Presence Of Hepatitis B Virus Infection Research Articles

Epidemiology of hepatitis B in Europe and worldwide.

Hepatitis B virus (HBV) infection is a major public health problem and cause of infectious disease mortality worldwide. Approximately 2 billion people one third of the world’s population have serologic evidence of past or present HBV infection, and 350 million people are chronically infected. Each year over 1 million people die from HBV-related chronic liver disease, including cirrhosis and hepatocellular carcinoma (HCC) (1). HCC is one of the most common cancers worldwide, and HBV is responsible for at least 75% of these cancers (2).

Occult hepatitis B virus infection and its clinical implications.

Occult hepatitis B virus (HBV) infection is characterized by presence of HBV infection with undetectable hepatitis B surface antigen (HBsAg). Serum HBV level is usually less than 104 copies/mL in these patients. Diagnosis of occult HBV infection requires sensitive HBV-DNA PCR assay. Several possibilities have been hypothesized as the mechanisms of occult HBV infection. These include: (i) mutations of HBV-DNA sequence; (ii) integration of HBV-DNA into host's chromosomes; (iii) infection of peripheral blood mononuclear cells by HBV; (iv) formation of HBV-containing immune complex; (v) altered host immune response; and (vi) interference of HBV by other viruses. The precise prevalence of occult HBV infection remains to be defined. The clinical implications of occult HBV infection involve different clinical aspects. First of all, occult HBV infection harbours potential risk of HBV transmission through blood transfusion, haemodialysis, and organ transplantation. Second, it may serve as the cause of cryptogenic liver disease, contribute to acute exacerbation of chronic hepatitis B, or even fulminant hepatitis. Third, it is associated with development of hepatocellular carcinoma. Fourth, it may affect disease progression and treatment response of chronic hepatitis C. Most of the previous studies utilized retrospective observation without control groups, and lacked direct association of occult HBV infection with specific pathological changes and disease progression. Highly sensitive, quantitative, and functional molecular analyses of HBV, combined with a well-designed prospective clinical assessment will provide the best approach for the future study of occult HBV infection.

Impact of hepatitis B and hepatitis C virus infections in a hematology-oncology unit at a children's hospital in Nicaragua, 1997 to 1999.

The risk of acquiring both hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in patients with hematological-oncological disorders has been documented. However, the impact and risk factors for such infections from different geographical areas vary, and the use of both immunological and molecular assays to determine HCV infections has been our approach. Children from a hematology-oncology unit (HOU) in Nicaragua were studied for both HBV and HCV serological markers; studies for the latter used both immunological (anti-HCV) and molecular (HCV RNA) assays. The children from the HOU included patients with leukemia, lymphoma, other neoplasias, and anemia and a smaller group with other hematological diseases. As a control group, children from other units at the same hospital were enrolled, as well as health care workers attending both patient populations. Pertinent clinical and personal data for each child at the HOU were obtained for statistical analysis. Of the 625 children from the HOU enrolled in this study 53.3% were infected with HCV and 29.4% had a prior or present HBV infection. In the child patient control group 3.2% had HBV markers and all were negative for HCV. The group of children with leukemia had the highest infection rate for both HBV and HCV. However, the determination of anti-HCV was found to have an overall low sensitivity in children from HOU, and a retest consisting of a molecular assay to determine HCV RNA was performed to better establish the total number of HCV-infected subjects in this group. The highest independent risk factor for infection was hospitalization. The very high prevalence rates for both HBV and HCV infection in this patient group indicate an urgent need to implement better control of known risk factors and to consider the use of both immunological and molecular assays for HCV diagnostic purposes.

Very high prevalence of hepatitis B and C in Bukharian Jewish immigrants to Israel.

