Transmission Of Hepatitis B Virus Infection Research Articles

Health status and infectious diseases in male unaccompanied immigrant minors from Africa in Spain

IntroductionThe aim was to examine the health status and infectious diseases in a cohort of unaccompanied immigrant minors (UIMs) from Africa in Spain, and to detect if there are differences according to the geographical area of origin. MethodsCross-sectional study in 622 African male UIMs at the time of admission to residential care in Aragon (Spain) during 2005-2019. A physical, nutritional and laboratory examination was performed following sanitary guidelines. ResultsThe mean age of the African UIMs was 16.1 years (SD 1.7; range 13-17). 88.9% were from Maghreb (mean age 15.9 years; SD 1.5) and 14.1% from Western Sub-Saharan (mean age 16.8 years; SD 1). We found that the prevalence of caries, iron deficiency and dermatological problems was significantly higher (p<.05) among Maghrebian, and the prevalence of past and present hepatitis B virus (HBV) infection, intestinal parasitosis, eosinophilia (p<.00001) and latent tuberculosis (p=.0034) was significantly higher in those of Sub-Saharan origin. ConclusionThe most relevant finding was the high prevalence of present HBV infection (14.8%) among Sub-Saharan adolescents. This finding highlights the importance of recommending targeted screening, preventive vaccination programs, and integration into local health care systems that allow for long-term treatment and follow-up as a way to prevent the transmission of HBV infection.

What is the Role of the Horizontal Transmission of Hepatitis B Virus Infection in Young Adult and Middle-Aged Roma Population Living in the Settlements in East Slovakia?

Background: The aim of our work is to objectify the manner of transmission of HBV infection in young adult and middle-aged Roma people who live in the settlements. Methods: We used data from the cross-sectional study HepaMeta. We analyzed Roma people living in the settlements in East Slovakia, who have had HBsAg and anti HBc IgG antibodies examined. Results: We analyzed a cohort of 452 Roma participants with a mean of age 34.67 ± 9.14 years—159 (35.2%) were males. HBsAg positivity was diagnosed in 12.4% and the presence of anti HBc IgG antibodies was confirmed in 52% of participants. Prevalence of HBsAg positivity increases significantly with higher age, (p = 0.026), as well as the presence of anti HBc IgG antibodies (p < 0.0001). The prevalence of HBsAg positivity has doubled and anti HBc IgG positivity has tripled within two decades (<25 years vs. 35–45 years) in Roma settlements in East Slovakia. Conclusions: These findings allow us to express an opinion that horizontal transmission in adulthood may play an important role in the spreading of HBV infection.

Programmed cell death protein 1 promotes hepatitis B virus transmission through the regulation of ERK1/2-mediated trophoblasts differentiation.

The purpose of our research is to evaluate the mechanism of PD-1 in the promotion of HBV transmission. HBV was used to infect two human choriocarcinoma cell line, including JEG-3, as well as BeWo. We used PCR and western blotting to detect PD-1 gene and protein expression levels in cells. Stable knockdown of the PD-1 gene in JEG-3 cells was obtained by lentiviral transfection. Trophoblast cell proliferation was evaluated using CCK8 and flow cytometry. The concentration of HBV antibody in the cell supernatant was measured by ELISA. DNA was then extracted from the cells and the copy number of the HBV virus was detected by PCR. Finally, ERK1/2 expression was detected by western blot. High PD-1 gene expression in HBV-infected trophoblasts and the knockdown of PD-1 gene can, respectively, improve the proliferation of HBV-infected trophoblasts and reduce viral replication in trophoblasts. In addition, PD-1 and ERK1/2 proteins were co-expressed in HBV-infected trophoblasts and inhibited the activation of ERK1/2 pathway in HBV-infected trophoblasts. ERK1/2 expression significantly increased after PD-1 knockdown. Therefore, PD-1 might be an important protein in trophoblast cells infected with HBV. PD-1 promoted HBV transmission through regulating ERK1/2-mediated trophoblasts differentiation. Therefore, our research may provide new ideas and methods for preventing mother-to-child transmission of HBV infection during pregnancy.

