily distributable, and needle-free vaccine alternatives has led to the exploration of plant-based vaccines. Plant-based techniques offer a promising avenue for producing viral hepatitis vaccines due to their low-cost cultivation, scalability, and the potential for oral administration. This review highlights the successful expression of hepatitis B surface antigens in plants and the subsequent formation of virus-like particles, which have shown immunogenicity in preclinical and clinical trials. The challenges such as achieving sufficient antigen expression levels, ensuring consistent dosing, and navigating regulatory frameworks, are addressed. The review considers the potential of plant-based vaccines to meet the demands of rapid vaccine deployment in response to outbreaks and their role in global immunization strategies, particularly in resource-limited settings. This review underscores the significant strides made in plant molecular farming and the potential of plant-based vaccines to complement existing immunization methods against viral hepatitis.

Self-reported hepatitis B testing among noninstitutionalized adults in the United States before the implementation of universal screening, 2013-2017: A nationwide population-based study.

In 2023, the US Centers for Disease Control and Prevention recommended universal screening for hepatitis B virus (HBV); however, the proportion of US adults screened before implementing this recommendation is unknown. We analysed nationally representative data from the National Health Interview Survey (2013-2017) on self-reported HBV testing among noninstitutionalized US adults ≥18 years. We employed Poisson logistic regression to identify factors associated with self-reported testing, using a conceptual framework that included four overarching factors: sociodemographic characteristics, healthcare access, health-seeking behaviours and experiences, and access to internet-based health information. Among 149,628 survey respondents, the self-reported HBV testing rate was 27.2% (95% CI 26.2-28.7) and increased by 1.7% from 2013 to 2017 (p = .006). In adjusted analysis, health-seeking behaviours and experiences had the strongest associations of self-reported testing including a history of hepatitis (AOR 2.68, 95% CI 1.92-3.73), receipt of hepatitis B vaccination (AOR 5.11, 95% CI 4.61-5.68) and prior testing for hepatitis C (AOR 9.14, 95% CI 7.97-10.48) and HIV (AOR 2.69, 95% CI 2.44-2.97). Other factors associated with testing included being male (AOR 1.14, 95% CI 1.03-1.26), ages 30-44 years (AOR 1.37, 95% CI 1.17-1.61), 45-60 years (AOR 1.55, 95% CI 1.30-1.80) and ≥60 years (AOR 1.53, 95% CI 1.28-1.84), residence in the Western US region (AOR 1.23, 95% CI 1.06-1.43), and access to internet-based health information (AOR 1.32, 95% CI 1.18-1.47). Being Hispanic was associated with lower odds of testing (AOR 0.80, 95% CI 0.66-0.97). These findings may help guide optimal HBV screening in the universal testing era.

Pediatric Perspectives on Liver Cirrhosis: Unravelling Clinical Patterns and Therapeutic Challenges.

Background: Liver cirrhosis presents significant challenges in the pediatric population due to a complex interplay of etiological factors, clinical manifestations, and limited therapeutic options. The leading contributors to cirrhosis among pediatric patients are chronic cholestasis, metabolic disorders present from birth, and long-term hepatitis. Materials and method: Our narrative review aimed to synthesize literature data on the etiology, clinical picture, diagnostic techniques, optimal management of complications, and timely transplantation. Results: The epidemiology of liver cirrhosis in pediatric patients is evolving. The introduction of a universal vaccination and effective long-term viral suppression in viral hepatitis have significantly decreased complications rates. Liver transplantation programs worldwide have also improved the management of cirrhosis complications. Conclusions: Early diagnosis, comprehensive management strategies, and advancements in treatment modalities are critical for improving outcomes. Understanding these differences is crucial in providing age-appropriate care and support for those affected by cirrhosis.

Modelling the potential impact of global hepatitis B vaccination on the burden of chronic hepatitis B in the United States.

About 80% of persons with chronic hepatitis B virus (HBV) infection in the United States are non-US-born. Despite improvements in infant hepatitis B vaccination globally since 2000, work remains to attain the World Health Organization's (WHO) global 2030 goal of 90% vaccination. We explore the impacts on the United States of global progress in hepatitis B vaccination since 2000 and of achieving WHO hepatitis B vaccination goals. We simulated immigrants with HBV infection arriving to the United States from 2000 to 2070 using models of the 10 countries from which the largest numbers of individuals with HBV infection were born. We estimated costs in the United States among these cohorts using a disease simulation model. We simulated three scenarios: a scenario with no progress in infant vaccination for hepatitis B since 2000 (baseline), current (2020) progress and achieving WHO 2030 goals for hepatitis B vaccination. We estimate current hepatitis B vaccination progress since the 2000 baseline in these 10 countries will lead to 468,686 fewer HBV infections, avoid 35,582 hepatitis B-related deaths and save $4.2 billion in the United States through 2070. Achieving the WHO 2030 90% hepatitis B infant vaccination targets could lead to an additional 16,762 fewer HBV infections, 989 fewer hepatitis B-related deaths and save $143 million through 2070. Global hepatitis B vaccination since 2000 reduced prevalence of HBV infection in the United States. Achieving the WHO 2030 infant vaccination goals globally could lead to over one hundred million dollars in additional savings.