In Israel, the reported prevalence of hepatitis-C virus (HCV) infection among blood donors is 0.44%. As we found a high prevalence of chronic hepatitis-B virus (HBV) and HCV infection in Jewish immigrants from Uzbekistan and Tajikistan (Bukharian Jews) among our general patient population, we determined the prevalence of HBV and HCV infection among "healthy" Bukharian Jewish immigrants by screening for HBV and HCV markers and risk factors in a population of Bukharian Jews in north Jerusalem. A total of 27 (26.5%) of 102 patients were anti-HCV positive (by ELISA and confirmation tests). The HCV positive patients were older and had a higher rate of liver enzyme abnormalities than were the HCV-negative patients (56.5 +/- 2.3 versus 47.6 +/- 1.8, p = 0.003; and 14 of 27 versus 7 of 75, p < 0.01, respectively). HCV-positive patients with liver enzyme abnormalities were younger than HCV-positive patients without liver enzyme abnormalities (52.5 +/- 3.0 versus 62.8 +/- 2.8, p = 0.02). Sixteen patients (15.7%) were hepatitis-B surface antigen (HBsAg) carriers, and only two of these HBsAg carriers had liver enzyme abnormalities. None of the HCV-positive patients were HBsAg carriers (0 of 27 among HCV-positive patients versus 16 of 75 among HCV-negative patients, p = 0.0055). Past infection with HBV was found in 67 examinees (66%) (45 of 75 HCV-negative patients and 22 of 27 HCV-positive patients, p = 0.058). However, similar proportions of patients from both groups had past and present exposure to HBV [61 (81.3%) of 75 among HCV-negative patients versus 22 (81.5%) of 27 among HCV-positive patients]. Only 14 patients (13.7%) had no exposure to either HCV or HBV. Possible risk factors were use of nondisposable needles during mass vaccination in the U.S.S.R. or possible intrafamilial spread. The study concluded that immigrant Jews from former Asiatic U.S.S.R. republics have the highest rate of HCV positivity ever reported, and many of them have past and present HBV infection. Measures to prevent intrafamilial transmission of both viruses should be instituted.

Complete nucleotide sequences and the characteristics of two hepatitis B virus mutants causing serologically negative acute or chronic hepatitis B

Hepatitis B virus (HBV) DNA was amplified by the polymerase chain reaction from the sera of a patient with acute hepatitis and a patient with chronic hepatitis. Both patients were negative for serum hepatitis B surface antigen and hepatitis B core antibodies and had been previously diagnosed as non-A, non-B, non-C, non-D, non-E hepatitis. The nucleotide sequence revealed an 8-nucleotide deletion in the X-gene coding region creating a C-terminally truncated X protein, and probable mutation of the enhancer II/core promoter element. In addition, DR2 showed a T-to-C mutation at the extreme 5'-terminus. These mutations within the X-gene coding region must suppress replication and expression of HBV DNA, and this seems to be responsible for absence of serological markers despite the presence of HBV infection.

Occupational and non-occupational hepatitis B virus infection among hospital employees in Jerusalem: a basis for immunisation strategy.

The present study was designed to assess the risk of hepatitis B virus (HBV) infection among hospital employees, who often contract the infection before the beginning of their employment, and to suggest a prevention strategy. The study population consisted of 2518 subjects working or studying at the two Hadassah University hospitals, on Mount Scopus and at Ein Kerem in Jerusalem. The total prevalence for anti-HBc positivity as an indicator for past or present HBV infection was 17.6%. Several variables, including country of birth, age, and duration of employment significantly affected the rate of anti-HBc positivity. The highest rates for anti-HBc+ were found in personnel of selected departments such as haemodialysis (31.8%), haematology/oncology (28.3%), and the blood bank (24.0%), after adjustment for country of birth, age, and sex. Specific occupations in the hospital were associated with an increased rate of anti-HBc positivity. Thus the highest rate of HBV infection (after adjustment for country of birth, age, and sex) was shown for housekeepers (32.4%) and departmental secretaries (23.6%), who take care of waste products containing blood, or who transfer vials containing blood to the hospital laboratories. By comparison, anti-HBc was positive in 17.2% of nurses, 15.6% of physicians, and only 7.8% of administrative clerks. Israel is a country of immigration, and anti-HBc rates were four times higher in employees born in countries where HBV is more endemic--for example, in north Africa and Mediterranean countries--than in employees born in western Europe or the United States. However, rate of anti-HBc + increased significantly with age as well as duration of employment in the hospital, irrespective of country of birth. These data indicate that although HBV infection often occurs in Israel before commencement of employment in the hospital, hospital employees are at significant risk for contracting HBV infection during their professional lifetime regardless of where they were born. Moreover, paramedical personnel such as housekeepers and departmental secretaries are in the highest risk group for contracting HBV. Finally, as a result of the high background of anti-HBC positivity in selected ethnic groups, mandatory screening for anti-HBc before employment in medical institutions in Israel is recommended for them, then active vaccination against HBV for employees at risk. Employees who immigrated from western Europe and the United States should be immunised without pre-vaccination screening for HBV.