Post Hepatitis B vaccination sero-conversion among health care workers in the Cape Coast Metropolis of Ghana.

BackgroundHBV vaccine is known to offer protection against transmission of HBV infection. Health care workers are mandated to have this vaccination as part of their occupational health safety measures. Post vaccination response data for HCWs in our setting is not available. This study therefore aimed to evaluate the anti-HBs titre levels after Hepatitis B vaccination among HCWs from selected heath facilities in the Cape Coast Metropolis, Ghana.MethodsA multicenter (3 selected sites) analytical cross-sectional study involving 711 HCWs was conducted. Five (5mls) of blood samples were collected from each study participant and the serum used for HBV immunological profile testing anti-HBs quantification by ELISA test (Fortress Diagnostics Limited, Northern Ireland, United Kingdom). Data analyses were performed using Stata version 14.0 software (STATA Corp, Texas USA).ResultsThe median age of participants was 29 years (IQR = 26–35 years). Majority (80.9%, n = 575) took their vaccination from Government health facilities compared with 19.1% (n = 136) from private vaccination sources. A total of 7 (3 males and 4 females) were found to be HBsAg positive giving prevalence of 1%. In all, 8.2% (n = 58) of the HCWs had anti-HBs titre levels <10IU/ml giving a sero-protection rate of 91.8%. HCWs who received 3 doses of HBV vaccine were more likely to be sero-protected as compared to those who received only one dose in multivariate analysis (aOR = 3.39, 95%CI: 1.08–10.67), p<0.037). Gender, cigarette smoking and alcohol consumption were not found to be associated with sero-protection.ConclusionThere is a high HBV vaccine efficacy among HCWs in the Cape Coast Metropolis of Ghana with higher prevalence of anti-HBs titre level associated with full vaccine dose adherence. Post vaccination antibody titre determination could be an integral part of HBV vaccination protocol for HCWs in Ghana.

Risk factors associated with horizontal transmission of hepatitis B viral infection from parents to children in Mexico.

Hepatitis B virus (HBV) infection in children is a health problem worldwide. In Mexico, a high prevalence rate of HBV infection and occult HBV infection have been reported in high-risk adults and children. However, studies regarding HBV infection transmitted from HBV-infected parents to children are limited. This study aimed to determine the risk factors associated with HBV transmission of HBV from parents to children in Mexico. A retrospective case-control study was carried out in 24 pediatric patients with clinical HBV infection and 48 healthy controls. Bivariate and forward conditional logistic regression analysis was used to compare demographic variables, the status of HBV vaccination, and risk factors for HBV infection transmission among children and their parents. No newborns were diagnosed with HBV infection, and no significant differences were found in age (p = 0.209) or gender (p = 0.612) compared to the control group. The independent risk factor associated with HBV transmission was the presence of a parent with a history of promiscuity (OR = 30.95, 95%CI = 3.382-283.326; p = 0.002), whereas having completed the HBV vaccination schedule for their age was a protective factor against HBV infection in the children (OR = 0.245, 95%CI = 0.079-0.764; p = 0.015). HBV infection in Mexican children is associated with close interpersonal contact with a parent engaged in high-risk sexual practices suggesting that the horizontal route could be the primary mode of infection. Child and adult vaccination campaigns should be reinforced to avoid HBV infection in Mexico.

