Materno-fetal transmission of hepatitis B virus in Ivory Coast. Plea for mass vaccination

BACKGROUND: Hepatitis B is a major public health problem in the developing countries of Africa and Asia because the prevalence of HBs antigen carriers is high. In Ivory Coast, the prevalence of HBs antigen carriers is more than 8% (6 to 29%). In these countries, in which hepatitis B is highly endemic, most infections with hepatitis B virus (HBV) occur during early childhood. The chronic carriage of HBV was found to be common in children, who played a key role in maintaining the high level of endemicity in these areas. Vaccines against HBV are effective and their introduction as part of the Expanded Program of Immunization (EPI), as recommended by the WHO, is feasible. OBJECTIVE: The aim of this study was to evaluate the prevalence of HBs antigen in pregnant women and to determine the rate of maternal transmission of HBV to the fetus, to demonstrate the importance of HBs antigen screening during pregnancy and the immunization of babies in the Ivory Coast. PATIENTS AND METHODS: Between August 1995 and February 1996, 395 women in the last three months of pregnancy (age 25 +/- 6.9 years) were screened for HBs antigen. Those testing positive were also screened for HBe antigen. Transmission of HBV in utero was studied with 322 mothers and their offspring. HBs antigen was assayed in the cord blood of the offspring of HBs antigen-positive mothers. If the test for HBs antigen was positive, HBe antigen was also assayed. Second-generation ELISA tests (MONOLISA HBs Ag and MONOLISA HBe Ag from Sanofi Pasteur) were used. Babies from HBs antigen-positive mothers were vaccinated at birth with three doses of GenHevac B.     

福建省五型病毒性肝炎流行特征

为了解福建省人群病毒性肝炎流行特征 ,福建省于 1992年进行五型病毒性肝炎感染的血清流行病学调查。采用多阶段分层整群随机抽样法 ,采集福建省疾病监测点自然人群的 12 37户家庭中 1～ 59岁居民血样本 380 9份。采用 RIA法检测 HBs Ag、抗 - HBs、抗 - HBc,采用 EIA法检测抗 - HAV、抗 - HCV、抗 - HDV、抗 - HEV和 HBe Ag。结果显示各标化流行率为 HAV 76.60 %、HBV77.2 6%、HCV 3.99%、HDV 2 .10 %、HEV 18.80 %、HBs Ag 17.2 5%、抗 - HBs 34 .33%、抗 - HBc68.58%、HBe Ag 8.4 2 %。农村 HAV、HBV、HEV流行率均高于城市。 HBs Ag流行率出现儿童峰和成人峰而且男性高于女性。 HBV和 HEV感染有明显的家庭聚集性。青壮年 HEV流行率高 ,城市儿童 HAV流行率低。提示福建省是 HAV、HBV、HCV、HEV的高流行区。预防甲、乙型肝炎病毒感染最有效策略是免疫接种甲、乙型肝炎疫苗。     

Sreening of pregnant women for hepatitis B markers in a French Provincial University Hospital (Limoges) during 15 years

Abstract. During the 15 years from January 1984 to December 1998 the Limoges University Hospital screened 22,859 pregnant patients for hepatitis B surface antigen (HBs Ag) and identified 149 positives. The overall prevalence (0.65%) was intermediate between prevalences observed among women of French origin (0.29%), French West Indies islands (5.68%) and of foreign origin particulary South East Asian origin (7.14%) and Sub Saharan African origin (6.52%). Hepatitis B Virus (HBV) replication markers was detected with relative low frequence (HBe Ag: 14.4%; HBV-DNA: 13.7–20%) among HBs Ag positive mothers. Markers of delta hepatitis virus was found among 10.5% of the HBs Ag carrier pregnant women. During the 15 years study period variations of the global prevalence were not statistically significant. Universal prenatal screening and infant immunisation could greatly contribute to the control of HBV infection if the polemic about the hepatitis B vaccination recently propagated in France will not have a negative effect on the acceptance and national programme of vaccination.     

