Risk Of Hepatitis B Virus Transmission Research Articles

The impact of donor hepatitis B virus infection on transplant outcomes in deceased donor kidney transplantation recipients.

The use of hepatitis B virus (HBV)-positive donor kidneys to expand the donor pool has been implemented, but limited evidence exists regarding their impact on transplant outcomes. This study aimed to investigate the effects of donor HBV infection on transplant outcomes. Donor and recipient data between 2015 and 2021 were collected. A total of 743 kidney transplant cases were screened, including 94 donor hepatitis B surface antigen (HBsAg)+/recipient HBsAg- (D+R-) and 649 donor HBsAg-/recipient HBsAg- (D-R-) cases. The analysis endpoints included recipient HBV infection, delayed graft function (DGF), peak estimated glomerular filtration rate (eGFR) within 12 months, recipient survival, and death-censored graft survival (DCGS). The D+R- group had a significantly higher risk of HBV infection compared to the D-R- group (6/72 vs. 3/231; relative risk, 6.4; p = 0.007). The risk of HBV transmission decreased significantly with increasing hepatitis B surface antibody (HBsAb) titer (p for trend = 0.003). Furthermore, the D+R- group did not exhibit an increased risk of DGF compared to the D-R- group (odds ratio, 0.70; p = 0.51) in the multivariable mixed model. Both groups had similar peak eGFR within 12 months (β = 1.01, p = 0.71), and this had no impact on patient survival (hazard ratio [HR], 0.36; p = 0.10) and DCGS (HR, 0.79, p = 0.59) in the shared-frailty Cox model. The use of HBsAg-positive donor kidneys appears relatively safe for HBV-immunized recipients in the short term. D+R- does not negatively affect graft function recovery and provides comparable posttransplant outcomes. Maintaining an HBsAb titer over 100 IU/L before transplantation is critical to reduce the risk of HBV transmission.

Hepatitis B transmission/reactivation associated with Hepatitis B core antibody and Hepatitis C nucleic acid testing positive organs: A report from the Organ Procurement and Transplantation Network Disease Transmission Advisory Committee.

Better access to direct-acting antiviral (DAA) therapy has broadened the utilization of hepatitis C virus (HCV) nucleic acid testing (NAT) positive organs with excellent outcomes. However, DAA therapy has been associated with hepatitis B virus (HBV) reactivation. To determine the risk of HBV transmission or reactivation with utilization of HBV core antibody positive (HBcAb+) and HCV NAT positive (HCV+) organs, which presumably required DAA therapy. The number of HBcAb+ donors with delineated HCV NAT status was obtained from the Organ Procurement and Transplantation Network (OPTN) database. The number of unexpected HBV infections from transplanted organs adjudicated as "proven" or "probable" transmission was obtained from the OPTN Ad Hoc Disease Transmission Advisory Committee database. A chart review of the donors of "proven" or "probable" cases was conducted. From January 1, 2016, to December 31, 2021, 7735 organs were procured from 3767 HBcAb+ donors and transplanted into 7469 recipients; 545 (14.5%) donors were also HCV+. HBV transmission or reactivation occurred in seven recipients. The rate is not significantly different between recipients of HCV+ (0.18%, 2/1115) and the HCV NAT negative (HCV-) organs (0.08%, 5/6354) (p = 0.28) or between recipients of HCV+ and HCV- livers as well as non-liver organs. HBV transmission or reactivation occurred within a median of 319 (range, 41-1117) days post-transplant in the setting of missing, inadequate, or truncated prophylaxis. HBV reactivation associated with DAA therapy for HBcAb+ HCV+ organs is less frequent than reported in the non-transplant population, possibly due to the common use of HBV prophylaxis in the at-risk transplant population.

Genetic diversity and occult hepatitis B infection in Africa: A comprehensive review.

Occult hepatitis B infection (OBI) is a globally prevalent infection, with its frequency being influenced by the prevalence of hepatitis B virus (HBV) infection in a particular geographic region, including Africa. OBI can be transmitted through blood transfusions and organ transplants and has been linked to the development of hepatocellular carcinoma (HCC). The associated HBV genotype influences the infection. To highlight the genetic diversity and prevalence of OBI in Africa. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a comprehensive search on PubMed, Google Scholar, Science Direct, and African Journals Online for published studies on the prevalence and genetic diversity of OBI in Africa. The synthesis included 83 articles, revealing that the prevalence of OBI varied between countries and population groups, with the highest prevalence being 90.9% in patients with hepatitis C virus infection and 38% in blood donors, indicating an increased risk of HBV transmission through blood transfusions. Cases of OBI reactivation have been reported following chemotherapy. Genotype D is the predominant, followed by genotypes A and E. This review highlights the prevalence of OBI in Africa, which varies across countries and population groups. The study also demonstrates that genotype D is the most prevalent.