Clinical study on blocking mother-to-child transmission of hepatitis B virus with high viral load and HBeAg positivity during pregnancy in Guizhou province

Objective: To observe the efficacy and safety related measures by blocking mother-to-child transmission of hepatitis B virus with high viral load and HBeAg positivity during pregnancy in Guizhou province. Methods: Outpatient and inpatient cases of the Department of Infectious Diseases and Obstetrics of Guizhou Medical University Affiliated Hospitals from May 2016 to July 2017 were retrospectively divided into intervention group, non-intervention group and non- hepatitis B pregnant women group; with 75 cases in each group. HBsAg and HBeAg were positive in the intervention group. Pregnant women with HBV DNA ≥10(6) IU/ml were treated with anti-HBV therapy for 24 to 28 weeks of gestation until delivery. According to oral drugs, they were divided into tenofovir (TDF) group or telbivudine (LDT) group, non-intervention group (HBsAg and HBeAg positive), HBV DNA positive pregnant women, pregnant women with no anti-HBV drugs, non-hepatitis B pregnant women (normal pregnant women without HBV infection). Infants and young children born to the three groups of women were immunized with the national viral hepatitis B action plan. The gestational weeks and Apgar scores at birth, delivery mode, feeding mode, sex and 7-months-old age were observed and counted. Serum hepatitis B markers (HBVM) and HBV DNA were quantitatively detected. HBVM was detected by time-resolved fluorescence immunoassay (TRFIA), and HBV DNA was detected by real-time PCR (FQ-PCR). The changes of liver parameters, HBsAg, HBeAg, HBV DNA, adverse drug reactions and treatment response of pregnant intervention group before medication (12-24 weeks of gestation), 4 weeks of medication (28-32 weeks of gestation), 36-40 weeks of gestation (36-40 weeks of gestation) were statistically calculated. A t-test was used to compare the data between the measurements. Data measurements within the groups were analyzed using rank -sum test. Results: In the intervention group, therapeutic medications showed no differences in demographic and clinical characteristics between TDF group and LDT group, including liver parameters, HBsAg, HBeAg and log10HBV DNA level. Compared with pre-treatment (TDF group: 4.84 ± 2.01; LDT group: 5.08 ± 1.99), TDF and LDT were significantly lower at the end of pregnancy (TDF group: 3.06 ± 0.66; LDT group: 3.51 ± 1.20). P < 0.05); and the treatment response rate was 100%. There were no serious adverse events in the intervention group. Infants and young children (7-months-old) in the intervention group had negative HBsAg, HBeAg and HBV DNA. The mother-to-child transmission rate of HBV was zero, with blocking rate of 100%. In addition, both infants and young children had different degrees of hepatitis B protective antibodies (anti-HBs, M: 144.33), and their antibody titers were higher than that of non-intervention group (anti-HBs, M: 65.91) and non-hepatitis B pregnant women (anti-HBs, M: 58.43). The difference was statistically significant (P < 0.05), and there was no significant correlation between the use of antiviral and the way of delivery and feeding. Outcomes of mother-to-child transmission of HBV infection in infants and young children (7-months-old) delivered by three groups of pregnant women in the non-intervention groups had 20.0% (15/75)/ 17.3% (13/75) HBsAg/HBeAg positivity rate, and 17.3% (13/75) HBV DNA positivity rate. Overall, mother-to-child transmission rate of HBV infection was 20% (15/75). Furthermore, the relationship between mother's HBV DNA load and infant HBV infection in the non-intervention group showed mother's HBV DNA ≥10(6) IU/ml. Conclusion: In the non-intervention group, mother-to-child transmission of HBV occurred, and infected mothers HBV DNA was ≥106 IU/ml before delivery. This suggests that HBeAg positive and high load HBV DNA replication were independent risk factors for mother-to-child transmission of hepatitis B. Therefore, prenatal drug intervention and postpartum standard immune blockade are necessary for high-risk pregnant women with hepatitis B to achieve zero mother-to-child transmission of hepatitis B in real- clinical practice.

Lamivudine's efficacy and safety in preventing mother-to-child transmission of hepatitis B: A meta-analysis.

