Protective Levels Of anti-HBs Research Articles

The Effectiveness and Sero-Immunity of Hepatitis B Vaccination in People Who Use Drugs: A Systematic Review and Meta-Analysis

Hepatitis B virus (HBV) vaccination has been available for over four decades. However, a synthesis of the evidence regarding the effectiveness of this strategy on preventing hepatitis B infection in people who use drugs (PWUD) is lacking. A systematic search of the MEDLINE (via PubMed), SCOPUS, Web of Science, and Cochrane Library databases was conducted up to June 2024. Eight studies reported on the effectiveness of HBV vaccination, defined as a positive result for HBsAg or anti-Hbc in vaccinated versus non-vaccinated PWUD, with a pooled effect size of 52% (95% CI: 28.2–67.9) for HBsAg and 31.89% (95% CI: 14.8–45.5) for anti-Hbc. For sero-immunity, defined as the proportion of vaccinated PWUD with levels of anti-HBs ≥ 10 mIU/mL, we found that 66.2% (95% CI: 0.61–0.71; I2 = 94%) had protective levels of anti-HBs. The results of this meta-analysis indicate that the incidence of HBV infection is lower in vaccinated PWUD than in those who did not receive the vaccine. However, the effectiveness is lower than that observed in the general population. This highlights the need for a thorough review of the factors influencing the prevention of HBV infection in PWUD.

HEPATITIS B VACCINATION STATUS AMONG A TARGET GROUP BORN IN 1992-2000: A STUDY FROM BULGARIA

The purpose of this study is to determine the prevalence of stress among students of various health Hepatitis B virus (HBV) infection is a significant cause of morbidity and mortality and a leading cause of chronic liver disease. Vaccination has a key role in hepatitis B prevention. Compulsory immunization for all healthy newborns was introduced in Bulgaria in 1992 as part of the WHO global strategy. Purpose: The aim of this study was to determine the extent of post-vaccination seroprotection among persons born in 1992 – 2000 who received recombinant hepatitis B vaccine. Material/methods: A total of 923 serum samples of a target group of vaccinated individuals (412 males and 511 females) at a mean age of 23.0±2.7 years were tested over a two-year period (2018-2019). The quantitative analysis of hepatitis B surface antibodies (anti-HBs) levels was performed by CLIA using a LIAISON® anti-HBs II quantitative diagnostic kit (Dia Sorin, Italy). Results: All 923 individuals included in the study were hepatitis B surface antigen (HBsAg) negative. Protective anti-HBs titers ranging from 11 to >1000 mIU/mL were found in 45.3% of them. The sex distribution of the tested subjects varied significantly between years (p=0.023). The difference in protective anti-HBs levels between the two sexes was non-significant (p>0.05). There was a weak negative correlation between year of birth and anti-HBs titer (Pearson's r=0.351, p<0.001). Conclusions: The results of this large study conducted among subjects immunized against hepatitis B in childhood showed varying levels of post-vaccination seroprotection. On average, 23 years after universal immunization, 54.7% of the study cohort had no protective levels of anti-HBs (negative or equivocal result).

Evaluation of Post-Vaccination Immunity in Children and Adolescents after Viral Hepatitis B Vaccine

Vaccination against viral hepatitis B is an effective method of protection against this infection. There is multiple decrease in the hepatitis B incidence. However, there was increase in chronic hepatitis B by 42.5%, 15 cases of acute viral hepatitis B in children and 2 deaths from this infection were registered according to the state report “On the sanitary and epidemiological wellbeing of the population of the Russian Federation for 2022”. The criteria for evaluating protection against viral hepatitis B are the anti-HBs level and the duration of post-vaccination immunity.Objective. The aim of the study is to evaluate the duration of postvaccination immunity in temporal aspect in children and adolescents vaccinated against viral hepatitis B.Methods. Prospective open-label study was conducted to assess post-vaccination immunity against viral hepatitis B in 143 children and adolescents. The study of anti-HBs was implemented via the immunoenzyme test system “Vectohep B-HBs-antigen”. Microsoft Office Excel 2010 package and the Prism9 program (GraphPad, USA) were used for statistical analysis.Results. It has been shown that hepatitis B vaccine provides 100% seroconversion. However, decrease in anti-HBs levels was revealed already 6 months after vaccination in 15.07% of cases of seronegative individuals, after 1 year their number has increased up to 28.77% of cases. On average, every fourth person had low protective level of anti-HBs. Almost two-thirds of adolescents became seronegative by the age of 14.Conclusion. Vaccination against viral hepatitis B ensures the maximum production of anti-HBs 1 month after the completed vaccination in 100% of cases. Antibody level begins to decrease 6 months after the third completed vaccination against hepatitis B, and in 14 years, 72.74% of those immunized become seronegative. All of these dictates the need to consider a booster dose in adolescents at the age of 14 years.