Hepatitis B Vaccination Coverage among Healthcare Workers and Evaluation of Immune Response by Estimating Anti-HBs Antibody Titers over Time at a Tertiary Care Hospital: A Cross-sectional Study

Introduction: Healthcare Workers (HCWs) are at a high-risk of acquiring Hepatitis B Virus (HBV) infection. However, this risk can be prevented through Hepatitis B vaccination. In some institutes, HCWs have a lower percentage of HBV vaccination, leading to a higher risk of HBV transmission. Therefore, the coverage of vaccination is an important point, along with the evaluation of protective immune status. Aim: To assess the vaccination coverage and evaluate the immune response post-vaccination through Anti-Hepatitis B surface Antibodies (Anti-HBs) titre. Materials and Methods: This cross-sectional study was conducted at Government Medical College, Pali, Rajasthan, India, over a period of one year from April 2021 to March 2022, following approval from the Institutional Ethics Committee (IEC). A total of 455 HCWs below 60 years of age were included in the study, and their demographic details such as age, gender, occupation, needle stick injury, blood exposure to mucous membranes and breached skin, hepatitis B vaccination status, and time duration since vaccination were noted. Additionally, their Anti-HBs titer was examined. The participants were initially classified into three groups: completely vaccinated, partially vaccinated, and non vaccinated. Among those who were vaccinated, they were further divided into two groups: vaccination ≤5 years (Group A) and >5 years (Group B). Furthermore, those who received a booster dose were divided into Group I (≤1 year) and Group II (>1 year). Blood samples were collected to assess the anti-HBs levels quantitatively in the sera using Enzyme Linked Immuno Sorbent Assay (ELISA). The data was entered into Microsoft Excel and later imported into Statistical Package for Social Sciences (SPSS) version 22.0 for statistical analysis. Results: Participants had a mean age of 29.65±9.603 years. Among them, 43 (30.1%) were doctors, and 37 (25.9%) were medical students who were found to be completely vaccinated. On the other hand, among other HCWs, 15 (10.5%) were nurses, 16 (11.2%) were nursing students, and 32 (22.4%) were lab technicians who were vaccinated. None of the support staff were vaccinated (p-value=0.0001). A total of 143 participants were completely vaccinated, and 97.9% (n=140) had protective immunity to Hepatitis B. The anti-Hbs titre was 567.32±434.494 in group A and 265.74± 211.80 in group B (p-value=0.0001). Similarly, it was 688.34±424.617 in group I and 221.14±141.221 in group II (p-value <0.0001).The anti-Hbs titre did not significantly increase among the partially vaccinated participants (n=162). It was found to be 25.47±27.595 in group A and 14.60±19.939 in group B (p-value=0.004). There was no significant difference in the results between males and females (p-value=0.961). Conclusion: The coverage of complete vaccination among HCWs was significantly low, which is crucial for obtaining a protective Anti-Hbs titre. Incomplete vaccination does not result in a sufficient level of anti-Hbs titre, and there may be a significant decline in the immune response over time (p-value<0.05). Therefore, it is essential to estimate the titre after 1-2 months of complete vaccination to ensure that individuals are fully protected against Hepatitis B.

Serological and Molecular Characterization of Occult HBV Infection in Blood Donors from South Italy.

Despite good vaccine coverage and careful blood donor selection policies, hepatitis B virus (HBV) is still the most frequent viral infection among blood donors (BDs) in Italy, mostly in the occult form (OBI). We studied the virological features of OBI in BDs from South Italy by serology, molecular testing for HBV-DNA, and sequencing for HBV genotypes and mutations. One hundred and two samples from 95 BDs (22.1% first time, 87.9% regular, median age 57 years) positive for HBV-DNA and negative for HBsAg were retrospectively analyzed. HBV biomarkers were detected in 96.9% (anti-HBc in 44.2%, anti-HBc plus anti-HBs in 49.5%, anti-HBs alone in 3.2%). No risk factor was declared by 45.3% of donors. HBV-DNA levels were very low (median: 7 IU/mL). All samples harbored HBV genotype D and single or multiple mutations in the S gene were found in 28/36 sequences analyzed and in 75% of donors. Mutations were unrelated to gender, donor group or serological patterns. An HBsAg assay with enhanced sensitivity was positive in samples from seven donors (7.4%), two of which negative for HBV-DNA by real-time PCR. OBI still represents a risk for HBV transmission from blood donations; screening by highly sensitive serological and molecular assays is warranted.