Mother-to-child transmission (MTCT) is a common transmission mode of hepatitis B virus (HBV). It has been shown that the infection may occur in some infants despite the use of immunoprophylaxis, and many studies have demonstrated the efficacy of antivirals such as lamivudine to reduce such events. A meta-analysis was conducted concerning the efficacy and safety of lamivudine during pregnancy, in the prevention of vertical transmission of HBV infection. Studies were identified by searching various databases up to January 2016 for variations of the following phrase: "lamivudine AND (pregnancy or pregnant) AND (HBV or hepatitis)." Subjects who had received lamivudine were included in the case group, and those who had not were included in the control group. Our search identified a total number of 881 citations, of which 25 studies (with a total number of 2,667 pregnant women) were included in the meta-analysis. The analysis showed a significant difference between the seropositive HBsAg infants from the case and control groups (RR= 16.97, 95% confidence interval 8.36-34.45), which is the most critical factor in determining the MTCT of HBV. No significant difference was reported between the prevalence of side effects in the case and control groups. This meta-analysis strongly suggests the use of lamivudine in the prevention of HBV vertical transmission in carrier pregnant women with the HBV DNA levels greater than 106 copies/mL. And for women with the HBV viral loads lower than 106 copies/mL, we suggest clinicians to examine the use of lamivudine on a case-to-case basis, noting that lamivudine seems to be a safe drug for the mother and the fetus.

Efficacy of tenofovir in preventing perinatal transmission of HBV infection in pregnant women with high viral loads

Mother-to-child transmission is the major cause of chronic hepatitis B virus (HBV) infection. This double-blind trial tested the effect of tenofovir disoproxil fumarate (TDF) in preventing vertical transmission. Pregnant women who were HBsAg/HBeAg-positive with a HBV DNA titer ≥ 2×106 IU/mL were randomly assigned to the control (n = 60) and TDF-treated (n = 60) groups. TDF treatment (oral dose 300 mg/day) was initiated at 24 weeks of gestation and continued to 4 weeks after delivery. The subjects were followed up to 28 weeks postpartum. The effects of TDF on vertical transmission, outcomes of the mothers and infants and virological changes were monitored. TDF dynamically reduced the serum HBV DNA level of the mothers, particularly during the first 4 weeks of treatment. The lower viral loads were maintained in the pregnancies until delivery. Approximately 90% and 33.9% of the TDF-treated mothers had viral loads ≤2000 IU/mL after delivery and at 28 weeks postpartum, respectively. No cervical transmission or adverse effects were observed in the TDF-treated individuals, whereas 13.5% of the infants were infected with HBV in the control group. We conclude that TDF treatment initiated at 24 weeks of gestation in high-viremia, HBsAg/HBeAg-positive mothers efficiently prevents mother-to-child HBV transmission without adverse events in mothers and infants.

Knowledge, Serological Markers and Risk Factors associated with Hepatitis B and C Virus Infection among Kuje Prison Inmates, Federal Capital Territory, Nigeria

Background: Prisons are known to be high-risk environments for the spread of blood borne and sexually transmitted infections. Compared to the general population, prevalence of Hepatitis B and C virus (HBV/HCV) infections are disproportionately higher among penitentiary institutionalized individuals worldwide. We determined the seroprevalence and risk factors associated with HBV and HCV infection among Kuje prison inmates, Nigeria. Methods & Materials: A cross-sectional study was conducted in 2016. Inmates who consented were randomly selected and stratified into convicts and awaiting trial stratum. Interviewer administered Questionnaires were used to obtain information on participants socio-demographic characteristics, HBV risk factors, previous HBV test and vaccination history. Blood samples were collected from all participants and analysed for HCV, HBsAg, HBsAb, HBcAb, HBeAg and HBeAb markers using rapid lateral chromatographic immunoassay kit. HBsAg positive samples were confirmed using ELISA. Epi-info version 7.2.0 was used for univariate, bivariate, and multivariate analysis. Results: 271 inmates (63 convicts and 208 awaiting trial inmates) were recruited for the study. The mean age of the participants was 32.7 SD ± 9 years. Of the 116(42.8%) who had ever heard of HBV infection, 114 (98%) had poor knowledge of the disease. HCV sero-prevalence was found to be 5.9%, (95% CI; 3.4-9.6) and HBV 13.7%, (95% CI; 9.8-18.3). 55.4% (95% CI; 49.2-61.4) of inmates were susceptible to HBV infection, 20.7% (95% CI; 16.0-26.0) had past or resolved HBV infection while 10.3% (95% CI; 7.0-14.6) had acquired natural or artificial HBV Immunity. Factors found to be associated with HBV infection include age group ≤25 (aOR 8.0; 95% CI = 2.9-22.3), ever married (aOR = 4.2, 95% CI = 1.7-10.4) and history of alcohol consumption (aOR = 3.4, 95% CI = 1.3-8.4). Conclusion: There is poor knowledge and high sero-prevalence of HBV and HCV infection among Kuje inmates. This study demonstrates the need for prison focused health intervention initiatives in Nigeria. We advocated HBV vaccination for all susceptible inmates and treatment for HBV positive inmates to reduce the transmission of HBV infection among inmates.

