Risk Factors For Hepatitis B Virus Infection Research Articles

Analysis of Knowledge, Attitudes, and Prevalence of Hepatitis B and C Seromarkers Among Barbers in Tehran.

BackgroundHepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major health problem in the world. Hairdressers (barbers) are in continuous contact with scissors and blades, and are considered a high-risk group for these infections.ObjectivesThe aim of this study was to analyze the prevalence of hepatitis B and C infections in barbers in Tehran and to evaluate their attitudes and knowledge about the occupational risk of these infections.MethodsSix hundred eleven barbers were included in this study. A group of 556 bakers were also selected from the same regions, as a low-risk control group. Serum levels of hepatitis B surface antigen (HBsAg), HBsAg-specific antibody (HBsAb), hepatitis B core antigen-specific antibody (HBcAb), and hepatitis C virus-specific (anti-HCV) antibody markers were measured with the enzyme-linked immunosorbent assay (ELISA). Participants were interviewed using a questionnaire consisting of four sections: demographic information, awareness, behavior, and personal attitudes.ResultsThere were no significant differences in the frequency of HBsAg between the two groups. However, the frequency of HCV Ab in barbers was significantly higher than that in bakers (P < 0.005). In addition, the frequency of HBsAb marker in barbers was significantly correlated with increased awareness (P < 0.05) and number of tattoos (P < 0.001). HBcAb marker was significantly correlated with age (P < 0.001) and duration of professional career (P < 0.005). With age, barbers’ attitudes improved significantly (P < 0.05).ConclusionsBeing a barber alone is not a potential risk factor for HBV infection, while HCV infection is still an occupational health hazards for barbers. We suggest more extensive case-control studies with regard to rates of hepatitis B and C markers among barbers in other Iranian cities to assess the incidence of hepatitis B and C infections among this population.

Survey of Hepatitis B virus infection and risk factors among pregnant women at public hospital in Ethiopia

Background: Hepatitis B is a global public health problem and a major cause of liver disease, including chronic hepatitis, cirrhosis and liver cancer. Pregnant women with hepatitis B virus infection are reservoir for the virus and do have high potential to transmit it to their fetuses and newborns. The objective of the study was to investigatesero-prevalence of hepatitis B surface antigen and assesses risk factors among pregnant women in Ethiopia. Methods: Institution based cross-sectional study was conducted from July to September, 2014 among pregnant women in Ethiopia. A pretested structured questionnaire was employed to collect data on socio-demographic and potential risk factors for HBV infection. Blood sample was collected and tested for the presence of hepatitis B surface antigen using Enzyme Linked Immunosorbent Assay kit. Obtained data were evaluated by frequency, logistic regression analyses, and a significance level of 5 % (α = 0.05) was established. Result: Of the total pregnant women, 11(5.4%) of the study participants were positive for HBsAg. Majority (40.1%) of participants were in age group 25-29 years. The prevalence of HBV infection was higher above 20 years of age. Our finding revealed that none of the study participants were aware of their HBV sero-status. Sero positivity for hepatitis B surface antigen was statistically associated with history of abortion (AOR: 6; 95% CI :( 1.39-27.69); P-value: 0.017), surgery (AOR: 5;95% CI: 1.04-24.31; P-value: 0.045) and family history for hepatitis (AOR: 11; 95% CI (1.63 80.44); P-value: 0.014). Conclusion: According to the research findings, there was an intermediate endemicity of hepatitis B virus infection. The finding revealed that history of abortion, surgery and family history for hepatitis were the major risk factors for the high prevalence of hepatitis B infection in the study area. Appropriate, targeted and timely response is mandatory for tackling the harmful health effects of HBV infection/disease.

Five-Year Eradication of Hepatitis B Infection After an Outreach Immunization Program in the Waorani Population in the Ecuadorian Amazon.