Sexual Practices in the Transmission of Hepatitis B Virus and Prevalence of Hepatitis Delta Virus Infection in Female Prostitutes in the United States

To evaluate heterosexual transmission of hepatitis B virus (HBV) and the prevalence of hepatitis delta virus (HDV) infection in female prostitutes. Survey. Sexually transmitted disease clinics, drug treatment programs, detention centers, and/or outreach efforts in eight areas in the United States. A total of 1368 female prostitutes 18 years of age or older. Seropositivity for HBV and HDV infection. The overall prevalence of past or present HBV infection was 56%: 74% in women who were injecting-drug users (IDUs), 38% in women reporting no history of injecting-drug use (non-IDUs), 51% in whites, 55% in blacks, and 67% in Hispanics. Of 21 HBV carrier IDUs, 21% had HDV infection; of 18 HBV carrier non-IDUs, 6% had HDV infection. In non-IDUs (49%), risk factors for HBV infection were a history of having penile-anal intercourse (odds ratio [OR], 3.1; 95% confidence limits [CL], 1.3, 7.3) and seropositivity for syphilis and human immunodeficiency virus (HIV) infection. In IDUs, factors associated with an increased risk of infection, in addition to behaviors related to injecting-drug use, were the number of lifetime sexual partners, having sexual partners from groups at high risk for HBV infection, and seropositivity for syphilis and HIV infection; spermicide and/or diaphragm use was associated with a markedly decreased risk of HBV infection among blacks (OR, 0.1; 95% CL, 0.03, 0.4) and Hispanics (OR, 0.2; 95% CL, 0.06, 0.9). This is the first study to suggest that having anal intercourse and failing to use vaginal contraceptives may facilitate transmission of HBV to women. Our data support guidelines that recommend hepatitis B vaccination for prostitutes and persons with a history of sexually transmitted diseases or multiple sexual partners.

Sexual practices in the transmission of hepatitis B virus and prevalence of hepatitis delta virus infection in female prostitutes in the United States

<h3>Objective.</h3> —To evaluate heterosexual transmission of hepatitis B virus (HBV) and the prevalence of hepatitis delta virus (HDV) infection in female prostitutes. <h3>Design.</h3> —Survey. <h3>Setting.</h3> —Sexually transmitted disease clinics, drug treatment programs, detention centers, and/or outreach efforts in eight areas in the United States. <h3>Participants.</h3> —A total of 1368 female prostitutes 18 years of age or older. <h3>Outcome Measures.</h3> —Seropositivity for HBV and HDV infection. <h3>Results.</h3> —The overall prevalence of past or present HBV infection was 56%: 74% in women who were injecting-drug users (IDUs), 38% in women reporting no history of injecting-drug use (non-IDUs), 51% in whites, 55% in blacks, and 67% in Hispanics. Of 21 HBV carrier IDUs, 21% had HDV infection; of 18 HBV carrier non-IDUs, 6% had HDV infection. In non-IDUs (49%), risk factors for HBV infection were a history of having penile-anal intercourse (odds ratio [OR], 3.1; 95% confidence limits [CL], 1.3, 7.3) and seropositivity for syphilis and human immunodeficiency virus (HIV) infection. In IDUs, factors associated with an increased risk of infection, in addition to behaviors related to injecting-drug use, were the number of lifetime sexual partners, having sexual partners from groups at high risk for HBV infection, and seropositivity for syphilis and HIV infection; spermicide and/or diaphragm use was associated with a markedly decreased risk of HBV infection among blacks (OR, 0.1; 95% CL, 0.03,0.4) and Hispanics (OR, 0.2; 95% CL, 0.06, 0.9). <h3>Conclusion.</h3> —This is the first study to suggest that having anal intercourse and failing to use vaginal contraceptives may facilitate transmission of HBV to women. Our data support guidelines that recommend hepatitis B vaccination for prostitutes and persons with a history of sexually transmitted diseases or multiple sexual partners. (<i>JAMA</i>. 1992;267:2477-2481)

Risk Assessment for Aflatoxin: II. Implications of Human Epidemiology Data

A review of epidemiology literature revealed that only studies conducted in Africa and Asia included data adequate to permit quantitative assessment of the dose-response relationship between aflatoxin exposure levels and liver cancer rates. Although these studies were judged adequate, their direct use to predict risks in U.S. populations may be questioned since hepatitis B virus (HBV) infections are far more common in the studied areas than in the U.S. Recent research indicates that, if aflatoxin contributes to the development of liver cancer, it almost always does so in the presence of HBV infection. The African/Asian data do not permit us to estimate the potency of aflatoxin in the absence of HBV. Recognizing this, these data can only be used to establish upper limits for the predicted excess lifetime risk for liver cancer in the U.S. When used in conjunction with aflatoxin exposure estimates for the Southeast U.S., these data predict a liver cancer rate, due to aflatoxin alone, far above that actually observed due to all causes; this provides an indication of the conservatism of this approach. Data from the Southeast U.S. may be used to estimate an excess lifetime risk for liver cancer of 2.17 x 10(-6) x (aflatoxin intake, ng/kg/day).