Household clustering and intra-household transmission patterns of hepatitis B virus infection in South Africa

The objective of this study was to investigate household clustering of hepatitis B virus (HBV) infection in South Africa in order to understand intra-household patterns of virus transmission that would provide information on potential risk factors of HBV infection. Subjects were the household contacts of 28 hepatitis B surface antigen (HBsAg) positive children (index-carrier), 22 hepatitis B surface antibody positive children (index-past-infection) and 35 children with no serological evidence of HBV infection (index-negative). Evidence of HBV infection (at least one positive HBV marker) was present in 73.7%, 48.7% and 38.2% and HBsAg was present in 19.9%, 8.7% and 2.9% of household contacts of index-carrier (N = 186), index-past-infection (N = 150) and index-negative (N = 207) children respectively. The clustering of HBV infection and HBsAg was present in all subgroups of household contacts regardless of the degree of relatedness to the index child. As age increased, the cumulative prevalence of HBV infection increased while the likelihood of being HBsAg positive decreased. Regardless of age, males were more likely (p less than 0.01) than females to be HBsAg positive. We conclude that HBV infection clusters in households; that there is an increased susceptibility, which is probably not genetically mediated, of becoming an HBV carrier in certain households and that males are at greater risk of being HBV carriers. Intra-household horizontal person-to-person transmission, the precise mechanisms of which are not known, is important in South African blacks.     

Incidence and prevalence of hepatitis B. A community-based survey in the Philippines

In a rural village in the Philippines, sera were collected from 744 residents and tested for evidence of hepatitis B virus infection. In the subsequent year, every household was visited every other week for a period of three months in an attempt to identify clinically apparent cases. At the end of the year, sera were obtained from 78% of persons initially negative for hepatitis B virus and 97% of those initially positive for hepatitis B surface antigen (HBsAg). Overall, HBsAg was found in 8.8% of the population tested, of whom 86% were still HBsAg-positive at the end of the year. Susceptibility to hepatitis B virus infection declined significantly with age, to only 16% in the age group 50 years and older. No difference in the prevalence of markers by sex was observed. The risk of infection in children appeared to increase if one or both parents were infected, compared with both parents susceptible (odds ratio = 3.3 and 7.6, respectively); the risk increased if older siblings were infected, compared with all older siblings susceptible. The overall incidence rate of hepatitis B virus infection was 3.3% per year. For those aged five years or younger, the incidence rate was 9.2%. None of the seroconverters manifested acute symptoms of infection. Despite the evident clustering in families of persons with hepatitis B virus markers, which is suggested by the prevalence survey, only two of nine incident infections observed were in children with HBsAg-positive close relatives. The findings support the impression that in countries endemic for hepatitis B virus, most new cases occur in the young and are clinically inapparent. Furthermore, screening families of young children for chronic carriers in an effort to identify children at high risk for hepatitis B virus infection would have a low sensitivity in the Philippine setting.     

Hepatitis B infection in Eastern Indian families: need for screening of adult siblings and mothers of adult index cases

OBJECTIVES: India, with its 43 million hepatitis B virus (HBV) carriers and absence of any national immunization programme, adds a substantial number of HBV infections to the HBV carrier pool yearly. The aim of this study was to assess the spread of HBV infection in families with an infected member and to identify the family members with the highest risk of infection in our community. METHODS: A total of 937 serum samples from 215 HBV-infected cases and 722 members of their households were screened prospectively for markers of HBV by commercial enzyme-linked immunosorbent assay. RESULTS: Among family members, 140 (19.4%) were HBsAg positive and 272 (37.6%) were negative for HBsAg but positive for either anti HBc or anti HBs. There were 145 HBsAg-positive adults among the index cases whose 133 adult siblings, 59 spouses and 59 mothers participated in the study. Interestingly, 28.81% mothers and 28.57% adult siblings of these adult index cases were positive for HBsAg compared with only 8.75% of their spouses (P < 0.001). Only 15.2% of the HBsAg-positive women in the childbearing age group were found to be HBeAg positive. CONCLUSIONS: Our results suggest that intrafamilial childhood horizontal transmission is important for HBV transmission in our community, and highlight the need for screening of adult siblings and mothers of adult HBsAg carriers in addition to their spouses and children.     