In Waorani communities of the Amazon basin of Ecuador, hepatitis B (HB) surface antigen was found in 14% of asymptomatic persons. The aim of this study was to identify the Waorani population in Ecuador and obtain an epidemiologically adequate coverage of vaccination against hepatitis B virus (HBV) among them. Between February and September 2010, three vaccination campaigns were completed as part of a collaborative activity between the Ecuadorian Ministry of Public Health and the community leaders in the intervention areas. In addition, in 10 of the 22 Waorani communities, during first contact, a questionnaire about risk factors for HBV infection was administered. A total of 16 Waorani communities were registered before the beginning of this intervention, but during the actual process, six additional communities were identified. In total, 1,251 community members were registered, 92.7% of which received all three doses of the vaccine. Among them, 83% of survey respondents reported having been vaccinated, but only 22% were able to show proof. Only 1% of respondents were intravenous drug users, whereas 22% had at least one tattoo. All self-identified as heterosexual, but only 32% reported using condoms during sexual intercourse. By March 2015, no new cases of HB were been reported in any of the Waorani communities. Herein, we report the importance of intersectoral collaboration to strengthen health interventions in an isolated population like the Waorani area.

Survey of Hepatitis B virus infection and risk factors among pregnant women at public hospital in Ethiopia

Background : Hepatitis B is a global public health problem and a major cause of liver disease, including chronic hepatitis, cirrhosis, and liver cancer. Pregnant women with hepatitis B virus infection are a reservoir for the virus and do have high potential to transmit it to their fetuses and newborns. The objective of the study was to investigate seroprevalence of hepatitis B surface antigen and assess risk factors among pregnant women. Methods : Institution based cross-sectional study was conducted from July to September 2014 among pregnant women in Ethiopia. A pretested structured questionnaire was employed to collect data on socio-demographic and potential risk factors for HBV infection. A blood sample was collected and tested for the presence of hepatitis B surface antigen using Enzyme Linked Immunosorbent Assay kit. Obtained data were evaluated by frequency, logistic regression analyses, and a significance level of 5 % (? = 0.05) was established. Result: Of the total pregnant women , 11(5.4%) of the study participants were positive for HBsAg. The majority (40.1%) of participants were in age group 25-29 years. The prevalence of HBV infection was higher above 20 years of age. Our finding revealed that none of the study participants were aware of their HBV serostatus. Seropositivity for hepatitis B surface antigen was statistically associated with history of abortion (AOR: 6; 95% CI :( 1.39-27.69); P-value: 0.017), surgery (AOR: 5;95% CI: 1.04-24.31; P-value: 0.045) and family history for hepatitis (AOR: 11; 95% CI (1.63 80.44); P-value: 0.014). Conclusion: According to the research findings, there was an intermediate endemicity of hepatitis B virus infection. The finding revealed that history of abortion, surgery and family history for hepatitis were the major risk factors for the high prevalence of hepatitis B infection in the study area.

Occult Hepatitis B virus infection in previously screened, blood donors in Ile-Ife, Nigeria: implications for blood transfusion and stem cell transplantation.

BackgroundHepatitis B virus (HBV) transmission through blood transfusion is reduced by screening for hepatitis B surface antigen (HBsAg). However this method cannot detect the presence of occult hepatitis B virus infection. This study sought to determine the prevalence of occult hepatitis B virus infection among blood donors in Ile-Ife, Nigeria. For the first time in Nigeria we employed an automated real-time PCR- method to investigate the prevalence of occult HBV in blood donors.MethodsBlood donors screened with HBsAg immunochromatographic rapid test kits at the blood transfusion units of two hospitals and found to be negative were recruited into the study. Questionnaires to elicit risk factors for HBV infection were administered and then 10 ml of blood was collected from each donor. Plasma samples obtained from these HBsAg negative blood donors were screened again for HBsAg using an enzyme-linked immunosorbent assay (ELISA) method, and those found negative were screened for the presence of total antibody to the HBV core antigen (anti-HBc) using ELISA method. Those positive to anti-HBc were then tested for HBV DNA, using an automated real-time PCR method.ResultsFive hundred and seven blood donors found HBsAg negative by immunochromatographic rapid test kits at both blood transfusion units, were tested for HBsAg using ELISA and 5 (1 %) were HBsAg positive. The 502 found negative were tested for anti-HBc and 354 (70.5 %) were found positive implying previous exposure to HBV and 19 (5.4 %) of the 354 anti-HBc positive had HBV DNA signifying occult HBV infection. No risk factors were found to be associated with the presence of HBV DNA among those who tested positive.ConclusionOccult HBV infection exists in blood donors in Ile-Ife, Nigeria and the use of HBsAg alone for screening prospective donors will not eliminate the risk of HBV transmission in blood transfusion or stem cell transplantation.

Testing and Linking Foreign-Born People with Chronic Hepatitis B Virus Infection to Care at Nine U.S. Programs, 2012-2014.