Antibody persistence of standard versus double three-dose hepatitis B vaccine in liver transplant children: a randomized controlled trial

Rapid hepatitis B (HB) surface antibody (anti-HBs) loss is prevalent after liver transplantation (LT). Herein, we evaluated anti-HBs persistence after HB vaccination using two regimens in LT children. We recruited 66 previously immunized LT children with anti-HBs level of < 100 mIU/mL. Participants were randomly reimmunized with standard-three-dose (SD) and double-three-dose (DD) intramuscular HB vaccination at 0, 1, and 6 months. Anti-HBs were assessed at every outpatient visit. Antibody loss defined as anti-HBs levels < 100 mIU/mL after three-dose vaccination. After three-dose vaccination, 81.8% and 78.7% of participants in the SD and DD groups, had anti-HBs levels > 100 mIU/mL, with a geometric mean titer (GMT) of 601.68 and 668.01 mIU/mL (P = 0.983). After a mean follow-up of 2.31 years, the anti-HBs GMT was 209.81 and 212.61 mIU/mL in the SD and DD groups (P = 0.969). The number of immunosuppressants used and an anti-HBs level < 1 mIU/mL at baseline were independently associated with anti-HB loss. The DD regimen strongly increased the risk of anti-HBs loss (adjusted hazard ratio, 2.97 [1.21–7.31]; P = 0.018). The SD HB reimmunization regimen effectively maintained protective anti-HBs levels in children undergoing LT, making it the preferred regimen for such children with anti-HB loss.Trial registration: TCTR20180723002.

Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infections in Hemodialysis Patients at Kano Kidney Center.

Background Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections are more prevalent in hemodialysis patients compared to the general population. The objective of this study was to evaluate the prevalence of HBV, HCV, and HIV infections in hemodialysis patients dialyzing regularly at Kano Kidney Center (KKC) in the Eastern Health Cluster of Saudi Arabia in 2022. Methods This retrospective study included all hemodialysis patients who were dialyzed regularly at KKC during 2022. Their electronic medical records were reviewed for the results of HBV, HCV, and HIV along with the patient's demographics, comorbid conditions, and dialysis history. The study was approved and monitored by the Institutional Review Board of Dammam Medical Complex. Results A total of 239 regular hemodialysis patients were included, consisting of 142 males and 97 females (59.41% and 40.59%, respectively), with a mean age of 52.71±15.83 years. Most of the patients were Saudis (156 patients, 65.27%) with the non-Saudi patients being composed mostly of Arabian patients.Nine patients (3.77%) tested positive forhepatitis B surface antigen (HBsAg), the serologic hallmark of HBV infection. Two patients (0.84%) had resolved HBV infections as evidenced by positive hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs). However, the majority (226 patients, 94.56%) were never tested for anti-HBc. Anti-HBs, which can imply long-term immunity against HBV from prior immunizations or infections, were positive in 165 patients (69.04%). A protective anti-HBs level of ≥ 10 IU/L was detected in 158 patients (66.11%) including 104 patients (43.51%) having ≥ 100 IU/L. Eighteen patients (7.53%) had reactive HCV antibodies. Four patients (1.67%) had chronic HCV infection as they had detectable HCV RNA. The remaining 14 patients (5.86%) cleared HCV either spontaneously (seven patients, 2.93%) or by medications (seven patients, 2.93%). HIV screening tests were negative in all 239 patients (100%). HBsAg-positive patients did not have any statistically significant differences from HBsAg-negative patients. On the other hand, the patients who were positive for HCV antibodies were older than the patients who were negative for HCV antibodies (60.66 vs 52.05 years on average, p-value <0.05). They also contained a statistically larger proportion of non-Saudi patients than the patients with no evidence of prior infections (61.11% vs 32.13%, p-value <0.05). Conclusions The study found that the prevalence of HBV and HCV infections among hemodialysis patients in KKC at 3.77% and 1.67%, respectively, is higher than that reported in the general populationin Saudi Arabia, with non-Saudis having a higher prevalence rate of HCV infection than Saudis.However, the current prevalence rate is lower compared to the previous studies that were conducted in Saudi Arabia in the first decade of the 21st century, and there were no cases of HIV infections. Nevertheless, a significant proportion of patients had unprotective or negative anti-HBs antibody titers, indicating the need for strict vaccination protocols and monitoring of antibody titers to ensure optimal protection.