Epidemiological characteristics of hepatitis B virus infection in cyprus

The prevalence of hepatitis B virus (HBV) infection in Cyprus was estimated in a sample of 795 blood donors, 388 armed forces recruits, 1872 hospital staff, 135 haemodialysis patients, 559 thalassaemic patients, 722 institutionalised adults, 98 mentally retarded children and 323 family contacts of HBsAg carriers.Commercially available radioimmunoassays were used for screening. Merck Sharpe and Dohme hepatitis B vaccine was used for a vaccination pilot program. Our results showed that the carrier rate of HBsAg in the blood donor and army recruit samples ranged between 0.77% and 1.01% and the prevalence of past infection between 11.1% and 13.6%. Among high risk groups the highest carrier rate was found in family contacts of HBsAg carriers (18.27%) , in mentally retarded children (6.12%) and in institutionalized adult patients (5.40%). The frequency of immunes was found 28.5%, 12.2% and 33.2% respectively. The highest frequency of immunes was found in thalassaemic (82.9%) and haemodialysis (43.7%) patients. The carrier rate (2.94%) and the prevalence of immunes (22.5%) in hospital personnel was higher than in general population.Vaccination studies in a limitted number of thalassaemic children and hospital personnel showed excellent acceptance of vaccination and excellent immunogenicity. We infer that HBV infection should be consider as a major public health problem in Cyprus. A National Vaccination program has to be implemented for containing its spread.Corresponding author.     

Hepatitis B in Wisconsin male prisoners: considerations for serologic screening and vaccination.

To develop a protocol for prevention of hepatitis B virus (HBV) transmission in Wisconsin prisons, we interviewed 619 male prisoners at incarceration to obtain information on hepatitis B risk factors. We defined previous infections by the presence of hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), or antibody to hepatitis B core antigen (anti-HBc). Logistic regression was used to develop a model of relative risk (RR) of HBV infection. Use of illicit intravenous (IV) drugs was the most important risk factor because of a high prevalence of IV drug use and an RR which ranged from 2.93-7.47. Other important risk factors were: prior hepatitis or jaundice (RR = 6.28), race (RR = 2.54 for Blacks, RR = 3.28 for Latinos), transfusion (RR = 3.00), and age. Previous imprisonment was not an independent risk factor for HBV, hence selective serologic screening and vaccination of prisoners are justified rather than mass screening and vaccination. Based upon prevalence of hepatitis B markers in subgroups, it is necessary to screen prisoners with prior hepatitis or jaundice, prior transfusion, and users of IV drugs. The identification of HBsAg carriers by such screening could prevent infection of "household" contacts. Users of IV drugs who are susceptible to HBV infection should be vaccinated. The remaining prisoners constitute a low-risk group for HBV infection and do not require serologic screening or vaccination.     

Transmission of hepatitis B and hepatitis delta viruses in the households of chronic hepatitis B surface antigen carriers: a regression analysis of indicators of risk

To evaluate whether clinical and laboratory features of a hepatitis B surface antigen (HBsAg) carrier can predict risks of infection, its chronicity, and the development of liver disease among close contacts, the authors studied a cohort of 994 first degree relatives or cohabitants (household contacts) of 226 non-drug-addicted chronic HBsAg carriers (index cases), of whom 77% had liver disease and 26% were superinfected by hepatitis D virus (HDV). A logistic form of regression analysis was used to assess the role of each feature in the index case as predictor of hepatitis B virus (HBV)- and HDV-related outcomes among household contacts. Six models of risk, expressed as odds ratios, were assessed by multivariate step-down analysis, with the following results. 1) Infection with HBV in the household contact was independently predicted by the index case being son, sibling, spouse, female, or HBV-DNA positive. 2) Chronic HBsAg carriage in the adult household contact was associated with female sex of the index case and with being a sibling; among young subjects, household contacts were more likely to be chronic HBsAg carriers when the index case was the mother, a sibling, or an HBV-DNA-positive subject. 3) HBV-DNA positivity in the young contact was more likely when the index case was HBV-DNA positive and when she was the mother. 4) HBV-DNA positivity in the absence of hepatitis B e antigen (HBeAg) in serum in the index case was not related to a similar pattern of infection in HBsAg-positive contacts. 5) Super-infection with HDV of an HBsAg-positive household contact was significantly predicted by female sex of the index case and by anti-HDV positivity. 6) Chronic liver disease in a contact was predicted only by HDV superinfection of the index case. We conclude that horizontal, nonparenteral transmission of HBV among siblings plays a major role in the household of HBsAg carriers from an intermediate endemicity area.     