Hepatitis B virus (HBV) infection continues to be a public health threat in the United States. As many as 2.2 million people are infected, approximately 70% of whom are foreign-born, and fewer than one-third are aware of their infection. We launched an HBV testing and linkage-to-care initiative among foreign-born people. As part of the Hepatitis Testing and Linkage to Care (HepTLC) initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites, nine U.S. programs in seven states conducted HBV screening from October 2012 to September 2014. The nine programs partnered with health-care centers and community-based organizations to recruit foreign-born people recommended for HBV testing. We assessed patient characteristics, region of origin, risk factors, hepatitis B surface antigen (HBsAg) status, and referral to medical care. Of 23,144 participants tested for HBV, 1,317 (5.7%) were HBsAg positive. Of these, the median age was 47 years, 1,205 (91%) had at least one risk factor for HBV infection, 1,117 (85%) received posttest counseling, 1,098 (83%) were referred to care, and 606 (46%) attended a first medical appointment. The proportion of HBsAg-positive participants by region of origin included Africa (10%, 206/2,129), Western Pacific (6%, 616/9,673), Eastern Mediterranean (5%, 174/3,337), Southeast Asia (5%, 191/3,891), South America (2%, 6/252), Eastern Europe (2%, 6/262), and North America (1%, 17/1,936). Community-based HBV testing initiatives can identify substantial numbers of people with chronic HBV infection, inform them of their infection status, and provide posttest counseling and linkage to care. However, strategies are needed to improve linkage to HBV-directed medical care for foreign-born individuals living with chronic HBV infection.

Hepatitis B Infection, Viral Load and Resistance in HIV-Infected Patients in Mozambique and Zambia.

BackgroundFew data on the virological determinants of hepatitis B virus (HBV) infection are available from southern Africa.MethodsWe enrolled consecutive HIV-infected adult patients initiating antiretroviral therapy (ART) at two urban clinics in Zambia and four rural clinics in Northern Mozambique between May 2013 and August 2014. HBsAg screening was performed using the Determine® rapid test. Quantitative real-time PCR and HBV sequencing were performed in HBsAg-positive patients. Risk factors for HBV infection were evaluated using Chi-square and Mann-Whitney tests and associations between baseline characteristics and high level HBV replication explored in multivariable logistic regression.ResultsSeventy-eight of 1,032 participants in Mozambique (7.6%, 95% confidence interval [CI]: 6.1–9.3) and 90 of 797 in Zambia (11.3%, 95% CI: 9.3–13.4) were HBsAg-positive. HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001). Among 156 (92.9%) HBsAg-positive patients with an available measurement, median HBV viral load was 13,645 IU/mL (interquartile range: 192–8,617,488 IU/mL) and 77 (49.4%) had high values (>20,000 UI/mL). HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001). In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22–5.53) and CD4 cell count below 200/μl (2.58, 1.20–5.54) were associated with high HBV DNA. HBV genotypes A1 (58.8%) and E (38.2%) were most prevalent. Four patients had probable resistance to lamivudine and/or entecavir.ConclusionOne half of HBsAg-positive patients demonstrated high HBV viremia, supporting the early initiation of tenofovir-containing ART in HIV/HBV-coinfected adults.

Assessment of mother-to-child HBV transmission at the prenatal consultation in Vientiane, Laos

Chronic infection with hepatitis B virus (HBV) remains highly endemic in Laos, mainly related to mother to child transmission. Despite the introduction of the vaccination against HBV in the Expanded Programme on Immunization in 2001 and the administration of a vaccine birth dose as part of a 3-dose schedule since 2004, infant immunization coverage remains inadequate because most mothers are not aware of the risks. A survey was conducted in early 2013 in Vientiane capital among women who undergo serologic screening for hepatitis B at the prenatal consultation, to assess their knowledge and risk factors of HBV infection. It included the administration of a standardized questionnaire divided into four parts (socio-demographic data, knowledge about hepatitis B, risk factors and immunization status) and a screening test for the HBV surface antigen (HBsAg). A total of 200 pregnant women were recruited consecutively in Mahosot hospital. They were aged 14-39 years (mean 27 ± 4.76 years), civil servants (37%) or housewives (33.5%) with a secondary or higher education level (80%). Most were multiparous (68.5%) and attended antenatal care in the third trimester of pregnancy (61%). Sixteen (8%) tested HBsAg positive. The HBsAg seroprevalence was higher in the 26-30 years age group, among women above the primary school education level and women practicing the profession of shopkeeper or civil servant, but these differences were not significant. Hepatitis B was known by a small majority (53%) but 26% could name the routes of transmission, 28% considered it as a serious illness and 24.5% were aware of the HBV vaccine. No risk factor for blood or sexual exposure to HBVinfection was significantly linked to the HBsAg carriage. In this sample of pregnant women mostly urban, educated and multiparous with access to a central hospital, the high rate of HBV infection and the low level of knowledge about the risk of mother-to-child HBV transmission reveals a major gap in information and advice that should be provided during prenatal visits. A large scale program of health education focused on the prevention of vertical transmission of HBV should be implemented, parallel to the extension of HBV vaccine coverage including a birth dose for the Lao children.