Efficacy of Hepatitis B Vaccination Procedures in Infants and Children Born from HBsAg-positive Mothers in Iran: A Case Study of Khorasan Razavi Province, Iran

Background: Viral infections have been a major public health concern in recent years. Viral hepatitis B virus (HBV) is one of the serious healthcare system issues in Iran. Family transmission of HBV in pregnant women is a major cause of the high prevalence of HBV infection in neonates and related persons. The expanded program on immunization (EPI) was the main way to prevent this infection. Objectives: This study aimed to estimate the effectiveness of the hepatitis B vaccine in infants born to HBsAg-positive mothers in Khorasan Razavi province. Materials and Methods: This cross-sectional descriptive study was conducted on 53 HBsAg-positive women between March 2017 and April 2019 in Khorasan Razavi province, Iran. The enzyme-linked immunosorbent assay (ELISA) was employed to conduct screenings for HBsAg in children. Risk factors for HBV infection were investigated using medical records and structured questionnaires. Results: The prevalence of HBsAg positivity was 1.2% (1/83) among children aged 1-3 years old. All children received three doses of HBV vaccine according to the HBV immunization program. The positive hepatitis B surface antibody (HBsAb) test among children under study was 80.7% (n=67). Conclusion: The results indicated a low prevalence of hepatitis B infection among infants and children born to HBsAg-positive mothers (1.2); however, protective anti-HBs levels were reported in 80.7% (&lt;95%) of the children. It appears that the efficiency level of the hepatitis B vaccination procedure was not sufficient in this study. Overall, revaccination is recommended for children who are anti-HBs-negative or not protected.

Persistence of hepatitis B surface antibody to hepatitis B vaccine among medical college students in Najran University, Saudi Arabia.

Around 257 to 291 million people worldwide are infected with the hepatitis B virus (HBV). Immunization is one of the most effective ways to combat HBV infection. Saudi Arabia implemented a mandatory hepatitis B immunization program in 1989. This project investigated the levels of hepatitis B surface antibodies (anti-HBs) among medical students in the college of applied medical science at Najran University in December 2020. Students (n=82) were tested for anti-HBs levels using a chemiluminescent microparticle immunoassay (CMIA). Anti-HBs levels were the main outcome measures. Results showed that about 81.7% of participants had an insufficient amount of Anti-HBs levels (<10 IU/ L) compared to 18.3 % of participants who had protective levels of anti-HBs (≥10 IU/ L). However, 78.5% of the reactive group was at risk of losing immunity with a level between 12 and 42 IU/ L. Our study also showed an association between the age and the level of anti-HBs. Moreover, male students were at more risk than female students. Our results showed a strong relationship between Blood Groups and Anti-HBs antibody levels. The O+ (with 38.8%) and A+ (with 25.4%) blood groups showed the highest percentage amongst participants who had inadequate protection of anti-HBs (<10 IU/ L). Thus, data helps in our understanding and observations on anti-HBV immunity in individuals twenty years after being vaccinated as a child. According to the findings of our study, a large majority of students had a non-protective anti-HBs titer.