Assessment of the Knowledge of Hepatitis B Virus Infection in Primary Healthcare Centers in Abuja, Nigeria

Hepatitis B virus (HBV) infection affects the liver and can lead to potentially life-threatening acute or chronic disease. The population with high HBV infection prevalence of ≥ 8%, such as Nigeria, presents the highest risk of HBV transmission among health-workers. There is a need to disseminate knowledge of HBV infection and the risk of transmission to health-workers. In this baseline study, the team assessed the knowledge of HBV infection among health-workers in Primary Healthcare Centers (PHCs) in AMAC, Abuja. We conducted cross-sectional descriptive research that studied 168 randomly selected health-workers from 58 PHCs in AMAC, collected data with a pre-tested structured questionnaire, and analyzed it with SPSS version 21.0. The knowledge level of HBV symptoms and transmission ranged from 57.1% to 85.7%s and 84.5% to 91.7%, respectively. About 67% demonstrated good knowledge of HBV screening for pregnant women and 69% of Hepatitis B vaccination at birth. All the PHCs (100%) reported the unavailability of guidelines/protocols for HBV infection in pregnancy management and prevention. Furthermore, 51.2%, 53.7%, and 55.6% demonstrated poor knowledge of referral, PMTCT eligibility, and increased need for laboratory tests, respectively. Moreover, 60.2% showed poor awareness of treatment eligibility and 61.2% of choice of drug. Concluding, the respondents demonstrated good knowledge of HBV infection symptoms, transmission, screening for pregnant women, and vaccination schedules to prevent HBV infection. They showed a poor understanding of the referral of pregnant HBV seropositive women from the PHCs to secondary/tertiary hospitals, PMTCT, laboratory requirements for pregnant seropositive clients, and management of chronic HBV in pregnancy. Keywords: Abuja, Hepatitis B virus Infection, Health-workers, Knowledge, Primary healthcare centers.

Burden of HIV, HBV and syphilis among children in urban Ethiopia: Community-based cross-sectional study.

Children have largely been ignored in the fight against sexually transmitted infection (STI). Among children, STI is reported to be a globally emerging public health challenge. We evaluated the burden of HIV, hepatitis B virus (HBV) and syphilis among children (< 15 years old) and its determinants in urban Ethiopia. For this study, we used data from the Ethiopian Population-based HIV Impact Assessment (EPHIA), collected through a nationally representative, community-based study conducted in Ethiopia from October 2017 to April 2018. We used plasma samples from 4729 children. Moreover, we linked the data and analysed them alongside their respective mothers. Child and maternal HIV status was determined using the national testing algorithm. Plasma samples from children were also tested for syphilis and HBV surface antigen. A descriptive analysis was done followed by bivariable analysis with 95% confidence interval (CI) at a significance level of p< 0.05. We finally evaluated predictors of STIs using regression analysis. HIV, HBV and syphilis prevalence rates among urban children in Ethiopia were 0.36%, 1.48% and 0.28%, respectively. Children living in Gambella and Addis Ababa had a 6.41-fold (95% CI:3.20-9.88) and 4.20-fold (95% CI:3.24-5.46) higher risk of HIV infection compared with those in Dire Dawa. Children of HIV-positive mothers had a 10.31-fold (95% CI:3.20-18.19) higher risk of HIV infection, and if those mothers were not taking highly active antiretroviral therapy (HAART), the risk was 7.27 times higher (95% CI:2.57-12.64). Those who were from HIV-positive mothers with viral load ≥ 1000 copies/mL had a 18.64-fold (95% CI:6.36-31.24) higher risk of HIV infection and those with a history of breastfeeding had a 3.27-fold (95% CI:1.11-5.67) higher risk. Children from Addis Ababa had a 3.26-fold (95% CI:1.64-6.66) higher risk of HBV infection compared with those from Dire Dawa. Moreover, for those from HIV-positive mothers and whose mother was not taking HAART, the risk of HBV transmission was 6.37 (95% CI:2.20-19.96) and 3.62 (95% CI:1.27-11.29), respectively. Children living in Gambella, Somali, Afar and Tigray had a 7.21-fold (95% CI:2.30-18.68), 3.10-fold (95% CI:1.28-3.74) and 1.32-fold (95% CI:1.11-3.38) higher risk of acquiring active syphilis compared with those living in Dire Dawa, respectively. Those from HIV-positive mothers also had a 4.22-fold (95% CI:1.16-8.39) higher risk of acquiring active syphilis. The burden of HIV, HBV and syphilis was high among children in urban Ethiopia. The key determinants for the high burden of HIV, syphilis and HBV were maternal factors including maternal HIV status and breastfeeding. This might be due to the challenges associated with mother-to-child transmission. Hence, the programme shall focus on the elimination of the triple infections of HIV, syphilis and HBV.

