Intermediate Endemicity Research Articles

Sa1008 Natural History of Hepatitis B in Afro-Caribbean Patient Population

Background: Hepatitis B virus infection (HBV) is a major health problem worldwide. Iran as an intermediate endemicity country has had a decreasing prevalence during the last decade. We aimed to study the epidemiological features of HBV and the spontaneous loss of hepatitis B surface antigen (HBsAg) in HBV infected (HBeAg negative and genotype D) subjects followed-up during 2003 to 2012. Methods: Golestan cohort study (GCS) is a prospective study of 50,049 adults (58% female, age 40-75 years) originally intended to study the upper GI cancers in North Eastern Iran (2004-2008). GCS subjects are74% Turkmen, 80% live in rural areas, 88% are married,83% are non-smokers, and 70% have no formal education. HBV infection (HBeAg negative and genotype D) was found to be the most common cause of end-stage liver disease during GCS follow-ups. Baseline serology for HBV and HCV infection was obtained for all participants and a subcohort of HBV infected subjects were established within the GCS. Repeated measurements of exposure including HBV infection risk factors and a repeated serologic assessment for markers of HBV infection was performed in 2012 after an average of 5 years from enrollment. Results: A total of 3532 subjects from GCS were found to be HBs Ag positive at baseline and were enrolled in Golestan HBV cohort study. After 5 years of follow-up, 2413 subjects were available for reassessment. Of those, 2123 were found to be HBs Ag positive and 290 subjects were HBs Ag negative (12.0%, annual rate: 2%). Among the 290 subjects with spontaneous loss of HBs Ag, 159 (54.8%) were anti-HBc antibody positive and 71 (24.5%, annual rate: 0.5%) subjects developed anti-HBs antibody. During the average of 5.9 years of follow-up (21107 Person years) 35 HBV infected subjects died of end stage liver disease (annual mortality rate: 1.66 per 1000 persons) Conclusions: HBe Ag negative HBV genotype D infected adults in our cohort had 6 year survival rate of 92.8% with 12.0% chance of spontaneous Loss of HBsAg.

Monoclonal Antibodies Against 24 kDa Surface Antigen of Hepatitis B Viruses

Hepatitis B virus (HBV) infection is one of the major public health problems worldwide. Effective control of HBV transmission in areas of high and intermediate endemicity would not be possible without vaccination of the vulnerable group. The diagnosis of acute and chronic hepatitis B infection is based on the detection of hepatitis B surface antigen (HBsAg). In this study, we prepared nine hybridomas that produced monoclonal antibodies specific for HBsAg. BALB/c mice were immunized with 24 kDa HBsAg and the immune spleen cells were fused with SP2/0 myeloma cell line. We obtained seven IgG1, one IgM, and one IgG2b positive clones. The stable hybrids were sub-cloned and ascitic fluid was prepared in the BALB/c mice. After antibody purification by protein G, the affinity column was prepared and the pure 24 kDa HBsAg from cell extract was eluted from the column. Western blot analysis showed that all monoclonal antibodies are specific for 24 kDa antigen. Since 24 kDa HBsAg is used for vaccination against hepatitis, these monoclonal antibodies are the best candidate for the isolation and purification of recombinant HBsAg from yeast expression vector by affinity column to be used for vaccination.

Hepatitis A vaccination coverage among adults 18–49 years traveling to a country of high or intermediate endemicity, United States

BackgroundSince 1996, hepatitis A vaccine (HepA) has been recommended for adults at increased risk for infection including travelers to high or intermediate hepatitis A endemic countries. In 2009, travel outside the United States and Canada was the most common exposure nationally reported for persons with hepatitis A virus (HAV) infection. ObjectiveTo assess HepA vaccination coverage among adults 18–49 years traveling to a country of high or intermediate endemicity in the United States. MethodsWe analyzed data from the 2010 National Health Interview Survey (NHIS), to determine self-reported HepA vaccination coverage (≥1 dose) and series completion (≥2 dose) among persons 18–49 years who traveled, since 1995, to a country of high or intermediate HAV endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with HepA vaccine receipt. ResultsIn 2010, approximately 36.6% of adults 18–49 years reported traveling to high or intermediate hepatitis A endemic countries; among this group unadjusted HepA vaccination coverage was 26.6% compared to 12.7% among non-travelers (P-values<0.001) and series completion were 16.9% and 7.6%, respectively (P-values<0.001). On multivariable analysis among all respondents, travel status was an independent predictor of HepA coverage and series completion (both P-values<0.001). Among travelers, HepA coverage and series completion (≥2 doses) were higher for travelers 18–25 years (prevalence ratios 2.3, 2.8, respectively, P-values<0.001) and for travelers 26–39 years (prevalence ratios 1.5, 1.5, respectively, P-value<0.001, P-value=0.002, respectively) compared to travelers 40–49 years. Other characteristics independently associated with a higher likelihood of HepA receipt among travelers included Asian race/ethnicity, male sex, never having been married, having a high school or higher education, living in the western United States, having greater number of physician contacts or receipt of influenza vaccination in the previous year. HepB vaccination was excluded from the model because of the significant correlation between receipt of HepA vaccination and HepB vaccination could distort the model. ConclusionsAlthough travel to a country of high or intermediate hepatitis A endemicity was associated with higher likelihood of HepA vaccination in 2010 among adults 18–49 years, self-reported HepA vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients’ upcoming travel plans and recommend and offer travel related vaccinations to their patients.