MOLECULAR EPIDEMIOLOGY OF HEPATITIS B VIRUS GENOTYPES ISOLATED IN BELARUS

The objective of the present work was to study the dissemination pathways of specific hepatitis B virus (HBV) genotypes and their subtypes and to determine the genetic interrelationships of HBV in patients ascribed to different risk factors of HBV infection in different regions of the Republic of Belarus. The molecular-epidemiological characteristics of HBV subtypes were determined using the phylogenetic analysis of the P region of viral genome. Possible HBV entry and dissemination pathways in different areas of Belarus were inferred. The comparison of genetically related HBV variants and reference sequences from different parts of the world shows that the D2, D3 and D4 subtypes of HBV from patients in Belarus form significantly different clusters. The data suggest that these variants spread predominantly via domestic pathways. The A2 and D1 subtypes disseminated independently via HBV entries from epidemiologically independent sources. The C2 and B4 subtypes originate from Southeast Asia and circulate among migrants from this area. Phylogenetic analysis made it possible to obtain objective information about the development of viral hepatitis B in the Republic of Belarus.

Epidemiology of HBV infection in a cohort of Ugandan HIV-infected patients and rate and pattern of lamivudine-resistant HBV infection in patients receiving antiretroviral therapy.

Many HIV-infected patients in sub-Saharan Africa are not routinely screened for hepatitis B virus (HBV) infection and are on antiretroviral therapy (ART) regimens containing only lamivudine as anti-HBV active drug. In 2009-2011, we screened for hepatitis B surface antigen (HBsAg) in 2820 HIV-infected adults patients at the Mbarara Hospital Uganda and investigated risk factors for HBV infection. Using samples of dried plasma or blood spots, we tested for HBV viral load and HBV drug resistance mutations in all HBsAg-positive patients on ART for ≥ 12 months. In this study, 109 patients tested HBsAg positive (3.9%; 109/2820). HBsAg-positive patients were more likely to have had >4 lifetime sexual partners (p<0.01). Of the 55 HBsAg-positive patients on ART for ≥ 12 months, 53 were only on lamivudine as anti-HBV active drug and two were on tenofovir and lamivudine. HBV-DNA was detected in 30 patients (54.5%; 30/55), all on lamivudine-monotherapy. Of the 23 patients in whom HBV-DNA sequencing was successful, 17 had lamivudine-resistant HBV strains harbouring rtM204V/I mutations accompanied by secondary/compensatory mutations. Our study suggests that sexual transmission may represent a major mode of spread of HBV in southwest Uganda and confirms the importance of screening for HBV and of using ART regimens containing tenofovir in HIV/HBV co-infected patients.

Effectiveness of prevention of mother-to-child transmission practice in three provinces of Southern China

Vaccination in prevention mother-to-child transmission (PMTCT) of hepatitis B has been recommended since plasma-derived hepatitis B vaccines became available in China in 1986; however, less study evaluated practice effectiveness of PMTCT systematically. We conducted a prospective survey to evaluate the effectiveness of PMTCT practices in 3 provinces of southern China. We selected prefectures with low timely birth dose coverage in Yunnan, Guangxi, and Hunan provinces. Infants born to HBsAg positive mothers were evaluated at 7–12 months of age. We tested hepatitis B virus (HBV) surface antigen (HBsAg) and HBV e antigen (HBeAg) of mothers and tested HBsAg of infants born to HBsAg positive mothers using Enzyme-linked Immunosorbent Assay (ELISA) at provincial CDC laboratories. We used logistic regression analysis to analyze the risk factors for HBV infection. Among 3,094 infants born to HBsAg positive mothers, 172 were positive for HBsAg (5.6%). HBeAg status of pregnant women, timely birth dose (TBD) of hepatitis B vaccine were major predictors for HBV infection of infants. PMTCT practices greatly reduced the prevalence of HBsAg among infants born to HBsAg positive mothers China. However, the effectiveness of strategies used in PMTCT varied. HBsAg screening for pregnant women, monitoring of infants born to HBsAg positive mother should be enhanced to evaluate the effectiveness of program.