Meningococcal colonization and infection in children and their household contacts.

A bacteriologic survey was performed to estimate the prevalence and duration of meningococcal carriage in children in Montreal, Canada. Infants and children with proven meningococcal infection, or with asymptomatic meningococcal nasopharyngeal (NP) carriage, and their household contacts, were also studied to define communicability. N. meningitidis was present in 30 (2.4%) of the NP cultures from 1238 asymptomatic infants and children in this civilian population during a non-epidemic period. Meningococcal carriage was not found in 278 subjects 1--60 days of age; there was no difference in carriage rates between the sexes and between hospitalized and non-hospitalized children in all age groups. Meningococci were initially isolated from 11 of 106 household contacts of 29 ill index cases and from 15 of 104 contacts of 29 asymptomatic carriers; 35% of all contacts (index cases and carriers) were colonized by the eighth week of surveillance. Duration of NP carriage was longer (mean 15.2 weeks) in disease-free families than in families of ill patients (mean 5.5 weeks). Serogroups B and C were most commonly isolated from both ill and asymptomatic subjects. Resistance to sulfadiazine (MIC greater than or equal to mg/100 ml) was present in 6.5% and 39.4% of group B and group C strains, respectively. Although chemoprophylaxis was not used, there were no secondary cases among the 29 families of index cases.     

Clinical significance of serum HBeAg and HBV-DNA-specific values of virus replication in chronic hepatitis-B virus infection.

The prevalence of serum HBV-DNA and that of HBeAg was evaluated in 44 subjects (27 males and 17 females) aged between 3 and 59 years. They were divided in two groups: (A) chronic asymptomatic HBsAg carriers; and (B) chronic HBsAg carriers with a history of HBV infection. The patients had been chronic HBV carriers between 8 months and 15 years. All underwent clinical and biochemical evaluation. The serological markers of HBV infection were tested using ABBOTT assay kits. The serum HBV-DNA was quantified using a hemiluminiscence molecular hybridization assay (Digene-Murex). HBV-DNA+ were 13 patients (29.55 +/- 6.88%). The highest level of viral replication (up to 50%) was measured in the patients aged from 3 to 29 years while in the others a 3 to 4-fold decrease of the viral replication was detected. HBV-DNA+ were 8 (23.53 +/- 6.39%) of the chronic asymptomatic hepatitis B carriers and 5 (50.00 +/- 7.5%) of the chronic HBV carriers with former acute hepatitis B infection. Similar results were obtained for the other index of viral replication--HBeAg/anti-HBe. Eight (23.53 +/- 6.39%) patients from group I and 4 (40.00 +/- 7.38%) patients from group II were HBeAg+ while anti-HBe+ were 26 (76.47 +/- 6.39%) and 6 (60.00 +/- 7.38%) patients from group I and II, respectively, i.e., about a quarter of the chronic asymptomatic HBsAg carriers and half of the chronic HBV carriers that had had an acute hepatitis B virus infection had HBV replication in their bodies. HBeAg+ patients had high levels of serum HBV-DNA (625.70-3328.00 pg/ml) which indicated extremely intensive viral replication. The presence of HBeAg and especially of HBV-DNA as markers of viral replication in chronic asymptomatic HBsAg carriers and chronic HBsAg carriers with a prior acute hepatitis B virus infection provide important information for the clinical decisions.     