Epidemiology of viral hepatitis B and C in Iraq: a national survey 2005-2006

Background and objective: Viral Hepatitis Type B&C is serious public health challenge throughout the world.Hepatitis B and C viruses still remain to be the major causes of chronic hepatitis.It is estimated that around 350-400 million people in the world are chronic carriers of HBV, which represents approximately 7% of the total populationwhereas infection with HCV is found in approximately 3% of the world population, which represents 160 million people. Hepatitis B infection has a wide range of seroprevalence in the Mediterranean countries ranging from intermediate (=>2% ) to high prevalence ( =>7%). World Health Organization estimated a prevalence rate for HCV infection of about 4.6% in Eastern Mediterranean in 1999. During the eightieths years of the last century, Iraq was considered to be of intermediate endemicity with hepatitis B as reflected by 3% seroprevalence of HBsAg in normal population. Hepatitis C was found to be of low endemicity among blood donors 0.5%. There were no national wide epidemiological studies regarding the prevalence of hepatitis B&C accordingly we conduct this study to determine the prevalence of both types all over the Iraq. Methods: From the 1 st of January 2005 to 31 st of December 2006, a community based cross-sectional study was conducted all over Iraqi governorates. A total of 9610 persons, recruited by surveying a nationally representative random sample of households were analyzed. A stratified random sample proportional to size of each of the 18 Iraqi governorates, both urban and rural areas were included. Prevalence estimates were therefore weighted and age-adjusted. Five (5ml) of blood samples were taken from the study subjects, and tested for hepatitis B surface antigen, antibody to hepatitis B core antigen antibody to hepatitis B surface antigen and hepatitis C antibodies . Results: The national prevalence rate of HBs Ag was 1.6% and correlated positively with age. The prevalence rate of anti-HBs antibodies was 17%. The prevalence of anti-HBc was 9.7%. The prevalence of anti-HCV was low (0.4%). The prevalence rate of anti-HBs antibodies in <10 years children is only 32.2%, which raise the issue of incomplete coverage of hepatitis B vaccine during the years preceding the study years. Conclusion: The findings revealed that Iraq is of low prevalence with HBsAg.On the other

Seroprevalence of hepatitis A virus in a cross-sectional study in Mexico

Hepatitis A virus (HAV) remains a public health concern worldwide contributing to significant morbidity in developed and developing countries. This cross-sectional database study estimated the overall HAV seroprevalence and the seroprevalence by gender, age, region and socioeconomic status in Mexico. Between January and October 2010, serum samples collected during the National Health and Nutrition survey (ENSANUT 2006) were obtained from subjects aged 1–95 y. Subjects’ gender, age, geographical region and socioeconomic status were extracted from the survey and compiled into a subset database by the Mexican National Institute of Public Health. Anti-HAV antibodies were measured using a chemiluminescent immunoassay. A total of 3658 subjects were included in the according-to-protocol cohort. Overall, the HAV seroprevalence was 84.2%. The HAV seroprevalence rates were similar between females (86.1%) and males (82.2%). The percentage of subjects seropositive for anti-HAV antibodies was highest in adults aged ≥ 20 y (96.9%), followed by adolescents aged 10–19 y (80.1%) and lowest in children aged 1–9 y (45.0%) (p < 0.0001). Regionally, the highest HAV seroprevalence rate was observed in the South (88.8%) followed by Central and Northern Mexico and Mexico City (p = 0.02). The HAV seroprevalence was similar between subjects of high socioeconomic (90.1%) status and of low socioeconomic status (86.6%). This study confirms the intermediate HAV endemicity in Mexico. Cost-effectiveness studies are necessary to evaluate the inclusion of an effective hepatitis A vaccine from a population-based perspective in addition to continuous efforts to improve hygiene and sanitation that have a substantial impact on the disease burden.