Frequency of Hepatitis B core antibody and Hepatitis B Virus DNA among apparently healthy male blood donors in Eastern Libya

Background/Objectives: Hepatitis B virus (HBV) infection represents one of the most serious blood transfusion-transmitted viral infections. By implementation of the hepatitis B surface antigen (HBsAg) screening assay, blood banks in Libya have been considerably increased blood transfusion safety in term of protecting against the transmission of HBV infection. However, several studies demonstrated that donors who are HBsAg negative and hepatitis B core antibody (anti-HBc) positive maybe a potential source for posttransfusion hepatitis B. The aim of this study is to determine the presence of anti-HBc and HBV DNA (hepatitis B viral DNA) in healthy HBsAg-negative blood donors in eastern Libya (Tobruk region). Materials and Methods: A total of 500 serum samples were tested for HBsAg and obtained from healthy blood donors in blood bank unit in Tobruk Medical Center. All donors were tested for anti-HBc, using commercial ELISA and microwell methods (MBS-SRL, Milano, Italy). The reactive samples were further tested for the presence of HBV DNA using polymerase chain reaction (PCR). Results: In this study, the seroprevalence rate of anti-HBc sample was 54 (10.8%) among donors. The majority of anti-HBc-positive cases (52 of 54) were in the age group of 20–49 years. Of the 54 anti-HBc-positive samples, 4 (7.4%) were tested positive for HBV DNA by PCR. Conclusion: Among all the samples, the rate of anti-HBc was 10.8%. This finding is comparable to a previous study performed in northwestern Libya. The present study estimated the expected exclusion rate of anti-HBc-positive donated blood that would be an important factor to consider before adopting anti-HBc testing in addition to HBsAg testing as a mandatory screening test to further enhance transfusion safety.

Detection of HBsAg mutants in the blood donor population of Pakistan.

BackgroundInfection with the Hepatitis B virus (HBV) continues to be one of the leading healthcare issues in Pakistan, affecting over 6 million people. The existence of HBsAg mutants is well documented in many countries. In Pakistan, HBV screening in the majority of the blood banks is performed by Rapid Detection Devices or ELISA tests. These tests are designed to detect HBsAg, but may not detect the mutant HBsAg. Failure to detect the HBsAg mutant may result in the transmission of HBV infection from donor to recipient. Hence, there is a need to identify a HBsAg assay which can detect mutants in a country where simple and conventional HBsAg assays with varying sensitivity and specificity are used to detect HBV infections.Material and methodsThree routinely used diagnostic tests (Rapid Detection Devices, ELISA and CLIA) for HBsAg were compared with the LIAISON® XL Murex HBsAg Quant Assay to determine the prevalence of HBV mutants in the Pakistani blood donor population.The samples of blood donors from different cities of Pakistan were collected. The testing was performed using SD Bioline rapid assay (n = 1500), ELISA (n = 1500), and Abbott ARCHITECT®CLIA system (n = 1500) at the centers where the donations were collected. All samples (n = 4500) were re-tested for comparative analysis on the LIAISON® XL Murex HBsAg Quant assay (DiaSorin S.p.A.). PCR testing was performed as a gold standard on all discordant samples.Results119/4500 (2.64%) of the samples were positive for antibodies against HBsAg. The sensitivity of SD Bioline Rapid, GB HBsAg ELISA, Abbott ARCHITECT® and LIAISON® XL Murex HBsAg Quant assay was 17.24%, 43.75%, 90.91%and 100% respectively. The specificity of SD Bioline Rapid, GB HBsAg ELISA, Abbott ARCHITECT® and LIAISON® XL Murex HBsAg Quant Assay was 98.82%, 99.59%, 100% and 100%, respectively.ConclusionLIAISON® XL Murex HBsAg Quant assay is a highly sensitive, specific and accurate screening assay for detecting wild type as well as mutant HBsAg.

