Risk Of HBV Transmission Research Articles

Serological profile of hepatitis B virus infection among traditional birth attendants and the attending pregnant women in Ibadan, Nigeria

ABSTRACT Although a sizable number of pregnant women patronize Traditional Birth Attendants (TBAs) for deliveries in Nigeria, efforts to prevent or reduce the risk of HBV transmission are not targeted at the TBAs and the pregnant women patronizing them. This may be linked to the dearth of information on the serological profiles of HBV among this cohort. We, therefore, show the serological profiles of HBV among the cohort. One hundred and seventy pregnant women and 91 TBAs participated in this study between May and July 2019. Serological markers of HBV infection were assayed using ELISA. A prevalence of, 8.0% (95% CI: 5.0% − 11.5%) for HBsAg, 0.8% (95% CI: 0.0% − 1.9%) for HBeAg, 2.7% (95% CI: 0.8% − 5.0%) for HBcIgM, 26.1% (95% CI: 20.7% − 31.4%) for anti-HBs, 21.5% (95% CI: 16.5% − 25.4%) for anti-HBe and 67.0% (95% CI: 60.9% – 72.8%) for anti-HBc was found indicating a high percentage of carriers. Although 32 (12.3%) of the entire participants claimed to be fully vaccinated, serological evidence was only detected in 4 (12.5%). The high percentage of carriers and low evidence of vaccination necessitate intensified efforts to ensure that adequate interventions are made available and accessible to the TBAs and the pregnant women patronizing them (including newborn babies).

Occult Hepatitis B Virus Infection Among Blood Donors in the Capital City of Addis Ababa, Ethiopia: Implications for Blood Transfusion Safety

BackgroundOccult hepatitis B virus infection (OBI) remains a potential threat to blood safety in developing countries. Nevertheless, there is no data available on the magnitude of occult hepatitis among blood donors in Ethiopia. Therefore, this study aimed to estimate the magnitude of OBI among blood donors in Ethiopia.ObjectivesThe aim of this study is to determine the magnitude of OBI and associated risk factors among blood donors at the National Blood Bank, Addis Ababa, Ethiopia.MethodsA total of 973 HBsAg-negative plasma samples were tested for anti-HBc antibody using an ELISA and viral DNA using automated ABBOTT real-time PCR. Along with plasma samples, demographic data were retrieved from the database with respect to donors. Both descriptive and inferential statistics were employed for the analysis of data by SPSS 20. p-values less than 0.05 were considered as statistically significant.ResultsOf the total of 973 study participants, 445 (45.7%) were female with a mean age of 26.5 years. A total of 144 (14.8%) blood samples were anti-HBc antibody reactive. Four (0.41% of all samples, and 2.8% of anti-HBc-positive samples) samples were confirmed to have OBI by DNA detection. The mean viral load among the confirmed OBI samples was 31 IU/ml with ±12 SD, suggesting true occult hepatitis BV infections. Age was found to be a risk factor for anti-core positivity and was statically significant at p = 0.0001.ConclusionAbout four out of 1,000 blood donors screened negative with HBsAg had occult HBV infection. This shows that there could be a risk of HBV transmission through blood transfusion in Ethiopia. Therefore, there is a need for further investigation and action to revise the existing blood screening strategy by including anti-HBc and HBV nucleic acid testing.

Prevalence of Hepatitis B Virus Infection Markers among Patients of the Ibn Sina University Hospital Center (Rabat, Morocco)

Introduction: Viral hepatitis B is a global scourge affecting millions of people worldwide. In Morocco, hepatitis B is considered a public health problem, and available data converge to consider Morocco as a country with intermediate endemicity. In the present study, we have planned to evaluate the HBV prevalence in Morocco on a large scale and to assess the prevalence of different serological markers for better management of this infection in Morocco. Methods: This study was conducted on 18,877 patients referring to the Ibn Sina University Hospital Center of Rabat, Morocco. HBV serological markers including HBsAg, HBsAb, HBeAg, HBeAb, and total HBcAb were assessed by immune-enzymatic assays. The quantification of HBV DNA was performed by real-time PCR. Results: The overall prevalence of positive cases for HBsAg, HBsAb, and total HBcAb was 2.47%, 27.66%, and 21.2%, respectively. From 141 patients with an isolated HBcAb serological profile (HBcAb+/HBsAb−/HBsAg−), HBV DNA was detected in 10 patients, representing a rate of 7.09%. In the present study, up to 95.78% of HBV chronic carriers were negative for HBeAg. Conclusion: This study highlights a higher prevalence of HBsAg in the hospital-based population than the general population reported previously in Morocco and a very low HBV immunization coverage. Of particular interest, detectable HBV DNA levels in isolated HBcAb patients show that exclusive HBsAg screening cannot eliminate the risk of HBV transmission in certain cases. Many efforts are then mandatory to promote serological testing and increase the vaccination rate to limit viral dissemination for better management of this disease in Morocco.