Immune Status for Hepatitis B and Risk for Occupational Exposure Virus Among Italian Nurses

Background: Healthcare workers (HCWs) are considered at higher risk for hepatitis B virus infection compared to the general population, due to their potential contact with blood or body fluids and possible needle stick injuries. In turn, infected HCWs may be a risk for patients. Hepatitis B vaccination programs represent a strategic approach to control the infection. Objectives: In this study, we aimed to evaluate the serological status of HCWs employed at the teaching hospital of Rome Tor Vergata and their risk of occupational injuries after the adoption of directive 2010/32/EU. Methods: Medical records of 539 HCWs were evaluated during their occupational medical examination at the Tor Vergata teaching hospital (PTV). All subjects were screened for specific viral markers: Hepatitis B surface antibodies (anti-HBs IgG), antibodies to hepatitis core antigen (anti-HBc IgG), and hepatitis B surface antigen (HBsAg). Data regarding needlestick injuries were collected by the prevention service team during the same year. Results: In this sample population, we found five subjects (0.9%) positive to the HBsAg, and most of them (four) were born in foreign countries. Moreover, seven subjects (1.3% of our population) were HBsAg-positive and anti-HBc-positive. A protective anti-HBs titer was found in 462 out of 527 (85.7%) subjects. The risk of being serologically unprotected was higher in males and subjects aged 40 years or older. The nurses were more protected than other healthcare professionals considering the anti-hepatitis B surface antibody titer. In 2018, 16 needlestick injuries were reported among our population of HCWs, with a global risk of 2.9% per year. Conclusions: Although hepatitis B virus (HBV) infection rate among HCWs was similar to that of the general population, the risk of HBV transmission in HCWs was likely to be high due to suboptimal vaccination coverage.

Immune Status for Hepatitis B and Risk for Occupational Exposure Virus Among Italian Nurses

Background: Healthcare workers (HCWs) are considered at higher risk for hepatitis B virus infection compared to the general population, due to their potential contact with blood or body fluids and possible needle stick injuries. In turn, infected HCWs may be a risk for patients. Hepatitis B vaccination programs represent a strategic approach to control the infection. Objectives: In this study, we aimed to evaluate the serological status of HCWs employed at the teaching hospital of Rome Tor Vergata and their risk of occupational injuries after the adoption of directive 2010/32/EU. Methods: Medical records of 539 HCWs were evaluated during their occupational medical examination at the Tor Vergata teaching hospital (PTV). All subjects were screened for specific viral markers: Hepatitis B surface antibodies (anti-HBs IgG), antibodies to hepatitis core antigen (anti-HBc IgG), and hepatitis B surface antigen (HBsAg). Data regarding needlestick injuries were collected by the prevention service team during the same year. Results: In this sample population, we found five subjects (0.9%) positive to the HBsAg, and most of them (four) were born in foreign countries. Moreover, seven subjects (1.3% of our population) were HBsAg-positive and anti-HBc-positive. A protective anti-HBs titer was found in 462 out of 527 (85.7%) subjects. The risk of being serologically unprotected was higher in males and subjects aged 40 years or older. The nurses were more protected than other healthcare professionals considering the anti-hepatitis B surface antibody titer. In 2018, 16 needlestick injuries were reported among our population of HCWs, with a global risk of 2.9% per year. Conclusions: Although hepatitis B virus (HBV) infection rate among HCWs was similar to that of the general population, the risk of HBV transmission in HCWs was likely to be high due to suboptimal vaccination coverage.