Hepatitis B Virus Screening for Patients With Cancer Before Therapy: American Society of Clinical Oncology Provisional Clinical Opinion Update.

This updated provisional clinical opinion presents a revised opinion based on American Society of Clinical Oncology panel consensus in the context of an evolving database. Despite the 2010 provisional clinical opinion recommendation, there is still evidence of suboptimal hepatitis B virus (HBV) screening among patients at high risk for HBV infection or HBV reactivation after chemotherapy. This updated provisional clinical opinion introduces a risk-adaptive strategy to identify and treat patients with HBV infection to reduce their risk of HBV reactivation. Medical providers should screen by testing patients for HBV infection before starting anti-CD20 therapy or hematopoietic cell transplantation. Providers should also screen patients with risk factors for HBV infection. Screening should include both hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc), because reactivation can occur in patients who are HBsAg positive/anti-HBc positive or HBsAg negative/anti-HBc positive. Either total anti-HBc or anti-HBc immunoglobulin G (not immunoglobulin M) test should be used. Clinicians should start antiviral therapy for HBsAg-positive/anti-HBc-positive patients before or contemporaneously with cancer therapy and monitor HBsAg-negative/anti-HBc-positive patients for reactivation with HBV DNA and ALT levels, promptly starting antivirals if reactivation occurs. Clinicians can initiate antivirals for HBsAg-negative/anti-HBc-positive patients anticipating cancer therapies associated with a high risk of reactivation, or they can monitor HBV DNA and ALT levels and initiate on-demand antivirals. For patients who neither have HBV risk factors nor anticipate cancer therapy associated with a high risk of reactivation, current evidence does not support HBV screening before initiation of cancer therapy. Two panel members provided a minority viewpoint, involving a strategy of universal HBsAg and selective anti-HBc testing.

Study on risk factors of hepatitis B virus infection among patients receiving hemodialysis by multi-level statistical model analysis

To understand the current status of HBV infection among patients receiving maintenance hemodialysis (MHD) and related influencing factors. A questionnaire survey was conducted among 1,524 MHD patients selected from hemodialysis units in 16 hospitals in Shanxi province from 1 November 2012 to 30 December 2014 to collect their demographic information and learn about their risk behaviors. Serological detection was conducted for them. Statistical software package SAS 9.3 was used for fitting a two level logistic regression model to identify the independent risk factors for HBV infection. Among the 1 524 MHD patients, the positive rate of HBsAg was 5.25% and the HBV infection rate was 38.85%. The HBV infection rate varied with hospital (t=2.33, P=0.034). The two-level logistic regression empty model showed that intra-class correlation coefficient was 0.106 4, indicating that about 10.64% of the total variation was caused by the differences in hospitals. After introducing explaining variables, the results showed that the HBV infection rate in age group 50-65 years group was higher than that in age group 0-35 years (OR=1.560, 95% CI: 1.061-2.293). Family history of HBV infection and dental surgery were the risk factors for HBV infection (OR=2.052 and 1.267, 95% CI: 1.176-3.582 and 1.009-1.591). Receiving HepB vaccination was a protective factor for HBV infection (OR=0.734, 95% CI: 0.541-0.996). The HBV infection rates were different among MHD patients in different hospitals. Old age (50-65 years), family history of HBV infection and dental surgery were the risk factors and receiving HepB vaccination was a protective factor for HBV infection among MHD patients.

Long-term effectiveness of accelerated hepatitis B vaccination schedule in drug users.