HBV-infections in Germany - health care costs in a real-life-setting

Background An estimated 500 000 people are infected with hepatitis B in Germany, inducing an enormous burden on infected patients and the health care system. The aim of our study was to estimate the real-life costs of treating hepatitis B and to analyze sociodemographic factors. Methods We conducted a retrospective, non-interventional, single-center study from 07/2009 to 12/2012. Information on health care delivery was extracted from patient records. Besides that, a questionnaire survey regarding sociodemographic parameters and quality of life of HBV-infected patients was performed. Results A total of 117 patients were included in our study and grouped in six different disease stages. The response rate of our survey was 80 %. We determined annual total costs of € 3509. The different groups altered between € 221 and € 5618. The main costs (80 %) were caused by the antiviral therapy. Costs of co-medication and hospitalizations were of minor importance. Laboratory costs were primarily caused by determination of virological parameters. Route of transmission of HBV-infection was unknown in 2/3 of all cases. Restrictions in quality of life due to the HBV-infection were reported by 60 % of the patients. Patients receiving interferon treatment reported highest restrictions. In an extrapolation, we estimated total annual hepatitis B treatment costs of 430 million € in Germany. Conclusion This is the first study estimating real-life treatment costs of hepatitis B infections in Germany. Further research should follow in the context of newly introduced generic antivirals.

Efficacy of Antiviral Therapy in HBsAg-Positive Pregnant Women to Reduce Mother-to-Infant Transmission of Hepatitis B Virus.

Hepatitis B is a major health concern in Asia. Chronic hepatitis B virus (HBV) infection may cause hepatic cirrhosis and liver cancer. HBV is transmitted horizontally through blood and blood products and vertically from mother to infant. Perinatal infection is the main route of transmission in regions with high prevalence of hepatitis B surface antigen (HbsAg) carriage, and perinatal transmission leads to high rates of chronic infection. Therefore, it is important to prevent mother-to-child transmission (MTCT) of HBV1. The present study aims at comparing the use of antivirals (lamivudine vs tenofovir) in reducing MTCT. A total of 60 HbsAg-positive pregnant women were enrolled in the prospective study to test the efficacy of antiviral (lamivudine vs tenofovir-category B drug) to reduce mother-to-child transmission and monitor hepatitis B viral status in infant. HbsAg-positive pregnant women aged 18-43years at gestational age between 28 and 32weeks were followed up. They were tested for HBsAg, liver function test and HBeAg. In whom HbeAg was positive, HBV viral load was tested. Sixty patients with high viral load (>6log copies/ml) were recruited in the study. Alternate patients were randomized into two groups. Group A comprised 31 subjects treated with lamivudine 100mg daily starting from 28 to 32weeks of gestation (third trimester) and continued to 1month after delivery. Group B comprised 29 pregnant women who were treated with tenofovir 300mg daily from 28 to 32weeks of gestation and continued to 1month post-partum. The newborn babies were given HBIG within 24h after delivery and HBV vaccines at 0, 1 and 6months. HBsAg infectivity was tested in the infant at 1year after birth. Antivirals, lamivudine/tenofovir treatment in HBV carrier mothers from 28weeks of gestation along with active and passive immunization of new born may interrupt MTCT of HBV efficiently. Tenofovir, category B drug, is more effective in preventing transmission of HBV infection to infants (p=0.004).