Disease Burden of Hepatitis B Infection and Section Vaccination Trends in Healthcare Workers: A Prospective Cohort Study

Introduction: Hepatitis B Virus (HBV) infection is an important occupational hazard for Healthcare Workers (HCWs), with an approximately four-fold increased risk of acquiring this infection compared to the normal population. The horizontal mode of transmission is the predominant mode among HCWs. Additionally, vaccination trends among HCWs have been disappointing, with paramedics reported to have a higher risk of HBV transmission and receiving HBV vaccination less often than doctors. Aim: To determine the burden of hepatitis B infection and vaccination trends among HCWs. Materials and Methods: This cross-sectional study was conducted at Pandit Bhagwat Dayal Sharma PGIMS, Rohtak Haryana, India, from March 2019 to January 2020, enrolling 250 HCWs. The study included 80 junior residents, 17 house surgeons, 123 nursing staff, 18 Laboratory Technicians (LTs), and 12 Operation Theatre Assistants (OTAs). The subjects were divided into two groups: medical workers (Group-1; House Surgeons and Junior Residents) and paramedical workers (Group-2; Nursing staff, LTs, OTAs). The sample size was calculated using Probability Proportion to Size (PPS) of HCWs. Descriptive statistics were performed. Results: None of the subjects tested positive for Hepatitis B surface Antigen (HBsAg) during the study period. A total of 196 (78.4%) subjects were vaccinated, while 54 (21.6%) subjects remained Non-Vaccinated (NV). Out of the 196 vaccinated subjects, 140 (71.4%) were Completely Vaccinated (CV), and 56 (28.6%) were Incompletely Vaccinated (IV). The vaccination rate was highest among junior residents (95%) and lowest among LTs and OTAs (50%). Among the 80 junior residents, 76 (95%) were vaccinated, and 4 (5%) were NV. Among the 123 nursing staff, 89 (72.3%) were vaccinated, and 34 (27.7%) were CV, 9 (50%) were NV and 3 were in category of IV. Among the 18 LTs, 6 (33.3%) were CV, and 9 (50%) were NV. None of the 12 OTAs were CV, with 6 (50%) being NV. Conclusion: HCWs are at a potential risk of contracting HBV infection as an occupational hazard. There is need to strengthen efforts towards vaccination and prevention of HBV infection.

Efficacy of Different Testing Scenarios in Reducing Transfusion-Transmitted Hepatitis B Virus (TT-HBV) Infection Risk.

The efficacy of different screening scenarios in reducing hepatitis B virus (HBV) transmission risk as compared to the risk without screening was modeled in 9,337,110 donations from four geographical regions that had been subjected to hepatitis B surface antigen (HBsAg) and individual donation nucleic acid amplification testing (ID-NAT). We used the Weusten models for estimating infectivity risk for Red Blood Cell (RBC) transfusions in eight HBV infection stages and then evaluated multiple screening strategies based on minipool (MP) and ID-NAT options of different sensitivity for their efficacy in reducing this risk. The efficacy in reducing HBV transmission risk by screening scenarios across the regions varied between 81% (HBsAg only) and 99.2% (ID-NAT and anti-HBc). Highly sensitive ID-NAT alone achieved a slightly higher risk reduction (97.6–99.0%) than minipool of 6 donations (MP6)-NAT in combination with HBsAg and anti-HBc (96.3–98.7%). In ID-NAT screened lapsed and repeat donors, the additional risk removed by HBsAg testing was minimal (<0.1%). The modeling outcomes in this and two previous reports using this multi-regional database suggest that one could consider an ID-NAT alone testing scenario as an alternative to MP-NAT and serology-based testing algorithms and restrict serologic testing to first-time donors only.

Clinical, Laboratory and Virological Characteristics of Patients with Positive Hepatitis B Surface Antigen