The Changes In The AntiHBs Values Following COVID-19 Pneumonia

Background/aim: We aimed to determine if there is a decrease in antiHBS titer below the protective value during Coronavirus-19 disease (COVID-19). Materials and methods: A prospective study was made of 67 patients who had positive antiHbs values checked in the last 1 year. Demographic data and the previous antiHBs values were collected from the patient files and the laboratory findings of new antiHBs titers checked after one months later following COVID-19 infection were compared with the previous ones. Results: In the postcovid evaluation, a statistically significant decrease in the antiHBs levels of COVID-19 patients was determined with respect to previous values before COVID-19 infection (p&amp;lt;0,001). Conclusion: In our study, we found that there was a statistically significant decrease in AntiHBs levels after COVID-19 infection, but none of them were below protective antiHBs levels. As a result, we can say a booster vaccination against hepatitis B is not needed during or after COVID-19 infection, but it would be appropriate to support it with studies with a higher number of patients.

Herd Immunity to Hepatitis B in the Russian Federation in 2017–2019

Relevance. Hepatitis B is a global problem of global and Russian public health due to its high prevalence and the possibility of forming a chronic form of the disease with the development of cirrhosis and hepatocellular carcinoma. Aims. Assessment of the herd immunity to hepatitis B in the population of the Russian Federation in 2017‒2019.Materials and methods. The research was carried out at the Central Institute of Epidemiology within the framework of a large-scale program to assess herd immunity to hepatitis B in the population of the Russian Federation. The results of studies for the presence of anti-HBs in various subjects of the Russian Federation in 2017 to 2019, which were performed in accordance with MU 3.1.2943-11, were analyzed. Additionally, as a reference study in 2020, a survey of donors in Moscow (n = 427) was conducted for the presence of anti-HBs. Standard methods of descriptive statistics Microsoft Excel and STATISTICA 12.0 (StatSoft, USA) were used for statistical processing. The mean values were estimated taking into account the 95% confidence interval [95% CI] (according to the Klopper-Pearson method (exact method).Results. The average annual values of the proportion of persons with protective immunity against hepatitis B for 2017, 2018 and 2019 were 70.03%, 67.95% and 66.36%, respectively. Significant differences were revealed in the average values of the proportion of persons with a protective level of anti-HBs in the Federal Districts (FD): higher than the average Russian indicators were found in the Northwestern (74.2%), Southern (71.0%) and Far Eastern FD (70.7%). In 44 subjects of the Russian Federation during the observation period, the proportion of persons with protective immunity against hepatitis B was less than 60%.Conclusion. The necessity of optimizing the system of serological monitoring of post-vaccination immunity against hepatitis B is substantiated, which will increase the effectiveness of preventive measures nationwide

Antibody levels and protection after Hepatitis B vaccine in adult vaccinated healthcare workers in northern Uganda.

Hepatitis B vaccine has contributed to the reduction in hepatitis B virus infections and chronic disease globally. Screening to establish extent of vaccine induced immune response and provision of booster dose are limited in most low-and-middle income countries (LMICs). Our study investigated the extent of protective immune response and breakthrough hepatitis B virus infections among adult vaccinated healthcare workers in selected health facilities in northern Uganda. A cross-sectional study was conducted among 300 randomly selected adult hepatitis B vaccinated healthcare workers in Lira and Gulu regional referral hospitals in northern Uganda. Blood samples were collected and qualitative analysis of Hepatitis B surface antigen (HBsAg), Hepatitis B surface antigen antibody (HBsAb), Hepatitis B envelop antigen (HBeAg), Hepatitis B envelop antibody (HBeAb) and Hepatitis B core antibody (HBcAb) conducted using ELISA method. Quantitative assessment of anti-hepatitis B antibody (anti-HBs) levels was done using COBAS immunoassay analyzer. Multiple logistic regression was done to establish factors associated with protective anti-HBs levels (≥ 10mIU/mL) among adult vaccinate healthcare workers at 95% level of significance. A high proportion, 81.3% (244/300) of the study participants completed all three hepatitis B vaccine dose schedules. Two (0.7%, 2/300) of the study participants had active hepatitis B virus infection. Of the 300 study participants, 2.3% (7/300) had positive HBsAg; 88.7% (266/300) had detectable HBsAb; 2.3% (7/300) had positive HBeAg; 4% (12/300) had positive HBeAb and 17.7% (53/300) had positive HBcAb. Majority, 83% (249/300) had a protective hepatitis B antibody levels (≥10mIU/mL). Hepatitis B vaccine provides protective immunity against hepatitis B virus infection regardless of whether one gets a booster dose or not. Protective immune response persisted for over ten years following hepatitis B vaccination among the healthcare workers.