Prevalence and risk factors of hepatitis B and C virus infections among the general population and blood donors in Morocco

BackgroundViral hepatitis is a serious public health problem affecting billions of people globally. Limited information is available on this issue in Morocco. This cross-sectional study was undertaken with the aim of determining the seroprevalence and risk factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) among the general population and among blood donors.MethodsBlood samples from volunteers, have been screened with ELISA tests for detecting the hepatitis-B surface antigen (HBsAg) and anti-HCV. Within the seroreactive patients for HCV in the general population, RT-PCR was performed by the Cobas Ampliprep/Cobas Amplicor.ResultsHCV and HBV-seropositivity was documented in 1.58% and 1.81% out of 41269 and 23578 participants respectively from the general population. Two patients were found to be co-infected. HCV-RNA was detected by PCR in 70.9% of the 195 anti-HCV positive subjects. The anti-HCV prevalence was not different among males and females (P = 0.3). It increased with age; the highest prevalence was observed among subjects with >50 years old (3.12%). Various risk factors for acquiring HCV infection were identified; age, dental treatment, use of glass syringes and surgical history. In addition to these factors, gender and sexual risk behaviors were found to be associated with higher prevalence of hepatitis B. The HBV positivity was significantly higher among males than females participants in all age groups (P < 0.01). The peak was noticed among males aged 30–49 years (2.4%). None of the 152 persons younger than 20 years had HBsAg or anti-HCV. The prevalence of anti-HCV and HBsAg among 169605 blood donors was 0.62% and 0.96% respectively.ConclusionsOur study provided much important information concerning hepatitis B and C prevalence and risk factors; it confirmed the intermediate endemicity for HCV infection and pointed to a decreasing trend of HBV incidence, which might reclassify Morocco in low HBV endemicity area. This could be attributed primarily to the universal HBV vaccination among infants and healthcare workers over the past 13 years. HCV and HBV infections in the present survey were mainly associated with nosocomial exposures. Prevention and control of HBV infection are needed to reduce HBV transmission between adults.

Evaluation of adults with acute viral hepatitis a and review of the literature.

In developing countries HAV infection is very common in the first years of life and it is often asymptomatic. However especially in regions of intermediate endemicity, exposure to the virus may delay and outbreaks of hepatitis A may be encountered in adults. The aim of this study is to evaluate the clinical and laboratory findings and risk factors of adults with acute viral hepatitis A. In present study we evaluated 203 patient with acute viral hepatitis A, who were admitted to four different hospitals of three cities of Turkey between January 2000-December 2011, retrospectively. The diagnosis of acute viral hepatitis A was performed by laboratory findings and clinically. In a total of 203 patients, 120 (59.1%) patients were male and 83 (40.9%) were female. Mean age of cases with acute viral hepatitis A was 24.7 +11.8 years (ranged 15 to 82 years old). Acute viral hepatitis A were seen in patient who were 15-20 years and 21-30 years old, commonly. Jaundice (74%), fatigue (68%), nausea- vomiting (56%) and dark urine (48%) were the most common symptoms in cases. Prolonged cholestasis (6.8%) was the most common atypical manifestation. Prolonged jaundice was more frequent in the cases with positive HBsAg (P < 0.001). Acute viral hepatitis A can cause atypical presentations such as prolonged cholestasis, acute kidney injury and fulminant hepatitis. Some precautions such as routine vaccination program, improvement of hygiene conditions and informing people about it, should be taken for reducing of acute viral hepatitis A infection incidence.

Analysis of the circulation of hepatitis A virus in Argentina since vaccine introduction

Hepatitis A virus (HAV) has shown intermediate endemicity in Argentina, but its incidence has decreased since vaccine introduction in 2005. Environmental surveillance was conducted in five rivers from Argentina from 2005 to 2012, complementing clinical information. HAV detection decreased since 2005, although its circulation continues, maintaining viral diversity but not undergoing antigenic drift. Most sequences belonged to subgenotype IA, closely related to Argentinean clinical sequences, but one belonged to proposed subgenotype IC, previously undetected in the country. Environmental surveillance might contribute to monitoring the single-dose vaccination schedule, representing not only strains causing disease but also the circulating population and the viral introductions.