Background and Aim: Globally, Hepatitis B virus (HBV) infection is a major health issue contributing to various diseases such as hepatocellular carcinoma (HCC) and liver cirrhosis. Virus replication complex interaction with host immune system response causes dynamic interplay leading to HBV infection. In developing countries, HBV infection plays a significant role in higher rates of morbidities and mortalities. The present study aimed to assess the clinical, laboratory, and virological characteristics of patients with positive HBV surface antigen. Methodology: This cross-sectional study was carried out on 182 positive HBV surface antigen (HBsAg) in the department of Medicine, Social Security Hospital, Multan Road Lahore from April 2021 to March 2022. All the patients with positive HBsAg and negative hepatitis C were enrolled. Patients with a history of chronic liver disease, acute hepatitis B infection, and antiviral therapy were excluded. All patients underwent CBC, liver function tests, clinical evaluation, and abdominal ultrasonography examination, HBV serological marker’s assessment, HBV transmission risk factors, and HBV-DNA quantitative detection. SPSS version 25 was used for data analysis. Results: Out of 182 HBV infected patients, there were 162 (89%) males and 20 (11%) females. The overall mean age was 38.6 ± 8.6 years. The most prevalent complaint and common findings was arthralgia and hepatomegaly with reported incidence of 32 (17.6%) and 16 (8.8%) respectively. Based on ultrasonography imaging results, the incidence of normal liver, coarse liver, splenomegaly, and cirrhosis were found in 81.3% (n=148), 12.6% (n=23), 5.9% (n=11), and 6.6% (n=12) respectively. Based on laboratory results, normal alanine aminotransferase, normal aspartate aminotransferase, reduced serum albumin, and low platelet count were found in 76.9%, 84.8%, 4.9%, and 10.2% respectively. Regarding laboratory, clinical, and imaging characteristics, HBV-DNA positive and negative had no significant differences. Conclusion: The present study found that HBV infected patient’s clinical manifestations were fatigue, bleeding gums, abdominal pain and fatigue. Majority of patients had normal liver on liver function tests and ultrasonographic examination. Most patients had negative HBV infection antigen. Based on comparisons made between HBV-DNA negative and positive, no substantial variations were reported on laboratory, clinical, and imaging characteristics. Keywords: HBV antigen, Virological characteristics, HBV

Prevalence of hepatitis B virus core antibodies among blood donors in Nigeria: Implications for blood safety.

BackgroundAnti-hepatitis B core antibody (anti-HBc) testing improves transfusion safety by detecting past and current hepatitis B virus (HBV) infection while detecting hepatitis B surface antigen (HBsAg) in serology-negative HBV infection. However, occult HBV infection (OBI) (serum or liver HBV DNA-positive but HBsAg-negative) remains unaddressed among replacement blood donors – family members or friends who donate to replace blood transfused to a relative.ObjectiveThis study assessed risk factors for a positive anti-HBc test among donors with OBI and determined the anti-HBc-positive status of replacement donors.MethodsThe study was conducted at the University College Hospital Blood Bank, Ibadan, Nigeria, using blood samples collected from blood donors between April 2019 and May 2019. Donors were screened for HBsAg by rapid diagnostic test (RDT) and enzyme-linked immunosorbent assay (ELISA) and anti-HBc by ELISA, while HBV DNA was detected using a semi-nested polymerase chain reaction.ResultsOf the 274 participants, 15 (5.5%) were HBsAg-positive by RDT and 36 (13.1%) by ELISA, while 133 (48.5%) were anti-HBc positive. Out of 232 HBsAg-negative donors, 107 (46.1%) were anti-HBc positive. Of the 107 HBsAg-negative but anti-HBc-positive samples, only one (0.93%) was HBV DNA-positive. The HBV DNA-positive donor was HBsAg-negative by both RDT and ELISA tests.ConclusionThis study establishes a potential risk for HBV transmission from isolated anti-HBc-positive donors to blood recipients. HBc immunoglobulin (antibody) M testing to identify blood units requiring further screening with polymerase chain reaction to detect OBI can prevent HBV transmission through blood transfusion.

Expanded screening for chronic hepatitis B virus infection in China

Expanded screening for chronic hepatitis B virus infection in China

Prevalence of Occult Hepatitis B Virus Infection in Blood Donors with Negative ID-NAT in Switzerland