High Frequency Occult Hepatitis B Virus Infection Detected in Non-Resolved Donations Suggests the Requirement of Anti-HBc Test in Blood Donors in Southern China.

BackgroundMost Chinese Blood Centers adopted mini pool (MP) nucleic acid testing (NAT) for HBV screening due to high cost of Individual donation (ID) NAT, and different proportions of MP-reactive but ID-non-reactive donations (MP+/ID−, defined as non-resolved donations) have been observed during daily donor screening process. Some of these non-resolved donations are occult HBV infections (OBIs), which pose potential risk of HBV transmission if they are not deferred. This study is aimed to further analyze these non-resolved donations.MethodsThe non-resolved plasma samples were further analyzed by serological tests and various HBV DNA amplification assays including quantitative PCR (qPCR) and nested PCR amplifying the basic core and pre-core promoter regions (BCP/PC; 295 base pairs) and HBsAg (S) region (496 base pairs). Molecular characterizations of HBV DNA+ non-resolved samples were determined by sequencing analysis.ResultsOf 17,226 MPs from 103,356 seronegative blood donations, 98 MPs were detected reactive for HBV. Fifty-six out of these 98 (57.1%) reactive MPs were resolved as HBV DNA+, but the remaining 42 pools (42.9%, 252 donations) were left non-resolved with a high rate (53.2%) of anti-HBc+. Surprisingly, among 42 non-resolved MPs, 17 contained one donation identified as OBIs by alternative NAT assays. Sequence analysis on HBV DNAs extracted from these OBI donations showed some key mutations in the S region that may lead to failure in HBsAg detection and vaccine escape.ConclusionA total of 53.2% of the non-resolved donations were anti-HBc+, and OBIs were identified in 40.5% of these non-resolved pools. Therefore, non-resolved donations with anti-HBc+ might pose potential risk for HBV transmission. Our present analysis indicates that anti-HBc testing in non-resolved donations should be used to identify OBIs in order to further increase blood safety in China.

Prevalence and factors associated with hepatitis B virus infection among household members: a cross-sectional study in Beijing

ABSTRACT HBV prevention and control presents a global public health priority because of the tremendous economic and healthcare burdens involved. This study was designed to investigate the status of HBV epidemics among household members, and to analyze the risk factors of HBV infection in couples and their offspring. A total of 1,035 couples and 541 offspring were included. We sourced the data from a population-based serological survey conducted by the Beijing Center for Disease Prevention and Control in 2014. Chi-square test and multiple logistic were used to assess differences in the prevalence of categorical variables, and identify risk factors for HBV infection and exposure in couples and offspring after controlling for confounding factors. In couples, the prevalence of chronic HBV infection was 4.3% and the prevalence of exposure 32.7%. The prevalence of chronic HBV infection in offspring was 0.9%, and the prevalence of exposure 8.7%. Sharing syringes with others and living with a spouse who was infected or exposed to HBV were associated with a significantly higher risk for transmission of HBV for couples. In offspring, maternal HBV infection was a significant risk factor for HBV exposure. This study provides evidence that having household members infected or exposed to HBV increases the risk of HBV transmission, and in order to achieve better control of HBV infection effective strategies must be established to prevent intra-familial transmission.

Prevalence of Hepatitis B Virus Infection Among Voluntary Blood Donors from the Northeastern Region of Iran: Genotyping, Viral Load Characterization and Drug Resistance Prediction.