The Difference of Anti-HBs Levels in Babies Vaccinated with Hepatitis B Vaccine Between at 2, 4, 6 Months with 2, 3, 4 Months Schedule in Denpasar

<i>Background</i>: Hepatitis B virus is one of the causes of the major health problem throughout the world. Hepatitis B vaccine is one way to control HBV infections effectively. The prevalence of HB infection shows a decreased effectivity of Hepatitis B vaccination. <i>Objective</i>: To discover the differences in anti-HBs levels between two schedules of vaccination recommended by the Indonesian Pediatric Society (at 2, 4, 6 months vs 2, 3, 4 months of age). <i>Methods</i>: This was an observational study on healthy babies comparing the effect of two treatment groups, each consisting of 30 subjects. Subjects were chosen by stratified random sampling. Blood samples were withdrawn three months after the subjects received their last dose of Hepatitis B vaccination, either in 2, 4, 6 months schedule (Group 1) or in 2, 3, 4 months schedule (Group 2). We used the independent t-test to assess the mean differences between the anti-HBs levels of the two groups. A p-value of<0.05 was considered statistically significant. <i>Results</i>: We found a significant difference in anti-HBs levels between Group 1 and Group 2 (820.06 mIU/ml vs 540.54 mIU/ml, respectively, p=0.002). <i>Conclusion</i>: Both vaccination schedules produced protective anti-HBs levels three months after the completed schedule. The anti-HBs level in group 1 produced higher anti-HBs level compared to Group 2.

Estimation of Anti-HBs Titer in Health Care Professionals of a Tertiary Care Centre of Southern Assam

Background- Due to occupational exposure to blood, body fluids and sharps, the health care professionals are at increased risk of contracting the Hepatitis B virus infection than general population. To combat this, all the health care professionals must be immunized with protective level of anti-HBs but anti-HBs titer gradually wanes with passage of time and may be influenced by gender, smoking or chewing tobacco, diabetes mellitus etc. This study was thus carried out to find the percentage of health care professionals with protective titer of anti-HBs and find the association (if any) of low anti-HBs titer and factors like gender, smoking, diabetes mellitus and time elapsed post vaccination. Method- This cross-sectional study has been carried out with proper ethical clearance from May2018- September2019 in Serology section of VRDL under Department of Microbiology in a Medical College of Southern Assam on serum samples collected from 150 health care professionals vaccinated with 3 doses of recombinant HBsAg vaccine atleast 5years back. Anti-HBs IgG concentration was measured by conventional ELISA in multistandard mode. Result- Out of 150 participants,95 were males and 55 were females.27 participants smoked/chewed tobacco,8 had diabetes mellitus. Booster dose was received by 23. Protective level of anti-HBs IgG (&gt;10 IU/ml) was found in 66% (98/150) of HCP only. Low anti-HBs titer has been found to be significantly associated with Diabetes mellitus (p–0.03) and passage of more than 10 years post primary vaccination(p-0.005) but no significant association has been found with gender, smoking and history of blood transfusion. Conclusion- HBsAg vaccine doesn’t impart everlasting protection. So, all HCP, especially those with co-morbidities should get their anti-HBs titer estimated after vaccination to check out for adequate seroconversion and attainment of protective titer. If found inadequate, they should go for repeat vaccination /booster doses. Keywords: Healthcare professionals, Vaccinated, Anti HBs IgG, Assam,

How does the immunogenicity of hepatitis B vaccine change over the years in childhood?