Introduction: Screening of hepatitis B surface antigen (HBsAg) and individual-donation nucleic acid amplification testing (ID-NAT) of blood donors have become standard to detect hepatitis B virus (HBV) infection. However, there is still a residual risk of HBV transmission by blood components of donors suffering from occult HBV infection (OBI). Therefore, many countries implemented universal testing of anti-HBV core antigen (anti-HBc) antibodies in order to increase blood safety. In Switzerland, anti-HBc testing is not part of the routine blood donor-screening repertoire. Therefore, we sought to assess prevalence of donors with OBI in a Swiss blood donor collective. Methods: Blood donations were prospectively investigated for the presence of anti-HBc antibodies during two time periods (I: all donors, March 2017; II: first-time donors only, April 2017 until February 2018). Anti-HBc-positive findings were confirmed by an anti-HBc neutralization test. Discarded plasma samples of anti-HBc-confirmed positive donors were ultracentrifuged and subsequently retested by regular HBV-ID-NAT to search for traces of HBV. Results: During time period I, 78 (1.6%) individuals out of 4,923 donors were confirmed anti-HBc-positive. Sixty-nine (88%) anti-HBc-positive samples were available and processed by ultracentrifugation followed by repeat HBV-ID-NAT. Four samples (5.8%) were found positive for HBV DNA. Sixty-five (94.2%) samples remained HBV NAT-negative upon ultracentrifugation. During time period II, 56 (0.9%) donor samples out of 6,509 exhibited anti-HBc-confirmed positive. Fifty-five (98%) samples could be reassessed by HBV-ID-NAT upon ultracentrifugation. Three (5.5%) samples contained HBV DNA and 52 (94.5%) samples remained HBV NAT-negative. Conclusion: Overall, we detected 7 viremic OBI carriers among 11,432 blood donors, which tested negative for HBV by standard HBV-ID-NAT and HBsAg screening. In contrast, OBI carriers showed positive anti-HBc findings which could be confirmed in 83.8% of the cases. Thus, OBI might be missed by the current HBV screening process of Swiss blood donors. We suggest to review current HBV screening algorithm. Extended donor screening by anti-HBc testing may unmask OBI carriers and contribute to blood safety for the recipient of blood products.

Kidney transplant from donors with hepatitis B: A challenging treatment option.

Utilizing kidneys from donors with hepatitis B is one way to alleviate the current organ shortage situation. However, the risk of hepatitis B virus (HBV) transmission remains a challenge that undermines the chance of organs being used. This is particularly true with hepatitis B surface antigen (HBsAg) positive donors despite the comparable long-term outcomes when compared with standard donors. To reduce the risk of HBV transmission, a comprehensive approach is needed. This includes assessment of donor risk, optimal allocation to the proper recipient, appropriate immunosuppressive regimen, optimizing the prophylactic therapy, and post-transplant monitoring. This review provides an overview of current evidence of kidney transplants from donors with HBsAg positivity and outlines the challenge of this treatment. The topics include donor risk assessment by adopting the nucleic acid test coupled with HBV DNA as the HBV screening, optimal recipient selection, importance of hepatitis B immunity, role of nucleos(t)ide analogues, and hepatitis B immunoglobulin. A summary of reported long-term outcomes after kidney transplantation and proposed criteria to utilize kidneys from this group of donors was also defined and discussed.

Mother to Infant Transmission of Hepatitis B Virus in the Face of Neonatal Immunization Is Not Necessarily Primary Vaccine Failure.

Surveillance programs undertaken in infants born to mothers with hepatitis B virus (HBV) provide an opportunity to analyze virological markers from the neonate and early infancy. These data inform on mechanisms of HBV transmission and how available interventions can be better used for control of HBV infections arising at the mother/child interface. Retrospective analysis of HBV serological markers was undertaken in dried blood spots collected from infants born to mothers infected with HBV. In addition, molecular analysis was performed in newborn blood spot cards, collected after birth, from infants identified as infected with HBV despite receiving prophylaxis. Perinatal exposure could not account for all transmissions, with at least one-quarter (22%) of infants already infected in utero. All harbored a wild-type hepatitis B surface antigen (HBsAg), with identical sequences noted in the neonatal and early infancy samples. In contrast, in infants infected perinatally (43%), selection of viruses harboring amino acid changes in the HBsAg were common (80% of sequences) and divergent from the linked maternal sample. Currently considered to represent vaccine failure, it is likely that a proportion of HBV infections result from in utero acquisition. These infections are unlikely to be susceptible to postnatal prophylaxis, and current recommendations for maternal antiviral treatment may be too late to prevent transmission. Consideration should be given to the earlier use of antivirals during gestation to reduce the risk of intrauterine transmission together with completion of the immunization schedule also to reduce the perinatal risk of HBV transmission.

Strategies for hepatitis B virus screening of Polish blood donors (2005–2020)

The risk of hepatitis B virus (HBV) transmission through blood and blood components is markedly reduced through serologic testing of each donation for the presence of HBV infection markers. Testing for hepatitis B virus surface antigen (HBsAg) is obligatory almost everywhere in the world. Several countries have also implemented testing for antibodies to hepatitis B core antigen (anti-HBc) and some perform HBV DNA tests, either in single donations or minipools of up to 96 donations. In countries with obligatory hepatitis B vaccination, the incidence of HBsAg-positive infections has been on the decline. Questions are therefore raised regarding the choice of optimal strategies for blood donor screening. In Poland, screening for hepatitis B virus surface antigen (HBsAg) to identify HBV infected donors was initiated in 1971. Pursuant to the guidelines of the Council of Europe, the analytical sensitivity of 0.13 IU/ml is required for a HBsAg diagnostic test to detect a HBsAg-positive infection. In 2005, HBV-DNA testing was added to the panel of screening tests for further reduction of HBV transmission risk through blood and blood components. The study presents the analysis of the HBV-DNA screening tests used in Poland so far. The analysis is based on the author’s doctoral dissertation and the outcome may largely contribute to the process of determining the effectiveness of the methods used up to date and to development of an optimal panel of HBV screening tests for Polish blood donors.