We demonstrated the effectiveness of an accelerated hepatitis B vaccination schedule in drug users. We compared the long-term effectiveness of accelerated (0-1-2 months) and standard (0-1-6 months) hepatitis B vaccination schedules in preventing hepatitis B virus (HBV) infections and anti-hepatitis B (anti-HBs) antibody loss during 2-year follow-up in 707 drug users (HIV and HBV negative at enrollment and completed 3 vaccine doses) from February 2004 to October 2009. Drug users in the accelerated schedule group had significantly lower HBV infection rates, but had a similar rate of anti-HBs antibody loss compared with the standard schedule group over 2 years of follow-up. No chronic HBV infections were observed. Hepatitis C positivity at enrollment and age younger than 40 years were independent risk factors for HBV infection and antibody loss, respectively. An accelerated vaccination schedule was more preferable than a standard vaccination schedule in preventing HBV infections in drug users. To overcome the disadvantages of a standard vaccination schedule, an accelerated vaccination schedule should be considered in drug users with low adherence. Our study should be repeated in different cohorts to validate our findings and establish the role of an accelerated schedule in hepatitis B vaccination guidelines for drug users.

Hepatitis B (HBV) Screening in Patients Receiving Rituximab: A Comprehensive Analysis Including Comparison of Adherence By Oncologists and Non-Oncologists

BACKGROUND: It is estimated that >1.4 million people in the US are living with chronic HBV, many of whom are unaware of their infection. Chronic infection is responsible for the majority of HBV-related morbidity and mortality ranging from hepatitis to fulminant hepatic failure. The monoclonal anti-CD20 antibody, rituximab, is used to treat a variety of malignant and non-malignant conditions. Its use is associated with reactivation of HBV (HBV-R), including in historically low risk populations (i.e., HBV core antibody (HBcAb) positivity) and HBV-R may occur >8-10 months after completion of therapy. Professional societies such as the CDC and Infectious Diseases Society of America (IDSA) recommend screening all persons receiving cytotoxic or immunosuppressive therapy for HBV infection, although not all guidelines surrounding this topic are consistent. The primary aim of this study was to determine the rate of rituximab-related HBV screening and HBV-R over a recent time period across multiple medical specialties and disease conditions.METHODS: We completed a single center, retrospective cohort study at an urban, academic medical center reviewing all patients (pts) ≥ 18 years of age who received rituximab 1/1/06 to 7/31/13 who had at least 12 months of follow-up following the final rituximab dose. Eligible pts were queried using an electronic pharmacy database and reviewed by 3 physicians. Detailed data included demographics, indication for rituximab, number of rituximab doses, HBV screening serology, vaccination status, and comorbidities and risk factors for HBV-R.RESULTS: We identified 407 pts; of these, 10 were excluded due inadequate follow-up, 7 for incomplete records, and 1 was due to age <18 years with 389 pts meeting inclusion criteria. 47% of pts were female and the median age was 63 years (range, 19-94 years). The median number of rituximab doses received was 5 (1-35) and 86% of pts had a hematologic or oncologic diagnosis (most common: DLBCL n=84, CLL n=49, follicular lymphoma n=35, marginal zone lymphoma n=17, mantle cell lymphoma n=15, acute leukemia n=14, myeloma/amyloid n=13, ITP n=12, hemolytic anemia, n=10 and Burkitt’s n=9) and 14% of pts had a non-oncology indication (most common: rheumatoid arthritis n=20, lupus n=5, vasculitits n=4, scleritis n=3, Wegner’s n=3, Sjogren’s n=3, and dermatomyositis n=3) for rituximab therapy. Overall, 32% of pts were screened for HBV <6 months prior to the 1st rituximab dose. Among hematology/oncology pts, 31% had HBV screening prior to rituximab with 24% occurring within 6 months prior to the 1st dose (3% 6-12 months, 3% 12-24 months, and 1% >24 months prior). For non-oncology pts, 40% had HBV screening with 26% occurring within 6 months prior to the 1st dose (6% 6-12 months, 2%, 12-24 months, and 6% >24 months prior). Interestingly, the type of HBV screening tests varied widely with no consistent panel of serologies tested, although the majority of pts who had screening had testing for HBV surface antigen (90.7%). HBcAb was not checked as often (66%), which represents a subset of pts at risk for developing HBV-R. Of pts screened for HBcAb, 15/88 (17%) were found to be positive for HBV (n=14 HBcAb and n=1 pt was positive for HBV surface antigen). 8/15 pts had no known or obvious risk factors for HBV infection. Of the 14 pts testing positive for HBcAb prior to rituximab, only 1 pt received anti-HBV prophylactic therapy. 3 of 14 pts without HBV prophylaxis experienced HBV-R (all HBcAb+ lymphoma pts treated with rituximab/chemotherapy), one of who died due to multiorgan failure.CONCLUSION: At our academic center, we identified a relatively low rate of HBV screening amongst pts receiving rituximab irrespective of disease specialist or diagnostic condition. In addition, among pts who were screened, testing panels were inconsistent and a significant minority of pts did not have testing for HBcAb. Furthermore, we identified a relatively high rate of occult positivity for HBcAb including in a significant fraction of pts without known risk factors. It is advocated that a National unified guideline be instituted towards rituximab-related HBV screening and institutions implement and adhere to these guidelines. Likewise, a standardized panel of HBV serology is essential, both for initial testing and follow up. This is especially important given the increasing number of FDA approvals of other anti-CD20 and related monoclonal antibodies that carry similar risks of HBV-R. DisclosuresEvens:Genentech: Honoraria, Speakers Bureau.