Blood donor selection, along with laboratory screening of the HBV, plays a pivotal role in providing safe blood products. This study was aimed to evaluate the prevalence, genotype, and drug resistance prediction of HBV among Iranian blood donors. This cross-sectional study was conducted on 47,506 blood donors referring to Golestan Blood Center from March 21, 2018, to March 20, 2019. Siemens Enzyngnost HBsAg6, INNO-LiPA Genotyping kits, and Nest-PCR were used for HBV screening, genotyping, and amplification of the polymerase gene, respectively. An online tool at hbv.geno2pheno.org and real-time PCR method were also utilized for drug resistance prediction and viral load measurement respectively. It was found that from among 47,506 donors, 47 (0.09%) were confirmed to be HBV positive subjects. About 0.94% of first-time blood donors (46 out of 4, 872) and 0.008% of repeated blood donors (1 out of 12,125) were found to be positive for HBV. First-time blood donors were also 8.6 times more likely to have a hepatitis B virus infection (odds ratio: 9.6; 95% confidence interval, 6.2 - 14.7). Seven donors had genotype D as predominant and one case had a mixed infection with genotypes A and D. Furthermore, the most predicted mutation in the polymerase gene was m204V, causing resistance to telbivudine and lamivudine. The results showed that the risk of HBV transmission is higher among first-time blood donors. Therefore, it is recommended that predonation laboratory screening in first-time blood donors be conducted to improve the safety of the donated blood in the studied region.

Clinical Course of Untreated and Treated Chronic Hepatitis B in Pregnant Patients: A Prospective Study

OBJECTIVE: Implementation of strategies to prevent vertical transmission is highly important steps in reducing the global burden of chronic hepatitis B. We conducted this prospective study to observe the clinical course and outcomes of untreated and treated HBV in pregnant.STUDY DESIGN: HBsAg-positive pregnants were prospectively enrolled from 2013 to 2016 and antiviral therapy was administered to eligible patients. Pregnancy and neonatal outcomes were determined in the treated (n=29) and untreated group (n=136). Active-passive immunoprophylaxis was administered to infants and they were tested for HBsAg.RESULTS: The risk factors for transmission (HBeAg positivity, history of previously-born HBsAg-positive child) were significantly higher in the treated group. All participants under treatment had sufficient viral suppression. Half of the pregnant women for whom the treatment was withheld at the postpartum period, experienced increased viral load. The treated group had significantly higher pre- and postpartum alanine aminotransferase levels more than the untreated group, although there were no significant differences in other biochemical parameters. There were no significant differences regarding fetal outcomes between the two groups. All infants were HBsAg-negative at seven months postpartum.CONCLUSION: While the untreated group included inactive carriers, there were more patients at risk for transmission of HBV to their offsprings in the treated group. Half of the pregnant women for whom the treatment was withheld at the postpartum period, experienced increased viral load. Antiviral therapy did not adversely affect the outcomes of infants. As a result, we successfully prevented perinatal HBV transmission by close monitoring of participant pregnant women and starting antiviral therapy when needed.

HEPATITIS B AND C: FREQUENCY, MODES OF TRANSMISSION AND RISK FACTORS ALONG WITH SOME UNORTHODOX ROUTES OF SPREAD

Background: Pakistan's being a country placed in intermediate endemicity zone of HBV and HCV, with rising population, there is lack scarcity of knowledge about transmission of risk factors specially unorthodox and frequency of this health challenge. Methods: A retrospective case control study where case records of all patients aged from 18 - 70 years from 2012 to 2017 with either gender diagnosed as chronic hepatitis B and C were included. Information about shave from barber-shop, sharing of toothbrush at home, tattooing, cautery, and ear piercing were collected. Information about unorthodox risks for transmission of HBV and HCV, like skin branding, cupping of blood, circumcision by the barber, sharing of tooth brushes and leech therapy was collected. Results: Among 1134 patients of chronic hepatitis B (HBV) and chronic hepatitis C (HCV), Age > 35 years, shave from barber and dental treatment were found to be risk factor for both HCV and HBV transmission. Amongst unorthodox risk factors like skin branding, cupping of blood, circumcision by the barber, sharing of tooth brushes and leech therapy, only cupping of blood (Hijama) was a significant risk for transmission of both HBV and HCV. Conclusion: Viral related chronic hepatitis is frequently reported problem in this part of the world where HCV supersedes HBV. Socieodemographic factor like age > 35 year, shave from barbers and dental treatment were risk factors for transmission of both HCV and HBV. Among orthodox routes of transmission blood cupping (hijama) has shown as a significant transmission risk for both HCV and HBV.