The Cost-effectiveness of Tenofovir Prophylaxis to Prevent Mother-to-Child Transmission of Hepatitis B Infection [28Q

INTRODUCTION: In the setting of maternal Hepatitis B (HBV) antigen positivity and a HBV DNA level greater than 200,000 IU per milliliter there is increased risk of vertical transmission to the neonate. Infected infants are at risk for chronic HBV infection and its complications (cirrhosis, hepatocellular carcinoma, death). Tenofovir (with standard postpartum HBV immunoprophylaxis) has safely prevented vertical transmission of HBV infection without the risk of viral resistance seen with alternative therapies. We designed a model to examine the cost-effectiveness of Tenofovir prophylaxis when compared to postpartum immunoprophylaxis alone. METHODS: A decision-analytic model was built using TreeagePro and incorporated probabilities, costs, and utilities from the literature. This model was applied to a theoretical cohort of 100,000 women in order to assess the outcomes of maternal side effects and consequences of neonatal HBV transmission. A cost-effectiveness threshold was set to $100,000 per quality-adjusted life year; the robustness of the model was assessed with sensitivity analyses. RESULTS: In our model, Tenofovir prophylaxis resulted in 12,845 fewer cases of vertical HBV transmission, 3,468 fewer cases of cirrhosis, 1,387 fewer cases of hepatocellular carcinoma, and 388 fewer liver transplants. The use of Tenofovir conferred a savings of $232.77 per pregnancy, and—on sensitivity analysis—was the cost-effective strategy to a baseline transmission risk of 5.4% or up to a 17.7% transmission risk with the use of Tenofovir. CONCLUSION: In high-risk pregnancies with HBV infection, Tenofovir administration—in addition to standard postpartum immunoprophylaxis—is the cost-effective strategy to reduce the risk of vertical HBV transmission.

Assessment of State Perinatal Hepatitis B Prevention Laws.

Identifying pregnant women with hepatitis B virus (HBV) infection for post-exposure prophylaxis of their infants is critical to preventing mother-to-child transmission of HBV infection. HBV infection in infancy results in premature death from chronic liver disease or cancer in 25% of affected infants. Universal screening of pregnant women for HBV infection is the standard of care, and in many states is supported by laws for screening and reporting these infections to public health. No recent assessment of state screening and reporting laws for HBV infection has been published. In 2014, the authors analyzed laws current through December 31, 2013 from U.S. jurisdictions (50 states and the District of Columbia) related to HBV infection and hepatitis B surface antigen screening and reporting requirements generally and for pregnant women specifically. All states require reporting of cases of HBV infection. Twenty-six states require pregnant women to be screened. Thirty-three states require public health reporting of HBV infections in pregnant women, but only 12 states require reporting pregnancy status of women with HBV infection. This assessment revealed significant variability in laws related to screening and reporting of HBV infection among pregnant women in the U.S. Implementing comprehensive HBV infection screening and reporting laws for pregnant women may facilitate identifying HBV-infected pregnant women and preventing HBV infection in their infants.

Transmission of HBV DNA Mediated by Ceramide-Triggered Extracellular Vesicles.

Background & AimsAn extracellular vesicle (EV) is a nanovesicle that shuttles proteins, nucleic acids, and lipids, thereby influencing cell behavior. A recent crop of reports have shown that EVs are involved in infectious biology, influencing host immunity and playing a role in the viral life cycle. In the present work, we investigated the EV-mediated transmission of hepatitis B virus (HBV) infection.MethodsWe investigated the EV-mediated transmission of HBV infection by using a HBV infectious culture system that uses primary human hepatocytes derived from humanized chimeric mice (PXB-cells). Purified EVs were isolated by ultracentrifugation. To analyze the EVs and virions, we used stimulated emission depletion microscopy.ResultsPurified EVs from HBV-infected PXB-cells were shown to contain HBV DNA and to be capable of transmitting HBV DNA to naive PXB-cells. These HBV-DNA–transmitting EVs were shown to be generated through a ceramide-triggered EV production pathway. Furthermore, we showed that these HBV-DNA–transmitting EVs were resistant to antibody neutralization; stimulated emission depletion microscopy showed that EVs lacked hepatitis B surface antigen, the target of neutralizing antibodies.ConclusionsThese findings suggest that EVs harbor a DNA cargo capable of transmitting viral DNA into hepatocytes during HBV infection, representing an additional antibody-neutralization–resistant route of HBV infection.