Heterosexual Transmission of Hepatitis B Virus in Belle Glade, Florida

A population-based serosurvey of human immunodeficiency virus in Belle Glade, FL, enabled evaluation of risk factors for hepatitis B virus (HBV) infection in this racially mixed community. Serum samples from 725 adults and 130 children were tested for markers of HBV infection, and histories of exposure to HBV were obtained by interview. The overall prevalence of past or present HBV infection was 26%; prevalence was 9% among whites, 5% among Hispanics, 30% among blacks, and 57% among Haitians. Prevalence of HBV infection was 3% in children aged 2-10 years and increased to 31% in adults greater than 17 years. Of adults seropositive for HBV, only 5% had homosexual partners or used parenteral drugs, but 47% had a positive serologic test for syphilis. Factors associated with HBV infection in adults were positive serologic test for syphilis (odd ratio [OR] = 3.1; 95% confidence limits [CL] = 2.0, 4.8), and having had two or more lifetime heterosexual partners (OR = 3.2; 95% CL = 1.6, 6.4). In this community, HBV infection was transmitted predominantly by heterosexual contact.

Hepatitis B virus infections transmitted from retarded children to their families during brief home exposure.

Hepatitis B virus (HBV) infection is endemic among institutionalized retarded patients, who usually have mild, anicteric hepatitis following nonparenteral exposure. We evaluated the risk of HBV infection (as evidenced by serologic studies) among their contacts, including noninstitutional caretakers, during brief home exposure. Caretakers shaved, bathed, and changed diapers for five patients during home visits or foster home placements. Seven of the 14 caretakers, who were exposed for 3-12 months, developed antibodies (anti-HBc and/or anti-HBs). A mother and her daughter's caretaker were found to have asymptomatic acute HBV infection, and the mother developed antibodies to HBs, HBc, and HBe. In a second household, another caretaker became anti-HBs-positive. Only one of nine play contacts and none of seven casual contacts had markers of past or present HBV infection. The study was a unique opportunity to retrospectively and prospectively monitor HBV transmission. Our results show that noninstitutional caretakers deserve the protection of HBV vaccine to diminish the potential for chronic infection and transmission of HBV infection.

472 HEPATITIS B DURING PREGNANCY: IDENTIFICATION OF HIGH RISK GROUPS

Recent studies confirming the efficacy of hepatitis B immune globulin for the prevention of neonatal hepatitis B virus (HBV) infection have highlighted the need for identifying high risk pregnant women in the United States. During the period March to November 1980, of 300 pregnant women of Chinese extraction at New York Infirmary Hospital who were tested for hepatitis B surface antigen (HBsAg), 43 (14.3%) were positive. Of 37 HBsAg-positive women who were tested for ‘e’ antigen (HBeAg), 18 (48.6%) were positive. Of 236 women who were tested for both HBsAg and its antibody (anti-HBs), 132 (56%) had evidence of present or past HBV infection; 13.5% HBsAg-positive and 42.5% anti-HBs-positive. About 98% of the women were born outside the United States, 80 to 90% from Mainland China and Hong Kong and the others from Taiwan, Burma, Macau and other islands. Their length of stay in the USA ranged from 3 months to 15 years. In view of these findings Chinese women should be routinely tested for HBsAg during pregnancy.

Prevalence of Hepatitis B in a High-Risk Setting: A Serologic Study of Patients and Staff in a Pediatric Oncology Unit

The prevalence of serologic markers for hepatitis B virus (HBV) among 188 patients and 158 employees in a pediatric oncology unit was evaluated. Evidence of past or present HBV infection was detected in 33 patients (18%) and in 25 employees (16%). The prevalence was higher among patients receiving chemotherapy (19%) than among those not receiving chemotherapy (7%). The prevalence of HBV serologic markers, while much higher than generally found among healthy children in the United States, was low compared to previously reported prevalences in such settings, and may reflect the use in recent years of blood and blood products screened by "third generation" methods (radioimmunoassay and reversed passive hemagglutination) for hepatitis B surface antigen and the use of all volunteer blood donors. This prevalence suggests that perhaps there is less urgent need for the use of hepatitis B immune globulin and hepatitis B vaccine (when it becomes available) in oncology units than had been anticipated from earlier data in oncology units.

Vertical Transmission Status of Hepatitis B Virus in Asymptomatic Carriers in Bangladesh – Experience from a Tertiary Centre

doi: 10.3329/taj.v21i1.3209 TAJ 2008; 21(1)