Asialoglycoprotein receptor expression in placenta of women with Hepatitis B Virus e Antigen (HBeAg) positive and negative

This study aimed to determine the relationship between Asialoglycoprotein receptor (ASGP-R) on the placenta and positivity of HBeAg in the mother's serum. We collected 52 placentas from delivered mothers who have HbsAg-positive serum. The HbsAg-positive serum was then examined for HBeAg-positive and HBeAg-negative. Immunohistochemistry staining was performed on block paraffin sections using monoclonal antibody of ASGP-R. The expression of ASGP-R of 52 placenta samples demonstrated that 37 samples were scored I, five samples were score II, two samples were score III, and eight samples were score IV. We found that 14 of 52 serum samples were HBeAg-positive and 38 were HBeAg-negative. There is a significant correlation between ASGP-R on the placenta and positivity of HBeAg in the mother's serum. The expression of the ASGP-R could increase the risk of HBV transmission. The result of this study could be used as a guideline for preventing and therapeutic approach of HBV from mother to child.

Presence of anti-HBc antibodies in antigene negatives HBs blood donors at the central hôpital of Yaounde

Introduction: In Cameroon, blood transfusion safety is a real public health problem. It is one of the African countries where screening for HBsAb is not systematic in blood donors, which can expose the beneficiaries of these donations to possible viral hepatitis B (VHB) infections. Methodology: We carry out a descriptive study at the Yaoundé Central Hospital blood bank during the period from August to October 2018. It was intended to determine the residual risk of transmission of VHB related to the presence of HBcAb in blood donors tested negative to HBsAg. The immunochromatographic technique was used for the detection of total HBcAb in blood donors tested negative for HBsAg, HCV, HIV and TPHA markers. The viral markers, HBsAg, HIV, HCVAb, and TPHA, were tested by ARCHITECT, an apparatus which uses the immunological principle of chemiluminescence. Results: Of the 148 donors registered in the study, we had 129 men and 19 women. We obtained an overall transmission risk of HBV related to the presence of HBcAb of 43.24%. This risk was 47.37% for family donors (p = 0.03999) and 27.3% for volunteers. No significant association was found between the sex of the participants (p = 0.3762), age (p = 0.7403), donor regularity (p = 0.4587) and HBcAb frequency. Concluson: In view of these results, the HBcAb remains very high in the blood donors tested HBsAg negative in Cameroon. To complete this study, we suggest the screening for viral DNA in donors who are tested HBsAg negative and HBcAb positive to eradicate this residual risk of HBV transmission through blood transfusion.

31. Viral load dynamics of hepatitis B virus DNA infection among diverse group of India

Background and Aims: Viral load dynamics of infectious diseases among diverse group are the most important aspects of epidemiological studies to control the disease for the destination countries. Objectives: To the best of viral dynamics, the present study was conducted to determine the virus DNA level, and the frequency of infection among the age group (1–15, 16–30, 31–45, 46–60, 61–75 years) and genders in Indian population. Methods: A total of 515 suspected cases including 378 (73.39%) male and 137 (26.60%) female, with ages ranging between 06 and 75 years (mean ± standard deviation: 35.90 ± 14.14 years) participated in this study From those, blood sample were collected and viral DNAs were extracted from the plasma and analyzed by Real-time PCR system with the combination of artus® HBV RG PCR assay for the specific region of HBV genome. Results: HBV DNA was detected in a total of 360/515 (69.90%) plasma samples; 269 (74.72%) male and 91 (25.27%) female. The level for viral load of HBV DNA ranged from 10.5 to >2 × 107 IU/ml in the plasma samples (median 461 IU/ml). On the evaluation of demographic data for the age groups and genders, the comparison of viral loads between the age groups and genders indicated no significant correlation (P > 0.05). However, the plasma HBV DNA infection rate among female significantly decreased in the age group of 16–30 years (P = 0.04). There was no significant difference of viral load between the genders in the study population (P > 0.05). Conclusions: Considering the results of the HBV DNA viral load and evaluation of studied group outcome can help to implement the diagnosis and prevention procedures in such cases, as well as to emphasize the risk of HBV transmission in the group of population. The authors have none to declare.