ABSTRACT Hepatitis B is the leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma worldwide. The incidence of HBV infection has significantly decreased with hepatitis B vaccination. Hepatitis B vaccine is administered to children at 0, 1 and 6 months of age according to the national schedule. There is a high rate of protective antibody (anti-HBs) development after hepatitis B vaccination. We conducted the study to investigate how the hepatitis B surface antibody (anti-HBs) positivity rates and the titers change over time in childhood following vaccination. Patients who presented at the general pediatric outpatient clinic of Yenimahalle Education and Training Hospital and the HBsAg and anti-HBs titers were tested for any reason between July 2011 and May 2018 were retrospectively evaluated. The cutoff level for protection by the anti-HBs titer was accepted as ≥10 mIU/mL with lower levels indicating no protection. Anti-HBs positivity was compared by age group. Anti-HBs levels were studied in 4326 children. The mean age of the included in the study was 127 ± 62 months. A protective anti-HBs level (≥10 mIU/mL) was present in 2292 children (69.2%). The highest anti-HBs antibody positivity rate was in the under 3 years’ age group. The positivity rate significantly decreased after age 7 years. The HBsAg level was determined in all children in the study and five had a positive result. In conclusion, our study found that the anti-HBs positivity rate and the anti-HBs level decreased with age. However, the anti-HBs antibody result remained positive in more than half of the children.

Long-term immune protection against HBV: associated factors and determinants

ABSTRACT In Italy, vaccination against hepatitis B became compulsory for all the newborns and 12-years-old adolescents in 1991. The main purpose of this study was to evaluate the persistence of long-term protection against HBV in medical students of the University of L’Aquila and in postgraduates Medical Doctors (HCWs) working in San Salvatore Hospital. The second aim was to study the variables associated with a protective anti-HBs antibody level, such as age at vaccination, gender, time elapsed from the last dose of vaccination. Three hundred and forty-two subjects were enrolled from January 2017 to January 2019 and a blood sample was collected to evaluate the levels of serum HBsAg, anti-HBs and anti-HBc. Statistical analysis calculated a multivariable logistic regression model to examine predictors of a protective anti-HBs titer. The larger part (239, 70%) of the students had an anti-HBs titer >10 mIU/mL, those were statistically significant older (26.7 vs 24.5 years, p < .001), vaccinated at age 12 years (83.5% vs 59.9% among vaccinate at infancy, p < .001) and more frequently attending postgraduate medical school (80.8% vs 57.5% among healthcare profession school, p < .001). The multivariable logistic regression model showed that HBV vaccination at age of 12 was significantly and independently associated with protective titers (OR = 10.27, p = .019). The results agreed with literature on HBV vaccination, confirming the efficacy of vaccination after 20 years. In particular, our results suggest that adolescent administration is the main predictor of a protective title, regardless of gender, course and years since vaccinations.

Seroconversion of hepatitis B surface antigen among those with previously successful immune response in Southern China

ABSTRACT Recommendations promoted worldwide have suggested a period of protection lasting more than 20 years against hepatitis B (HB) following primary immunization. Starting in 1987, universal HB vaccinations were carried out in Long An County, Guangxi Province, one of the earliest counties in which plasma-derived HB vaccine was delivered to newborns across China. Data collection targeted toward understanding the long term (26–33 years since primary immunization) immune effects of the plasma-derived HB vaccine was conducted in 2015; a second data collection was carried out in 2019 to assess seroconversion in the same cohort. This study qualitatively compared positive vs negative results and quantitatively assessed HB biomarkers – HB surface antigen (HBsAg), antibody to HBsAg (anti-HBs), HB e-antigen (HBeAg), antibody to HBeAg (anti-HBe), and antibody to HB core antigen (anti-HBc) – in serum 26–33 years after the full initial course of HB vaccination, then analyzed anti-HBs seroconversion using the two-phase sampling method in the same cohort and calculated the anti-HBs seroconversion rate from 2015 to 2019. The protective sero-conversion rate (anti-HBs ≥10mIU/mL) was 37.6% (192/511); the HBsAg-positive rate was 5.3% (27/511); the anti-HBs mean geometric titer (GMT) was 11.1 mIU/mL. Among the 143 participants involved in both 2015 and 2019 data collections, the seroconversion rate was 3.5% (5/143); two individuals had protective anti-HBs levels in 2015. These findings indicate that anti-HBs status can be seroconverted to a protective concentration level 4 years earlier in a high HBV epidemic region. The role of genomic mutations and the disappearance of immune memory and seroconversion should be investigated.