In Silico Study, Design, and Expression of an Intranasal Dual Chimeric Vaccine for Indonesian-Based Norovirus GII-2 and Hepatitis B

Hepatitis B virus (HBV) remains an important healthcare challenge, leading to liver diseases like cirrhosis and cancer. In response, we created a prophylactic and therapeutic HBV vaccine by integrating HBcAg and HBsAg from HBV genotype B into Norovirus (NoV) GII.2 P domain (PdomGII.2-HBV) for enhanced intranasal delivery. This vaccine also aimed to simultaneously prevent NoV infection, which causes gastroenteritis. Since the selected HBV epitopes have undergone extensive research and are tailored to the Indonesian population, this study focused on identifying NoV epitopes and assessing T cell epitopes coverage of the PdomGII.2-HBV for the Indonesian population. Following that, we expressed the PdomGII.2-HBV protein using Escherichia coli BL21(DE3) and employed a gentle solubilization technique for protein purification. Our in-silico analysis identified two B cell epitopes, along with 15 CD4+T cell epitopes and 35 CD8+T cell epitopes within the GII.2 P domain. These T cell epitopes cover 100% of the Javanese-Sundanese population's HLA allele variations, which constituted the largest demographic group in Indonesia. Subsequently, we successfully purified the presumed PdomGII.2-HBV protein, revealing a molecular weight of 39.5 kDa. Following the successful expression and purification of the presumed PdomGII.2-HBV protein, it is evident that this vaccine design has significant potential, warranting further study.

Updated vaccination and screening recommendations for hepatitis B: Implications for pharmacists

The number of new infections of hepatitis B is rising and a large number of cases are undiagnosed. These factors are contributing to hepatitis B-related liver complications, including liver cancer, and deaths that could be prevented. The Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention recently updated vaccination and screening/testing recommendations for hepatitis B. The updated recommendations remove the need for risk assessment before screening or vaccination. Pharmacists will play a key role in a concerted national effort to implement these updated recommendations. A multistakeholder advisory council convened by the Hepatitis B Foundation identified key barriers to screening and vaccination. The council also formulated strategies to optimize implementation of the updated recommendations. These strategies include educating pharmacists about the new recommendations and how they will help to reduce the burden of hepatitis B and liver cancer. Pharmacists could explore establishing pharmacy-provider collaborative practice agreements and potentially leverage capacity built with COVID-19 vaccine implementation. Hospital systems and other clinic settings could update their electronic health records to include prompts for hepatitis B vaccination and screening. Pharmacy systems can implement different reminder options to help patients complete the hepatitis B vaccine series. To address a lack of vaccine confidence, pharmacists can emphasize the cancer prevention benefit of hepatitis B screening and vaccination and engage with patients on an individual level to understand their concerns, assess vaccine status, and discuss vaccine recommendations. Effective implementation of the new recommendations will help achieve national and global goals of eliminating hepatitis B as a public health threat by 2030.

Designing the fusion protein of rotavirus VP8 and hepatitis A virus VP1 and evaluating the immunological response in BALB/c mice.

Rotavirus and Hepatitis A virus are responsible for causing gastroenteritis and jaundice. The current vaccination approaches have proven insufficient, especially in low-income countries. In this study, we presented a novel dual-vaccine candidate that combines the rotavirus VP8 protein and the hepatitis A virus VP1. The VP8*-rotavirus+AAY+HAV-VP1 fusion protein was produced using an Escherichia coli expression system. The recombinant protein had a molecular weight of approximately 45.5 kDa and was purified through affinity chromatography. BALB/c mice were injected subcutaneously with the recombinant protein, VP1, VP8 and vaccines for rotavirus and hepatitis A virus, both with and without ALUM and M720 adjuvants. ELISA assays were used to measure total IgG, IgG1, IgG2, and short-term and long-term IL-5 and IFN-γ responses. The fusion protein, when combined with adjuvants, elicited significantly higher total IgG, IgG1, and IgG2 responses compared to VP1 and VP8 alone, as well as the rotavirus and hepatitis A vaccines. Furthermore, it induced a higher short-term IL-5 and IFN-γ response while demonstrating a higher long-term IL-5 response compared to the rotavirus and hepatitis A vaccines. This study demonstrates that the VP8*-rotavirus+AAY+HAV-VP1 fusion protein is a promising dual vaccine candidate for immunization against hepatitis A and rotaviruses.