IMPACT OF MULTIPLEX PCR IN REDUCING THE RISK OF RESIDUAL TRANSFUSION-TRANSMITTED HUMAN IMMUNODEFICIENCY AND HEPATITIS B AND C VIRUSES IN BURKINA FASO

Background and ObjectiveThe improved performance of serological tests has significantly reduced the risk of human immunodeficiency and hepatitis B and C viruses transmission by blood transfusion, but there is a persistence of residual risk. The objective of this study was to evaluate the impact of multiplex PCR in reducing the risk of residual transmission of these viruses in seronegative blood donors in Burkina Faso.MethodsThis cross-sectional study was conducted from March to September 2017. The serological tests were performed on sera using ARCHITECTSR i1000 (Abbot diagnosis, USA). Detection of viral nucleic acids was performed by multiplex PCR on mini-pools of seronegative plasma for HBV, HCV and HIV using SaCycler-96 Real Time PCR v.7.3 (Sacace Biotechnologies). Multiplex PCR-positive samples from these mini-pools were then individually tested by the same method.ResultsA total of 989 donors aged 17 to 65 were included in the present study. “Repeat donors” accounted for 44.79% (443/989). Seroprevalences for HIV, HBV, and HCV were 2.53% (25/989), 7.28% (72/989) and 2.73% (27/989), respectively. Of the 14 co-infections detected, HBV/HCV was the most common with 0.71% (7/989) of cases. Of 808 donations tested by multiplex PCR, 4.70% (38/808) were positive for HBV while no donation was positive for HIV or HCV.ConclusionOur study showed a high residual risk of HBV transmission through blood transfusion. Due to the high prevalence of blood-borne infections in Burkina Faso, we recommend the addition of multiplex PCR to serologic tests for optimal blood donation screening.

Clinical course and perinatal transmission of chronic hepatitis B during pregnancy: A real-world prospective cohort study

To determine the clinical course and perinatal transmission of chronic hepatitis B during pregnancy in a real life setting. A total of 221 singleton pregnant women with detectable HBV-DNA levels (≥103 copies/mL) were enrolled during January 2011 to June 2015. Forty-three high viraemic patients (≥106 copies/mL) received telbivudine in the 2nd or 3rd trimester according to their intention, while 89 high viraemic and 79 low viraemic (≥103 and <106 copies/mL) patients were the control cohorts. Primary endpoint was the pregnancy outcomes and secondary endpoint the perinatal transmission including intrauterine infection, immunoprophylaxis failure and occult infection. In all, 209 patients completed pregnancy with 209 infants, while 2 in telbivudine-treated cohort had unexplained late stillbirths. Twenty-nine (70.7%) of telbivudine-treated patients and 3 (3.4%) of untreated high viraemic controls achieved undetectable HBV-DNA levels prior delivery. At 7 months postpartum, immunoprophylaxis failure was significantly lower (2.4%) in telbivudine-treated cohort, compared with 16.9% and 10.1% in untreated high and low viraemic cohorts, respectively. Low viraemic patients may also need antiviral therapy since they bear moderate risk for perinatal transmission of HBV. However, more multicenter, large-scale studies are required before antepartum antiviral therapy is routinely recommended in patients with detectable viral loads.

Cost-effectiveness of antiviral therapy during late pregnancy to prevent perinatal transmission of hepatitis B virus.