THE MANAGEMENT OF B HEPATITIS VIRUS INFECTION IN RELATION WITH HUMAN REPRODUCTION

The HBV infection is a major public health problem. It is estimated that worldwide around 2 billion people have markers that show they passed through this infection. In the majority of the cases of HBV infection occurring in adult patients, the natural evolution is towards HBs Ag clearance (which is though not equivalent in all the cases with complete healing as the virus may persist in the hepatocytes in the form of cccDNA). The situation is completely different when the infection is contracted perinatal (intra- or post- partum or more rarely intrauterine) as in these patients, most frequently the infection evolves to chronic forms, either active or inactive or in the form of immune-tolerance. The vertical transmission of HBV infection represents the main problem regarding the management of this infection in pregnancy. In the following review of the literature I synthetized the data regarding the impact of HBV infection on pregnancy as well as the impact of pregnancy on HBV infection. I also searched data regarding the possibility of father-to-offspring transmission and I tried to clarify the mechanisms that make the transmission possible. Finally, I synthetized the existing recommendations in algorithms that are dedicated to ease the activity of the infectious diseases specialist that has to deal with such cases.

Potential Risk of Respiratory Secretions in the Transmission of HBV Infection: A Review of the Literature

Potential Risk of Respiratory Secretions in the Transmission of HBV Infection: A Review of the Literature

Knowledge, attitude, and practices of hepatitis B infection among dental students

Background: Hepatitis B virus (HBV) infection is a major worldwide public health problem. Nearly 45% of the world’s population lives in areas of high endemicity, with India being a country of intermediate endemicity. Objective: To assess the knowledge, attitude, and practices of dental students about HBV infection at a private dental institution in Mysore, Karnataka, India. Materials and Methods: A cross-sectional survey was conducted using a pretested, structured, and validated questionnaire containing 16 questions on awareness, transmission, prevention, diagnosis, treatment, vaccination status, and postexposure prophylaxis of HBV infection. Descriptive statistics were carried out along with chi-square test and contingency coefficient. Result: The response rate was 100% (n = 486). A total of 88.7% of the students knew about the transmission of HBV infection. Only 64% students were immunized against HBV. Majority of the students (91.1%) agreed for vaccination against HBV infection. Only 28.4% students knew about the postexposure treatment against HBV infection. About 58.8% students knew about the preventive measures against HBV infection. Conclusion: The overall awareness regarding HBV disease was found to be lacking among the dental students.

Hepatitis B virus infection in northern Uganda: Impact of pentavalent hepatitis B vaccination

Chronic hepatitis B virus infection (CHBI) is effectively prevented by vaccination starting at birth. Beginning in 2002 Uganda adopted a policy of providing the pentavalent hepatitis B vaccine starting at 6 weeks of age. However, there is concern that this delay may leave the infant vulnerable to infection during the first 6 weeks of life. We assessed whether vaccination at 6 weeks was an effective strategy by HBV serologic study. Of 656 persons tested for HBV, 9.4% were chronically infected; among children aged 5–9 years the prevalence was 7.6%. Of all tested, 73 were born (i.e., aged ≤4 years) after the introduction of the pentavalent vaccine; none were infected with HBV (p=0.003). In this study, vaccination with the pentavalent vaccine at 6 weeks did not result in CHBI, but rather provides an opportunity to prevent mother-to-infant transmission of HBV infection where there is no access to birth-dose vaccine.