Molecular analysis of the interspousal transmission of hepatitis B virus in two Japanese patients who acquired fulminant hepatitis B after 50 and 49 years of marriage

A 71-year-old (C1I) and 69-year-old (C2I) Japanese female contracted fulminant hepatitis B after 50 and 49 years of marriage, respectively. Both index cases exhibited high levels of anti-HBc IgM antibodies (24.2 and 31.5 S/CO, respectively), suggestive of acute hepatitis B virus (HBV) infection, although they had no discernible risk factors for HBV infection, except for chronically HBV-infected spouses with detectable HBV DNA (3.3 log copies/ml [C1S: 72-year-old] and 7.2 log copies/ml [C2S: 71-year-old]). The HBV genotype/subgenotype was identical in each couple (B/B1 or C/C2). The HBV isolates from the index cases and spouses shared a nucleotide sequence identity of 99.5% and 99.7%, respectively, over the entire genome, and these four isolates had the highest nucleotide sequence identity of only 97% to HBV isolates deposited in DNA databases. Phylogenetic trees confirmed a close relationship of the HBV isolates between C1I and C1S and between C2I and C2S, supported by a high bootstrap value of 100% within each couple, indicating the transfer of HBV infection between spouses. These four isolates shared a precore mutation of G1896A known to be associated with fulminant hepatitis B. Although the history of sexual contact within a reasonable incubation period was obscure for one stable, monogamous couple (C1I and C1S), the other couple had a monogamous sexual relationship within six months prior to disease onset. This study indicates that two elderly Japanese patients with fulminant hepatitis B acquired HBV infection via interspousal (most likely sexual) transmission during long-lasting marriages.

Prevalence of Hepatitis-B Viral Markers in Patients With Inflammatory Bowel Disease in a Hepatitis-B-Endemic Area

There are few data regarding the prevalence of hepatitis-B virus (HBV) markers in inflammatory bowel disease (IBD) patients in Korea, which is a hepatitis-B-endemic area. The aim of this study was to assess the prevalence of HBV markers in IBD patients in comparison with controls. We enrolled 513 IBD patients [241 Crohn's disease (CD) and 272 ulcerative colitis (UC)] whose hepatitis-B surface antigen and anti-HBs levels were evaluated. Anti-HBc was assayed in 357 patients. These markers were compared with those of 1020 sex-matched and age-matched controls. Prevalence of hepatitis-B surface antigen in IBD patients was 3.7% and there was no significant difference between groups (CD 4.1%, UC 3.3%, control 4.4%, P=0.713). The frequency of effective vaccination against HBV (positive anti-HBs, without anti-HBc) was lower in IBD patients less than 30 years old compared with the same-aged controls (CD 43.3%, UC 48.5%, control 61.9%, P=0.002), whereas there was no difference between groups in subjects more than 30 years old. One third of IBD patients were at risk of susceptibility to HBV infection (nonimmune), particularly those less than 30 years old, compared with controls of the same age (CD 43.3%, UC 36.4%, control 21%, P<0.001). In IBD patients, multivariate analysis identified that age less than 30 years was an independent risk factor for nonimmune status. IBD was not a risk factor for HBV infection even in endemic areas. However, many young IBD patients were susceptible to HBV infection. It is crucial to screen for HBV immunity and to implement a meticulous vaccination strategy for young Korean IBD patients.

A population-based study examining hepatitis B virus infection and immunization rates in Northwest China.