Background. Hepatitis B virus (HBV) infections are perinatally transmitted from chronically infected mothers. Supplemental antiviral therapy during late pregnancy with lamivudine (LAM), telbivudine (LdT), or tenofovir (TDF) can substantially reduce perinatal HBV transmission compared to postnatal immunoprophylaxis (IP) alone. However, the cost-effectiveness of these measures is not clear.Aim. This study evaluated the cost-effectiveness from a societal perspective of supplemental antiviral agents for preventing perinatal HBV transmission in mothers with high viral load (>6 log10 copies/mL).Methods. A systematic review and network meta-analysis were performed for the risk of perinatal HBV transmission with antiviral therapies. A decision analysis was conducted to evaluate the clinical and economic outcomes in China of four competing strategies: postnatal IP alone (strategy IP), or in combination with perinatal LAM (strategy LAM + IP), LdT (strategy LdT + IP), or TDF (strategy TDF + IP). Antiviral treatments were administered from week 28 of gestation to 4 weeks after birth. Outcomes included treatment-related costs, number of infections, and quality-adjusted life years (QALYs). One- and two-way sensitivity analyses were performed to identify influential clinical and cost-related variables. Probabilistic sensitivity analyses were used to estimate the probabilities of being cost-effective for each strategy.Results. LdT + IP and TDF + IP averted the most infections and HBV-related deaths, and gained the most QALYs. IP and TDF + IP were dominated as they resulted in less or equal QALYs with higher associated costs. LdT + IP had an incremental $2,891 per QALY gained (95% CI [$932–$20,372]) compared to LAM + IP (GDP per capita for China in 2013 was $6,800). One-way sensitivity analyses showed that the cost-effectiveness of LdT + IP was only sensitive to the relative risk of HBV transmission comparing LdT + IP with LAM + IP. Probabilistic sensitivity analyses demonstrated that LdT + IP was cost-effective in most cases across willingness-to-pay range of $6,800 ∼ $20,400 per QALY gained.Conclusions. For pregnant HBV-infected women with high levels of viremia, supplemental use of LdT during late pregnancy combined with postnatal IP for infants is cost-effective in China.

Hemodiyaliz hastalarında gizli Hepatit B enfeksiyonunun polimeraz zincir reaksiyonu ile araştırılması

Aim: It is known as the occult Hepatitis B that Hepatitis B virus DNA (HBV DNA) exists in serum very little if Hepatitis B virus surface antigen in serum is negative. The studies about occult Hepatitis B infection prevalence are limited in patients who undergo hemodialysis implements for along time. HBV existence is able to continue in plasma and liver tissue of some patients whose HBsAg test is negative. This condition causes many diagnostic problems. It is very crucial the description of people who have this clinical risk of HBV transmission in the community, especially in dialysis units. This study is aimed to determine the prevalence of occult Hepatitis B in dialysis patients. Material and Methods: 160 HBsAg-negative patients and 28 predialysis total of 188 patients were included in this study. 5 ml venous blood samples taken from the patients into sterile vacutainer tubes contain anticoagulant. Blood tubes to separate serum 800-1600 x g for 20 min. centrifuged. The separated serum was collected into polypropylene tubes and was stored at -20 oC until the applied test procedure. For the detection of HBV DNA; HBV Isolation Device (Magnesia 16 Geneworks Anatolia, Turkey) and HBV DNA isolation kit (16/201 viral nucleic acid isolation kit) was used and isolated, then serum were tagged on the elution tube. Real-Time PCR Device (Montanide 483 Geneworks Anatolia, Turkey) and Real-time PCR kit (Bosphore Quantification Kit V2) was used in PCR process. Real Time PCR kit, which is used in the study, was detected whole HBV genotypes between A and H of the Hepatit B virus DNA in human serum or plasma sample. Analytical sensitivity of the kit was 10 IU / mL linear range 1x101-1x109 IU/ml. Hepatitis B virus markers (HBsAg, anti-HBcAg, anti-HBs) ) were studied using commercial ELISA kits (Abbott ARCHITECT Qualitative Reagan Kit) and ELISA device (Abbott ARCHITECT i2000 SR), CRP (SIEMENS cardiophase to hsCRP the kit and SIEMENS BN II device. Likewise, aspartate aminotransferase (AST), alanine aminotransferase (ALT), (aspartate aminotransferase A / Alanine aminotransferase Roche Cobas INTEGRA / cobas c system) were studied using with test kits Roche Cobas 501 devices. Results: In 11.3% of hemodialysis patients (18/160) HBV DNA positivity (occult Hepatitis B infection) were detected. Predialysis patients who are in the control group was not observed HBV DNA positivity (0/28). Anti-HBs positivity in 142 hemodialysis patients (88.7%), while 14 predialysis patients (50%) were found (p <0.05). There was no statistically significant difference between the other parameters. Conclusions : Dialysis centers are areas of risk for transmission of HBV. HBV DNA screening of all patients undergoing dialysis must be performed. In addition; suggested to vaccination of susceptible patients, GHB has been diagnosed patients isolating dialyzer, the diagnosis of HBV patients receiving a specific service area. Key Words: HBV, occult Hepatitis B, hemodialysis

What Is the Risk of Transmission From HBcAb Positive Donors To the Recipient in Kidney and Pancreas Transplantation?