Screening for chronic hepatitis B among Asian/Pacific Islander populations--New York City, 2005

Chronic hepatitis B virus (HBV) infection is the most common cause of cirrhosis and liver cancer worldwide. In Asian and western Pacific countries where HBV is endemic, estimated prevalence of chronic HBV infection ranges from 2.4%-16.0%, and liver cancer is a leading cause of mortality. Although population-based prevalence data for Asians/ Pacific Islanders (A/PIs) living in the United States are lacking, they are believed to constitute a sizeable percentage of persons with chronic HBV infection in the United States, a country of low endemicity. To assess the prevalence of chronic HBV infection among A/PI populations living in New York City, the Asian American Hepatitis B Program (AAHBP) conducted a seroprevalence study among persons who participated in an ongoing hepatitis B screening, evaluation, and treatment program. The results indicated that approximately 15% of participants who had not been previously tested had chronic HBV infection; all were born outside the United States. Screening programs are needed in A/PI communities in the United States to identify persons with chronic HBV infection so that they can be referred for appropriate medical management to prevent cirrhosis and liver cancer and so that their susceptible household and sex contacts can receive hepatitis B vaccine.     

贵州少数民族人群乙肝流行率及流行模式分析

摘要:目的　了解贵州少数民族人群乙肝流行率及流行模式,为制定乙肝防治策略提供依据。方法　采用多阶段整群随机抽样方法,于2013年11-12月抽取贵州省3个少数民族自治州中的2个县8个村共1629名常住居民,进行问卷调查同时采集血样,用时间分辨免疫荧光法（TRFIA）检测血清中乙肝表面抗原（HBsAg）、乙肝表面抗体（HBsAb）、乙肝核心抗体（HBcAb）,分析乙肝流行模式。结果　1629名调查对象中,HBV 感染者825例,总感染率为 50.6%;共有 6种血清标志物模式组合,按照血清标志物模式分布特征将乙肝流行模式分为三类,其中以易感模式为主占45.9%、免疫模式占31.9%、感染模式占22.2%;不同民族、一起生活的人有无表面抗原阳性、不同婚姻状态、不同年龄、家庭HBV感染人数、是否接种乙肝疫苗、家庭人口数、是否饮酒、文化程度在3组流行模式间差异均有统计学意义（P＜0.05）;是否外出打工过、性别、是否共用牙刷、过去1年家庭总收入不同、是否吸烟在3组流行模式间差异均无统计学意义（P＞0.05）。结论　贵州少数民族人群乙肝流行模式以易感模式（3项全阴）为主,不同特征人群流行模式存在差异;易感模式流行的人群应加强免疫接种,提高该人群的乙肝特异性免疫力;对感染模式流行人群加强健康宣教,减少其乙肝的传播。     

Prevention of horizontal transmission of hepatitis B: efficacy of hepatitis B immunoglobulin and vaccine in an institution for the handicapped

In a Japanese institution for the handicapped with confirmed continuous outbreaks of hepatitis B virus (HBV) infection by horizontal nosocomial transmission, 29 susceptible subjects (8 institutionalized children and 21 medical staff) were injected intramuscularly with anti-human HBs immunoglobulin (HB Ig) and subcutaneously with HB vaccine. All cases acquired HBs antibody after injection of HB Ig and seropositivity for HB after the third inoculation of HB vaccine was 78.6%. No new case of HB occurred among the study population throughout the period investigated. This suggested the effectiveness of HB Ig and HB vaccine in the prevention of horizontal nosocomial transmission of HBV.     

Preventing transmission of hepatitis B virus from people with chronic infection

BACKGROUND: People with chronic hepatitis B virus (HBV) infection are the major source of HBV transmission in the United States. The Public Health Service recommends prevention counseling for HBV-infected people and vaccination of their household contacts and sexual partners. OBJECTIVES: To describe the implementation of these recommendations by community physicians. METHODS: Telephone survey of 69 people with chronic HBV infection and their healthcare providers, October 1997 through November 1997, in San Diego, California. MAIN OUTCOME MEASURES: Counseling of people with chronic HBV infection and vaccination of their household contacts and sexual partners. RESULTS: Forty-three percent of providers reported providing prevention counseling to their HBV-infected patients to reduce transmission; 16% of patients reported receiving counseling. For the 32 pairs for which both the patient and provider could be reached and the patients were aware of their HBV infection, 20 (63%) providers reported counseling patients, and 10 (50%) of these providers' patients reported receiving counseling. Fifty-five percent of providers recommended vaccination of contacts; 13% of eligible adult household contacts and sexual partners and 20% of eligible child household contacts had begun hepatitis B vaccination. CONCLUSIONS: Prevention counseling of people with chronic HBV infection and vaccination of their contacts occur infrequently despite guidelines and an effective vaccine. Collaborative efforts between providers and people involved in public health are needed to improve delivery of these preventive health services.     