Occult Hepatitis B virus infection among HIV negative and positive isolated anti-HBc individuals in eastern Ethiopia

The absence of hepatitis B surface antigen (HBsAg) and the presence of antibody to hepatitis B core antigen (anti-HBc) in the blood of apparently healthy individuals may not indicate the absence of circulating hepatitis B virus (HBV) and might be infectious. Despite the risk of HBV transmission, there has been no report from Ethiopia examining this issue; therefore, this study determined occult HBV infection (OBI) among isolated anti-HBc (IAHBc) HIV negative and HIV positive individuals on ART in eastern Ethiopia. A total of 306 IAHBc individuals were included in this study. DNA was extracted, amplified, and detected from plasma using a commercially available RealTime PCR platform (Abbott m2000rt) following the manufacturer’s instructions. Data were entered into EPI Data version 3.1, cleaned, and analyzed using Stata version 13. Descriptive analysis was used to calculate prevalence, summarize sociodemographic data and other factors. From the 306 IAHBc individuals (184 HIV positive and 122 HIV negative) included in the study, 183 (59.8%) were female of which 142 (77.6%) were within the reproductive age group. DNA extraction, amplified and detection was conducted in 224 individuals. The overall OBI prevalence was 5.8% (5.6% in HIV negative and 6% in HIV positive) among the IAHBc individuals. The HBV DNA concentration among the occult hepatitis B individuals was < 200 IU/mL, indicating a true occult. This study reported the burden of OBI, which pauses a significant public health problem due to the high burden of HBV infection in the country. OBI may cause substantial risk of HBV transmission from blood transfusion, organ transplantation as well as vertical transmission as screening is solely dependent on HBsAg testing.

Frequency of brucellosis and hepatitis b virus seropositivity in patients with chronic lymphocytic leukemia

Objective: Patients with chronic lymphocytic leukemia (CLL) show defective cellular and humoral immune responses. Although such immune failure is known to be associated with an increase in the frequency of particularly gram–positive and –negative bacterial infections, data on the increase in the frequency of zoonoses such as brucellosis and viral infections such as the hepatitis B virus (HBV) are inconclusive. This study aims to investigate the frequency of brucellosis and HBV seropositivity in patients diagnosed with CLL. Methods: Patients followed–up for CLL between 2005 and 2019 were evaluated. Results of patients who were tested for HBsAg and anti–HBs serology using the ELISA assay and for brucellosis using the serum agglutination (Wright) test were recorded. Demographic data and laboratory results of all patients included in the study were evaluated. Results: This study included 188 patients diagnosed with CLL, of whom 56 (29.8%) were female and 132 (70.2%) were male. Median age was 62 (33–92) years. Complete blood count parameters at diagnosis were as follows: median leukocyte count, 54.4×109/L (5.1–312.3×109/L); median lymphocyte count, 42.3×109/L (2.8–296.8×109/L); median platelet count, 148×109/L (86.3–342.3×109/L); median hemoglobin level, 13.4 g/dL (8.5-16.9 g/dL). HBsAg and anti–HBs were tested in 142 patients. A total of 16 (11.27%) patients were HBsAg–positive; with 5 (3.52%) positive cases in females and 11 (7.75%) in males. A total of 105 (73.95%) patients were anti–HBs–positive; with 32 (22.54%) positive cases in females and 73 (51.41%) in males. Wright agglutination test was performed on 82 patients. A total of 4 (4.88%) patients reacted positively to the Wright test; with 3 (3.66%) positive cases in females and 1 (1.22%) in males. Conclusion: Compared with the epidemiological studies conducted in the same region; the rate of positive reactions to the Wright agglutination test was consistent with the literature data; however, a higher rate of HBsAg positivity was determined. This may be linked to the increase in the risk of HBV transmission due to the immune defect caused by CLL or the immunosuppressive picture induced by the medication used in the treatment, or viral reactivation.