Introduction: There is variation of practice amongst UK kidney and pancreas transplant units in implanting grafts from HBcAb +ve donors due to the perceived risk of transmission of hepatitis B (HBV). Centres transplanting such grafts have variable practice of antiviral prophylaxis with lamivudine ranging from no prophylaxis to life-long prophylaxis. The aim of this study was to assess the rate of HBV infection in HBsAg -ve recipients of renal and pancreas allografts receiving organs from HBcAb +ve, HBsAg -ve donors. Methods: We surveyed the UK kidney and pancreas transplant units regarding their practices of accepting HBcAb +ve donor grafts and the subsequent use of antiviral prophylaxis. All patients receiving a kidney (KT) and or pancreas (PT) allograft from HBcAb +ve, HBsAg -ve donors between Jan 2002 and Dec 2011 were identified retrospectively from the UK Transplant Registry. Post transplant virology data were also collected. All patients had a minimum follow-up of 2 years. Results: The survey was incomplete at the time of this analysis and hence is not presented. A total of 277 patients were identified who underwent KT (n=252) or PT (n=25) from HBcAb +ve donors. Of these 2 KT recipients were HBsAg +ve prior to transplantation and were excluded from the analysis. Of the remaining 275, seven recipients (6 KT, 1 PT) had documented evidence of HBV positive virology post transplant (2.5%). At the time of this analysis, 178 patients (159 KT, 19 PT) had documented negative virology (65%) and 98 (93 KT and 5 PT) were recorded as ‘not reported’ (35%). Of the 11 KT in our centre, no HBV transmission recorded. All received 100 day lamivudine prophylaxisConclusions: The risk of HBV transmission following kidney and pancreas transplantation from HBcAb +ve donors remains low. Use of antiviral prophylaxis can help reduce this risk further. We suggest 100-day post-transplant lamivudine prophylaxis in kidney and pancreas transplantation. There is a need for clear guidelines for the safe and effective use of HBcAb +ve grafts

Occult hepatitis B virus infection among Iranian blood donors: a preliminary study.

Although serological screening tests for blood-borne hepatitis viruses have effectively reduced the risk of HBV transmission through transfusion of infected blood, there is still a possibility that infected blood units from occult carriers being released into the blood supply. The aim of this study was to determine the prevalence of anti-HBc among Iranian blood donors and evaluate the presence of HBV DNA in HBsAg negative plasma samples. In the present study, 5000 HBsAg negative samples were collected from donors in blood transfusion centers in Tehran. All HBsAg negative samples were tested for the presence of anti-HBc antibody and anti-HBs antibody (HBsAb) using ELISA method. Also, all HBsAg negative samples were tested for the presence of HBV DNA by real-time PCR. Four hundred ninety nine (9.98%) out of the 5000 HBsAg negative blood donors were anti-HBc positive. Out of 499 anti-HBc positive samples that were tested for anti-HBs, 394 (78.4 %) were anti-HBs positive, and 275 (62.7%) had an antibody titer greater than 100 IU/mL. HBV DNA was detected in two samples. In countries with intermediate rate of HBV infection like Iran, the prevalence of anti-HBc antibody in HBsAg negative blood donors is found to be high. As a result, routine anti-HBc screening of HBsAg-negative blood donors without complementary tests (anti-HBs / HBV-DNA) can limit the number of blood transfusions. Therefore, it might be better to include the detection of HBV DNA along with the routine tests.