Background and AimCurrent baseline data regarding the prevalence of hepatitis B virus (HBV) infections and the immune status in hyperendemic areas is necessary in evaluating the effectiveness of ongoing HBV prevention and control programs in northwest China. This study aims to determine the prevalence of chronic HBV infections, past exposure rates, and immune response profiles in Wuwei City, northwest China in 2010.MethodsCross-sectional household survey representative of the Wuwei City population. 28,579 participants were interviewed in the seroepidemiological survey ≥1 year of age. House to house screening was conducted using a standard questionnaire. All serum samples were screened by enzyme-linked immunoassays for the presence of hepatitis B surface antigen, antibodies against HBV surface antigen, and antibodies to the hepatitis B core antigen.ResultsAmong individuals ≥1 year of age, 7.2% (95%CI: 6.3–8.1%) had chronic HBV infections, 43.9% (CI: 40.4–47.4%) had been exposed to HBV, and 23.49% (CI: 21.6–25.3%) had vaccine-induced immunity. Multi-factor weighted logistic regression analysis showed that having household contact with HBV carriers (OR = 2.6, 95%CI: 2.3–3.0) and beauty treatments in public places (OR = 1.2, 95%CI: 1.1–1.3) were the risk factors of HBV infection in whole population. Having household contact with HBV carriers (OR = 3.8, 95% CI: 2.2–6.5) and lack of hepatitis vaccination (OR = 2.0, 95% CI: 1.4–3.3) were the risk factors for HBV infection in children aged 1–14 years.ConclusionsHepatitis B infection remains a serious public health problem in northwest China. Having household contact with HBV carriers and beauty treatments in public places represented HBV infection risk factors. Hepatitis B vaccine immunization strategies need further improvement, particularly by targeting the immunization of rural migrant workers.

Hepatitis B vaccine knowledge and uptake among medical students in Cameroon

Background: Hepatitis B virus (HBV) is the most contagious blood borne pathogen. The risk of occupational exposure to HBV among health care workers is a major concern, especially among medical trainees. In this study, we describe the knowledge of risk factors for HBV infection, history of accidental exposure to blood, awareness of HBV vaccine and the vaccination status among medical students in Cameroon. Methods & Materials: In April 2012, a cross-sectional survey was carried out using a pretested self-administered questionnaire among 111 medical students Results: Sixty-two students (55.9%) had had at least one accidental exposure to blood since the beginning of their medical training, with a median of 2 (IQR, 1-3) exposures. There was a good knowledge of the risk factors for HBV infection and awareness of HBV vaccine among participants. However, only 20 (18%) participants had completed the three doses of primary HBV vaccination. Furthermore, only 2 of the 20 (10%) adequately vaccinated participants had a post-vaccination test to confirm a good immune response and thus an effective protection against HBV infection. The main reason for not being vaccinated was lack of money to pay for the vaccine (45.6%). Forty seven (42.3%) participants had been sensitized by their training institutions about the importance of HBV vaccination. These were more likely to be vaccinated compared to those who had not been sensitized (p < 0,001). Conclusion: There is a high rate of accidental exposure to blood and a very low HBV vaccination uptake among medical students in Cameroon, leading to a high occupational risk of HBV infection. HBV vaccination should be strongly recommended for medical students and the vaccine made available free of charge at the beginning of their training

Role of lamivudine in the therapy of Nigerian patients with chronic HBV infection

The study was conducted to determine the role of lamivudine in the treatment of Nigerian patients with chronic HBV infection (CHB). Twenty one Nigerian patients with laboratory, histologic and clinical features of CHB were studied over a period of 30 months for response to a six-month therapy with lamivudine using liver biopsy as gold standard for assessment of response to therapy. The mean age of the patients was 32.6±9.3 years and the receipt of injection from chemists (76%) was the most common risk factor for HBV infection among the subjects. About 67% of the patients were asymptomatic while 90.5% had normal liver span. Patients with low serum albumin, raised serum alkaline phosphatase, bilirubin and globulin prior to lamivudine therapy had restoration to normal values after 24 weeks of therapy. There was prolongation of prothrombin time (five patients) and hypokalaemia (one patient) after lamivudine therapy but there were no changes in the HBsAg, anti-HIV and anti-HCV status of all the patients. Although, post therapy liver biopsy was declined by 8 patients and contraindicated in 5 patients, there was 48% reduction in Knodell score of histologic findings in the liver biopsy specimens of 8 patients who had pre- and post-lamivudine therapy liver biopsies. The findings from this study suggested that six-month therapy with lamivudine is beneficial in treating Nigerian patients with CHB using biochemical markers and liver histology in assessing response to treatment.