High Risk of HBV Infection Among Vaccinated Polytransfused Children With Malignancy.

The national Egyptian hepatitis B virus (HBV) vaccination program coverage of all infants started in 1992. The study aimed to assess immunity against HBV and occurrence of HBV breakthrough infections in vaccinated polytransfused children with malignancies. Eighty-nine polytransfused children with malignancies were recruited; 37 were on chemotherapy (male:female 20:17; mean age 7.7±4.0 y), and there were 52 naive patients (male:female 31:21; mean age 7.6±3.2 y). In addition, 162 age-matched and sex-matched healthy controls were recruited. Patients' sera were tested for quantitative anti-hepatitis B surface (HBs) (enzyme-linked immunoassays technique), hepatitis B surface antigen (HBsAg), total anti-hepatitis B core, and HBV-DNA (nested polymerase chain reaction for surface, core, and x-regions). There was a significant lower percentage of having protective anti-HBs (10 to 100 IU/L) level among those receiving chemotherapy (13.5%) than those without (44.2%) and controls (32.1%). Twenty-one (67.7%) of those on chemotherapy were HBsAg positive compared with 10 (32.2%) of those without. Overall, 46 patients were HBV-DNA positive; 38 were c-region positive, 5 were s-region positive, 2 positive for the c-region and the s-region, and 1 tested positive for the c-region and the x-region. Of 46 patients, 20 were also positive for HBsAg (overt infection), while 26 had occult HBV infection (HBsAg-negative). Anti-HBs ≥10 IU/L co-existed among 45% of patients with overt infection and in 50% of those with occult infection. There was nonsignificant impact of receiving chemotherapy on the level of HBV-DNA. Vaccinated children with malignancies, especially those under chemotherapy, are at a significant risk of HBV infection. The co-existence of anti-HBs with HBsAg and/or HBV-DNA may represent a possible residual transfusion-transmission risk with mutant HBV strains.

HBV and HCV in Health care workers and students of a newly established Tertiary care hospital at Rishikesh: Prevalence and immunity status

Background: Hepatitis B and C cause serious infectious disease of the liver which affects millions of people worldwide. More than 2 billion people living today have been infected with Hepatitis B virus (HBV) at some time in their lives and about 350 million people are carriers of the virus. Aim: To detect HBV and HCV infection and assess HBV immunity status amongst healthcare workers, medical students and nursing students at AIIMS Rishikesh. Methods: 135 participants (Medical faculty, Nursing Faculty, Resident Doctors, laboratory technicians, laboratory attendants, medical and nursing students) were enrolled for the study. Serological tests HBsAg, anti-hepatitis C virus antibodies (anti-HCV), anti-HBs antibodies, were performed. None were positive for HBsAg 1.5% were positive for Anti HCV antibodies and 61.75% had protective levels of antiHBs. Conclusion: HBV vaccination and screening for HBV, HCV, and anti-HBs of all HCW and students at time of entry should be done. Yearly screening thereafter should be done to check as follow up. Regular training on HBV vaccination and safe practices should be emphasized at all levels of HCW.

Prevalence of chronic HBV infection in pregnant woman attending antenatal care in a tertiary hospital in Mwanza, Tanzania: a cross-sectional study