The importance of imported infections in maintaining hepatitis B in The Netherlands

In The Netherlands, in May 1999 an enhanced surveillance of hepatitis B was begun to collect detailed information of patients with acute hepatitis B virus (HBV) infection. The objective was to gain insight in transmission routes and source of infection of new HBV cases. Through public health services, patients were interviewed on risk factors. It appeared that the majority (59%) acquired the infection through sexual contact; 52% of these by homosexual and 48% by heterosexual contact. In 60% of the heterosexual cases, the source of infection was a partner originating from a hepatitis B-endemic region. Sexual transmission is the most common route of transmission of acute hepatitis B in The Netherlands and introduction of infections from abroad plays a key role in the current epidemiology of HBV. As well as prevention programmes targeted at sexual high-risk groups, prevention efforts should focus more on the heterosexual transmission from HBV carriers.     

Epidemiology of acute hepatitis among outpatients in the urban community of Lyon, 1983

We conducted in 1983 an hepatitis surveillance programme in collaboration with 93% of the medical analysis laboratories in Lyons' urban area (1,100,000 inhabitants) and diagnosed 1,002 cases of acute hepatitis (incidence : 90.5 cases/10(5) inhabitants; HAV : 50.4 cases/10(5) inhabitants; HBV : 12 cases/10(5) inhabitants; non A non B : 24 cases/10(5) inhabitants; drugs : 4.2 cases/10(5) inhabitants). HBs Ag was undetectable in 12% of acute hepatitis B. Hepatitis A accounted for 91% of children's cases and 48% of cases among adults between 20 and 40 years old. Epidemics were observed among children after summer holidays related to the return of migrants from trips to their native country. For acute hepatitis B and non A non B, classical epidemiological data were observed, but the prevalence of drug addicts and homosexuals was low.     

嘉定地区饮食服务行业HBV感染血清流行病学调查

目的 旨在了解嘉定地区饮食、公共场所从业人员HBV感染状况。方法:选择嘉定地区饮食食品、公共场所从业人员健康体检者3 125例,用ELISA法检测HBsAg、抗—HBs、HBeAg、抗—HBe、抗—HBc5项血清学指标。结果 受检人群的HBV感染率为27.97％,HBsAg携带率为7.33％,男性感染率与携带率均高于女性(x~2=9.55,P<0.005;x~2=11.28,P<0.001)。不同年龄组人群的感染率与携带率亦存在着显著性差别 真感染模式有7种,以抗—HBs合并抗—HBc阳性、单纯抗—HBc阳性、HB-sAg阳性合并抗—HBe加抗—HBc阳性3种模式多见,其构成比分别为31.24％、20.37%、13.50%。单纯抗—HBs阳性率为4.16％。结论:以年轻人和男性为重点,定期对饮食、公共场所从业人员进行健康体检,加强卫生监督;进一步提高人群乙肝疫苗接种覆盖率;严格从业人员卫生执法力度;广泛开展预防乙肝知识的健康教育,培养科学的生活行为方式等综合措施的实施对降低乙肝在人群中的流行率具有十分重要的意义。     

乙型肝炎表面抗原无症状携带者的传染性及其传染源作用的研究

通过对无症状HBsAg携带者血清的HBeAg、HBV-DNA和Dane颗粒检查,揭示HBeAg、HBV-DNA均为阳性HBsAg的无症状携带者的血清具有传染性,而单纯HBsAg阳性(HBeAg、HBV-DNA均为阴性)血清传染性不强。
经三年观察,发现HBsAg、HBeAg、HBV-DNA均阳性的无症状携带者对同一个班内密切接触者能引起HBV感染,其感染的相对危险性比对照组高3.7倍。