Hepatitis B and C

Hepatitis B and C

Hepatocellular Carcinoma in Pakistan: Where do We Stand?

ContextFrom the 1970s till the mid 1990s, hepatitis B was the most common etiological factor for hepatocellular carcinoma (HCC) in Pakistan. Afterwards, a shift in HCC etiology was observed with a steady rise in hepatitis C virus (HCV) related HCC cases. HCV-3a, which is the most prevalent genotype, is also most frequent in HCV related HCC. There was an increase in the proportion of non-B non-C (NBNC) HCC cases as well, which might be attributed to an increase in non-alcoholic fatty liver disease.Evidence AcquisitionThe age-standardized rate for HCC is 7.64/100 000 in males and 2.8/100 000 in females. Male to female ratio is 3.6:1. Usual age of presentation is in the fifth and sixth decade. Most patients present with advanced disease, as they are not in a regular surveillance program. This is more so for patients with NBNC chronic liver disease. As many sonologists in Pakistan are practicing without sufficient training to pick up early lesions, alpha-fetoprotein is still recommended to compliment ultrasound in the surveillance of HCC.ResultsMajority of HCC patients present with nonresectable disease. Interventions such as transarterial chemoembolization, radiofrequency ablation, resection and chemotherapy including sorafenib are available in selected centers. Pakistan appears to be in an area of intermediate endemicity for HCC. There is a need for population based epidemiological studies to estimate the exact disease burden.ConclusionsMeasures to prevent the spread of hepatitis C and B can slow down the epidemic rise in the incidence of HCC in the coming decades. There is a need to implement a proper surveillance program to identify HCC cases at an early stage.

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context

ObjectiveTo conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. MethodsAn age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South+Southeast (low endemicity) and one for the North+Northeast+Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). ResultsA universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. ConclusionsUniversal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program.

Programas de vacunación universal contra la hepatitis A en el mundo

Hepatitis A occurs worldwide and has high morbidity. Tens of millions of infections are estimated to occur every year, but many are not reported due to the high percentage of asymptomatic cases. The presence of clinical manifestations is related to age: most cases in children aged < 6 years are asymptomatic and thus represent an important source of infection, while adults usually present symptoms. Hepatitis A is transmitted by the faecal-oral route and its incidence is related to hygiene and access to safe water.In areas of very low endemicity (high income countries), the virus hardly circulates, and the disease mainly occurs in high risk groups, in whom the World Health Organization (WHO) recommends vaccination. In areas of high endemicity (low income countries) most people are infected during childhood, so very few cases of clinical infection occur. In these countries, the WHO does not recommend vaccination. Clinical hepatitis occurs more frequently in areas of low or intermediate endemicity (developing countries) and the WHO recommends universal vaccination programs against hepatitis A in these countries. Recently, in July 2012, the WHO published an update document on hepatitis A vaccines.In the last 15 years, some countries, such as the USA, Israel and some parts of Spain and Italy, have implemented universal vaccination programs against hepatitis A. In this article, we review the different strategies used and the results obtained with each program.

Clinical course and management of acute hepatitis A infection in adults

Background. Hepatitis A is the most common type of viral hepatitis in Mexico. The change of hepatitis A epidemiology in Mexico from high to intermediate endemicity leads to increasing susceptible adults for severe illness. Objective. To describe the clinical characteristics and hospital outcome of adult patients with acute hepatitis A infection, and determine risk factor for mortality.Material and methods. This is a retrospective observational, multicentre study in Mexico City and in Guatemala City. All inhospital patients were followed until discharge or death. Risk factors for death/acute liver failure were identified.Results. Forty seven patients were analyzed, sixty percent were male, the prodrome phase was from 3 to 30 days. The three most common symptoms were fever, malaise and jaundice, with 87%, 74% and 62% respectively. The incidence of patients who were treated with antibiotics before hospital admission was up to 34%. Unnecessary imaging studies and out of guidelines drugs were used. Presence of encephalopathy, leukocytes > 19,000/mL, blood urea nitrogen > 36 mg/dL, creatinine > 2 mg/dL, albumin < 2.5 mg/dL andtotal bilirubin > 9.6 mg/dL, are predictors of mortality. Serum creatinine > 2 mg/dL has the best sensibility and specificity for predicting fulminant hepatitis/death.Conclusion. Acute hepatitis A infection in adults is associated some unnecessary diagnostic and therapeutic approach. Could be associated with fulminant hepatitis, and a creatinine value > 2 mg/dL is the best predictor for fulminant hepatitis and death.