Lower Intrafamilial Transmission Rate of Hepatitis B in Patients With Hepatitis D Coinfection: A Data-Mining Approach

BackgroundThe presence of an infected family member significantly increases the risk of HBV transmission, but many socio-demographic and viral characteristics of family members affect the transmission rate.ObjectivesIn this study, we have used data mining techniques to investigate the impact of different variables in intrafamilial transmission of HBV infection.Patients and Methodsdemographic information, viral markers, and medical history of 330 patients with chronic hepatitis B and their offspring attending a referral center in Tehran were collected. Data-mining techniques were administered to detect patterns.ResultsThe overall transmission rate was 15.7% (5.4% and 27.3% for male and female index cases respectively). In female patients, HBe Ag positively affected the transmission rate (49% vs. 23.4%). There was a dominant change in transmission rate of female patients with negative results for Hbe Ag with HDV coinfection, where the transmission rate changed from 25% in patients with negative results for HDV Ab to 5% in those with positive results. In Hbe Ag negative male index cases, the transmission rate was 1.3% in cases with positive results for HDV Ab compared to 7% in those with negative findings. The overall transmission rate was statistically different between patients with positive and negative results for HDV Ab (P = 0.016).ConclusionsThere is a minor but consistent pattern change in the presence of HDV infection which reduces familial transmission of HBV, especially in female patients with negative results for HBe Ag.

Study on the status of HBV infection and its determinants among family members with HBV infected persons in Shanghai

To understand the status of HBV infection among family members with HBV infected persons in Shanghai and to probe the determinants of HBV infection so as to provide evidence for improving the related strategies on hepatitis B prevention and control. Three hundred and four hepatitis B patients together with 288 HBsAg carriers from 6 districts in Shanghai were randomly sampled in 2010. All the said persons and their families members were asked to fill in questionnaires and to be drawn 5 ml venous blood for HBV serologic indicators detection. The subjects were divided into case group and control group according to their status of HBV infection. Univariate analysis and multivariate logistic regression analysis were carried out to identify the determinants of HBV infection among family members. Among 1485 subjects from 592 households, a total of 1137 persons were infected by HBV, with the overall infection rate as 76.57%. Fifteen infection modes were noticed, in which double positive of anti-HBs and anti-HBc, triple positive of HBsAg, anti-HBe and anti-HBc, together with triple positive of anti-HBs, anti-HBe and anti-HBc accounted for the top three, with the proportions as 30.69%, 26.65% and 10.03% respectively. The differences between the years of carrying HBV and the proportions of numbers that carrying HBV in families, were not statistically significant. The infection rate among children (42.86%) was significantly lower than that of their parents (87.54%) (P < 0.001). Results from both univariate and multivariate analysis showed that gender, age, utensil sharing, histories of receiving hepatitis B vaccines and dental outpatient service were determinants of HBV infection among families members (P < 0.05), with OR values being 9.009 for persons without immunization history of hepatitis B vaccines, 3.817 for persons above 40 years old and 2.283 for persons of 21 - 40 years old, 2.222 for families members who sharing utensil, 2.124 for persons with history of dental outpatient service and 1.339 for male members, respectively. Family clustering of HBV infection in was seen in Shanghai. In order to reduce the number of HBV infection in families, hepatitis B vaccination program need to be carried out. Healthy lifestyle should be emphasized to prevent HBV infection due to close contact. The risk of iatrogenic HBV transmission should also be prevented.

Familial clustering of HBV in families with children who are diagnosed as chronic hepatitis B or inactive carriers of HBV

The aim of this study was to assess and compare the spread of HBV infection in families with children who are diagnosed as chronic hepatitis B or are inactive carriers of HBV. A total of 570 patients aged 2-16 years and 2358 family members were included in the study. Patients were classified as inactive carriers (Group 1, 350 patients) or patients diagnosed as chronic active hepatitis B (Group 2, 220 patients). Demographic features of the families, HBV serological markers and routes of transmission were evaluated. Parental transmission was lower compared to nonparental transmission (34.8% and 65.1%, respectively). HBsAg positivity rate was found to be highest among mothers in both of the groups. HBeAg positivity and anti-HBs positivity were significantly higher in family members of Group 2. Transmission rates were significantly higher in families consisting of five or more members compared to families consisting of less than five members. HBsAg positivity of siblings was lowest when both parents were HbsAg negative and highest when both parents were HBsAg positive in both groups. A high risk of HBV transmission among mothers of HBsAg carriers and patients with chronic hepatitis B was demonstrated.