BackgroundTanzania has a high prevalence (7.17%) of chronic hepatitis B infection. Mother to Child transmission is very common, resulting in high rate of chronic infections. Currently, there is no screening program for HBV in pregnant women. This study investigated the prevalence and risk factors for chronic HBV infection in pregnant women in a tertiary hospital in Mwanza, Tanzania.MethodsSeven hundred and forty-three women attending antenatal care and/or delivering at the Bugando Medical Centre were enrolled. All answered a questionnaire on sociodemographic and other risk factors and were tested for HBsAg using a rapid test. In HBsAg positive mothers, maternal blood and umbilical cord blood samples collected after delivery were analyzed for serological (HBsAg, HBeAg and anti-HBe) and virologic (HBV-DNA viral load and genotype) markers. All their babies were vaccinated within 24 h of delivery. The children were followed up at 3 years of age. Data was analyzed using the Mann-Whitney U-test, independent sample T-test and logistic regression.ResultsOf the 743 participants, 22 (3%) were positive for HBsAg, and 2 (9%) had detectable HBe-antigen. Low condom use was the only statistically significant risk factor for chronic HBV infection (OR = 3.514, 95%CI = 1.4–8.0). Of 14 maternal blood samples genotyped, 10 (71%) were genotype A and 4 (29%) were genotype D. HBV-DNA was detected in 21/22 samples, with a median of 241 IU/ml (range: 27.4–25.9 × 107 IU/ml). Five (33%) of 15 available cord blood samples were positive for HBsAg and 10 (67%) were negative. At follow-up, one child showed chronic HBV infection characteristics, one had anti-HBs level of 7 mIU/ml and 5/7(71%) had protective anti-HBs levels (> 10 mIU/ml).ConclusionThis cohort of pregnant women showed a lower-intermediate prevalence of HBV of 3%. In the 3 years follow-up only 1 out of 7 children showed evidence of chronic HBV infection. The child’s mother with high viral load (25.9 × 107 IU/ml), was positive for HBeAg with a high degree of sequence similarity suggesting vertical transmission. These results highlight a need for improved diagnosis and treatment of HBV infection in pregnant women in Tanzania, in order to prevent vertical transmission.

Long-term follow-up of a vaccination program for infants born to HBsAg-positive mothers in Stockholm County, Sweden

We investigated the long-term antibody response to hepatitis B virus (HBV) vaccination in babies born to chronically infected mothers. They received one dose of monovalent HBV vaccination at birth and one month of age, followed by 3 doses of hexavalent vaccine including an HBV component at ages 3, 5, and 12 months, respectively, with a very high percentage of protective anti-HBs levels at 13 months. At the age of 8–12 years, 56 out of 68 children (82%) had protective levels of anti-HBs, two had signs of anti-HBc seroconversion without any history of clinical disease and none had ongoing infection. A small subgroup was retested after one booster dose, in all resulting in increase in anti-HBs from below 10 IU/L to levels corresponding to protective immunity. We conclude that this vaccination strategy is effective throughout the first decade of life in avoiding chronic infection and in maintaining a good serological response.

Long-term persistency of hepatitis B immunity: an observational cross-sectional study on medical students and resident doctors.

SummaryHepatitis B virus (HBV) is a main cause of chronic and acute hepatitis. Healthcare workers (HCWs), including medical students and resident doctors, have an occupational risk of HBV infection.The study aimed to evaluate the long-term persistence of protective anti-HBs antibody levels in healthcare students and resident doctors at risk for occupational exposure to HBV at 15 years after primary vaccination course. Further objective was to evaluate the anamnestic response observed in non-seroprotected subjects receiving a booster dose.Data were collected from the clinical documentation filled in during the occupational medical check of medical students and resident doctors undergoing Occupational Health Surveillance by the University of Ferrara.Of the 621 included individuals, 27.7% had an anti-HBs concentration < 10 mIU/mL. Subjects vaccinated during infancy had more frequently a concentration < 10 mIU/mL than those vaccinated during adolescence (42.7% vs 6.9%; p-value < 0.001). Multivariate analysis confirmed the statistical significance of the vaccination age. 94 subjects who had an anti-HBs concentration < 10 mIU/mL received a booster dose. The proportion of subjects who had an anamnestic response was higher in those vaccinated in infancy rather than during adolescence (94.1% vs 77.8% respectively).These findings suggest that the anti-HBs concentration decreases below 10 mIU/mL more frequently in subjects vaccinated during infancy. Immunological memory seems to persist after the decline of the anti-HB titer, as observed in response to a booster dose. In conclusion, vaccinated subjects at increased risk of HBV infection should be monitored and a booster dose administered if anti-HBs titer is below 10 mIU/mL.