Model-based projections of the population-level impact of hepatitis A vaccination in Mexico

There are indications of a shift in the pattern of hepatitis A (HAV) in Mexico from high to intermediate endemicity, progressively increasing the mean age of infection and the proportion of cases which are symptomatic. This study estimated the potential impact of universal infant HAV vaccination in Mexico with two doses of Havrix™ at 12 and 18 mo of age on all HAV infections and symptomatic HAV infections. We developed a dynamic transmission model that accounts for changes in demography and HAV epidemiology. It was calibrated using Mexican age-specific seroprevalence and symptomatic HAV incidence data. With 70% first-dose coverage and 85% second-dose coverage, the calibrated model projected that HAV vaccination would reduce the incidence of all HAV infections (symptomatic and asymptomatic) after the first 25 y of vaccination by 71–76% (minimum and maximum for different transmission scenarios). The projected reduction in cumulative incidence of symptomatic HAV infections over the first 25 y of vaccination was 45–51%. With 90% first-dose coverage and 85% second-dose coverage, the projected reduction in incidence of all HAV infections was 85–93%, and the projected reduction in the cumulative incidence of symptomatic HAV infections was 61–67%, over a 25-y time frame. Sensitivity analyses indicated that second-dose coverage is important under the conservative base-case assumptions made about the duration of vaccine protection. The model indicated that universal infant HAV vaccination could substantially reduce the burden of HAV disease in Mexico.

Lower chronic hepatitis B in South Asia despite all odds: Bucking the trend of other infectious diseases

Hepatitis B virus (HBV) infection remains a significant global health problem. As per estimates of the World Health Organization (WHO), approximately 2 billion people have been infected worldwide, which represents one-third of the world population. Of these, more than 350 million (5-7% of the world’s population) suffer from chronic HBV infection. Approximately 15-40% of the infected patients will develop life-threatening liver diseases (cirrhosis, liver failure and hepatocellular carcinoma) resulting in 600,000 to 1.2 million deaths per year due to HBV. Epidemiological data on HBV infection is therefore important for strategies to tackle the spread of the disease. Based on the prevalence of hepatitis B surface antigen (HBsAg), countries are classified as having high (>8%), intermediate (2-7%) or low ( 8% of the population is HBsAg positive) include South-East Asia, China, most of Africa, most of Pacific Islands, the Amazon basin and parts of the Middle East. The areas of intermediate endemicity (2-7%) include South Asia, Eastern and Southern Europe, Russia and Central and South America. On the other hand areas with low endemicity (<2%) include United States, Western Europe and Australia. The South Asian countries, a contiguous block of countries which have been classified together as Global Burden of Disease Regions include Afghanistan, Bangladesh, Bhutan, India, Nepal and Pakistan. People in South Asia are at a higher risk of developing infectious diseases due to poverty and its associated problems of unhygienic living conditions, malnutrition, illiteracy, and poor access to clean water, toilet facilities, and quality health care. Spread of HBV infection in many South Asian countries is attributed to unsafe blood supply, reuse of contaminated syringes, lack of maternal screening to prevent perinatal transmission and delay in the introduction of hepatitis B vaccine. However, it is intriguing that bucking the trend of other infectious diseases, the prevalence of HBV in South Asian countries is lower than some of the more affluent neighbors in the South East Asian countries. Re-emphasizing the lower prevalence of HBV in South Asia is an article by Shrestha et al in this issue of Tropical Gastroenterology, which shows that the prevalence of HBV in Nepal is even lower than that in other countries of South Asia.

Prevalence of Occult Hepatitis B Virus Infection in Hemodialysis Patients From Egypt With or Without Hepatitis C Virus Infection

: Background: While prevalence of Hepatitis B virus (HBV) in patients with end-stage renal failure (ESRF) who are undergoing dialysis has decreased significantly during the past few decades, it still remains a distinct clinical problem. The immunosuppressive nature of renal disease often leads to chronicity of the HBV infection and an opportunity for nosocomial spread of the infection among dialysis patients. Egypt is among the countries with intermediate endemicity of HBsAg (range, 2%–7%). Large-scale geographic heterogeneity in HBV prevalence has been reported worldwide and HBV prevalence is especially heterogeneous in Egypt.Objectives: To assess the prevalence of occult HBV infection (OBI) in hemodialysis patients with or without chronic hepatitis C (HCV) from Minia and Assuit, Upper Egypt, using HBV DNA assays.Patient and Methods: Sera from 145 hemodialysis patients with negative HbsAg were investigated for HBV DNA using real-time polymerase chain reaction (RT-PCR). Only serum samples with repeatedly detectable HBV DNA were considered positive. Patients were divided into 2 groups: HCV RNA positive and HCV RNA negative, based on the results of a third generation enzyme linked immunosorbent assay (ELISA) anti-HCV test and HCV RNA PCR.Results: HBV DNA was detected in 6 of the 145 patients (4.1%) and HBcAb was detected in 29/145 patients (20%). There were no statistically significant differences in the age, duration of hemodialysis, biochemical parameters, serological markers of HBV, or HBV DNA between patients with and without HCV infection.Conclusions: Four percent of the hemodialysis patients had OBI. There was no significant difference in the prevalence of OBI between hemodialysis patients with or without HCV co-infection. Implication for health policy/practice/research/medical education:Exploring the prevalence of occult HBV infection in hemodialysis patients with or without chronic hepatitis C in Egypt has significant clinical implication. Reading this article is recommended to all internists, gastroenterologists and hepatologists. Please cite this paper as:Abu El Makarem MA, Abdel Hamid M, Abdel Aleem A, Ali A, Shatat M, Sayed D, et al. Prevalence of Occult Hepatitis B Virus Infection in Hemodialysis Patients From Egypt With or Without Hepatitis C Virus Infection. Hepat Mon. 2012;12(4):253-8. DOI: 10.5812/hepatmon.665 Copyright © 2012 Kowsar Corp. All rights reserved.

Prevalence of Occult Hepatitis B Virus Infection in Hemodialysis Patients From Egypt With or Without Hepatitis C Virus Infection

While prevalence of Hepatitis B virus (HBV) in patients with end-stage renal failure (ESRF) who are undergoing dialysis has decreased significantly during the past few decades, it still remains a distinct clinical problem. The immunosuppressive nature of renal disease often leads to chronicity of the HBV infection and an opportunity for nosocomial spread of the infection among dialysis patients. Egypt is among the countries with intermediate endemicity of HBsAg (range, 2%-7%). Large-scale geographic heterogeneity in HBV prevalence has been reported worldwide and HBV prevalence is especially heterogeneous in Egypt. To assess the prevalence of occult HBV infection (OBI) in hemodialysis patients with or without chronic hepatitis C (HCV) from Minia and Assuit, Upper Egypt, using HBV DNA assays. Sera from 145 hemodialysis patients with negative HbsAg were investigated for HBV DNA using real-time polymerase chain reaction (RT-PCR). Only serum samples with repeatedly detectable HBV DNA were considered positive. Patients were divided into 2 groups: HCV RNA positive and HCV RNA negative, based on the results of a third generation enzyme linked immunosorbent assay (ELISA) anti-HCV test and HCV RNA PCR. HBV DNA was detected in 6 of the 145 patients (4.1%) and HBcAb was detected in 29/145 patients (20%). There were no statistically significant differences in the age, duration of hemodialysis, biochemical parameters, serological markers of HBV, or HBV DNA between patients with and without HCV infection. Four percent of the hemodialysis patients had OBI. There was no significant difference in the prevalence of OBI between hemodialysis patients with or without HCV co-infection.

Recommended Adult Immunization Schedule: United States, 2012*

Recommended Adult Immunization Schedule: United States, 2012*

Hepatitis A: Epidemiology and prevention in developing countries.

Hepatitis A is the most common form of acute viral hepatitis in the world. Major geographical differences in endemicity of hepatitis A are closely related to hygienic and sanitary conditions and other indicators of the level of socioeconomic development. The anti-hepatitis A virus (HAV) seroprevalence rate is presently decreasing in many parts of the world, but in less developed regions and in several developing countries, HAV infection is still very common in the first years of life and seroprevalence rates approach 100%. In areas of intermediate endemicity, the delay in the exposure to the virus has generated a huge number of susceptible adolescents and adults and significantly increased the average age at infection. As the severity of disease increases with age, this has led to outbreaks of hepatitis A. Several factors contribute to the decline of the infection rate, including rising socioeconomic levels, increased access to clean water and the availability of a hepatitis A vaccine that was developed in the 1990s. For populations with a high proportion of susceptible adults, implementing vaccination programs may be considered. In this report, we review available epidemiological data and implementation of vaccination strategies, particularly focusing on developing countries.

Economic Analysis of Hepatitis B Screening and Treatment

Economic Analysis of Hepatitis B Screening and Treatment