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Anderson M, Mangogola T, Phinius BB, Mpebe G, Aimakhu CO, Choga WT, Phakedi B, Bhebhe LN, Ditshwanelo D, Baruti K, Mpofu-Dobo L, Othusitse L, Ratsoma T, Gaolathe T, Makhema J, Shapiro R, Lockman S, Moyo S, Gaseitsiwe S. Hepatitis B Virus Prevalence among HIV-Uninfected People Living in Rural and Peri-Urban Areas in Botswana. Microorganisms 2024; 12:1207. [PMID: 38930589 PMCID: PMC11205512 DOI: 10.3390/microorganisms12061207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: we determined the prevalence of the hepatitis B virus (HBV) amongst people without human immunodeficiency virus (HIV) in rural and peri-urban areas in Botswana. (2) Methods: We screened for the hepatitis B surface antigen (HBsAg) from archived plasma samples of people without HIV (n = 2135) randomly selected from the Botswana Combination Prevention Program (BCPP) (2013-2018). We sequenced 415 bp of the surface region using BigDye sequencing chemistry. (3) Results: The median age of participants was 31 (IQR: 24-46) and 64% (1360/2135) were female. HBV prevalence was 4.0% (86/2135) [95% CI: 3.3-4.9]) and ranged between 0-9.2%. Older participants (>35 years) had increased odds of HBV positivity (OR: 1.94; 95% CI: [1.32-2.86]; p = 0.001). Thirteen samples were sequenced and seven (53.8%) were genotype A, three (23.1%) were genotype D and genotype E each. Clinically significant mutations were identified in the surface region, but no classic drug resistance mutations were identified. (4) Conclusions: We report an HBV prevalence of 4.0% (95% CI 3.3-4.9) among people without HIV in rural and peri-urban communities in Botswana with varying rates in different communities. A comprehensive national HBV program is required in Botswana to guide HBV prevention, testing and management.
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Affiliation(s)
- Motswedi Anderson
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Africa Health Research Institute, Durban 4013, South Africa
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - Thabo Mangogola
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Pan-African University (Life and Earth Sciences Institute), University of Ibadan, Ibadan 200132, Nigeria;
| | - Bonolo B. Phinius
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Gorata Mpebe
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Christopher O. Aimakhu
- Pan-African University (Life and Earth Sciences Institute), University of Ibadan, Ibadan 200132, Nigeria;
| | - Wonderful T. Choga
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Basetsana Phakedi
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
| | - Lynnette N. Bhebhe
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
| | - Doreen Ditshwanelo
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
| | - Kabo Baruti
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Linda Mpofu-Dobo
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Department of Biological Sciences and Biotechnology, Faculty of Sciences, Botswana International University of Science and Technology, Private Bag 16, Palapye, Botswana
| | - Lebogang Othusitse
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
| | - Tsholofelo Ratsoma
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Tendani Gaolathe
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Faculty of Medicine, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
| | - Joseph Makhema
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Roger Shapiro
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Shahin Lockman
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Sikhulile Moyo
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Division of Medical Virology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, Private Bag X1, Matieland 7602, South Africa
- School of Health Systems and Public Health, University of Pretoria, Private Bag X20, Pretoria 0028, South Africa
| | - Simani Gaseitsiwe
- Botswana Harvard Health Partnership, Private Bag BO320, Gaborone, Botswana; (M.A.); (T.M.); (B.B.P.); (G.M.); (W.T.C.); (B.P.); (L.N.B.); (D.D.); (K.B.); (L.M.-D.); (L.O.); (T.R.); (T.G.); (J.M.); (R.S.); (S.L.); (S.M.)
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Kramvis A, Mammas IN, Spandidos DA. Exploring the optimal vaccination strategy against hepatitis B virus in childhood (Review). Biomed Rep 2023; 19:48. [PMID: 37383679 PMCID: PMC10293880 DOI: 10.3892/br.2023.1631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023] Open
Abstract
Vaccination against hepatitis B virus (HBV) remains the most effective strategy against HBV infection in humans. The present review summarized the optimal vaccination strategies against HBV in childhood. The following points are discussed: i) When and how the first HBV vaccines were developed; ii) the dosages, schedules and injection routes that are used for HBV vaccination; iii) the contraindications for HBV vaccination in the general paediatric population; iv) the challenges with the use of multivalent vaccines; v) the long-term immunogenicity and duration of protection against HBV; vi) the use of selective HBV vaccination and the hepatitis B immune globulin strategy in HBV-exposed infants; and vii) the effectiveness of the current HBV vaccination schemes. The present review is based on a Paediatric Virology Study Group (PVSG) webinar performed in the context of the 8th Workshop on Paediatric Virology.
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Affiliation(s)
- Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg 2193, South Africa
| | - Ioannis N. Mammas
- Paediatric Clinic, Aliveri, 34500 Island of Euboea
- First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
- Department of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Department of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
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Maepa MB, Ely A, Kramvis A, Bloom K, Naidoo K, Simani OE, Maponga TG, Arbuthnot P. Hepatitis B Virus Research in South Africa. Viruses 2022; 14:v14091939. [PMID: 36146747 PMCID: PMC9503375 DOI: 10.3390/v14091939] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/11/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
Despite being vaccine-preventable, hepatitis B virus (HBV) infection remains the seventh leading cause of mortality in the world. In South Africa (SA), over 1.9 million people are chronically infected with HBV, and 70% of all Black chronic carriers are infected with HBV subgenotype A1. The virus remains a significant burden on public health in SA despite the introduction of an infant immunization program implemented in 1995 and the availability of effective treatment for chronic HBV infection. In addition, the high prevalence of HIV infection amplifies HBV replication, predisposes patients to chronicity, and complicates management of the infection. HBV research has made significant progress leading to better understanding of HBV epidemiology and management challenges in the SA context. This has led to recent revision of the national HBV infection management guidelines. Research on developing new vaccines and therapies is underway and progress has been made with designing potentially curative gene therapies against HBV. This review summarizes research carried out in SA on HBV molecular biology, epidemiology, treatment, and vaccination strategies.
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Affiliation(s)
- Mohube B. Maepa
- Wits/SAMRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, Infectious Diseases and Oncology Research Institute (IDORI), University of the Witwatersrand, Johannesburg 2000, South Africa
- Correspondence:
| | - Abdullah Ely
- Wits/SAMRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, Infectious Diseases and Oncology Research Institute (IDORI), University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Anna Kramvis
- Hepatitis Diversity Research Unit, Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Kristie Bloom
- Wits/SAMRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, Infectious Diseases and Oncology Research Institute (IDORI), University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Kubendran Naidoo
- Wits/SAMRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, Infectious Diseases and Oncology Research Institute (IDORI), University of the Witwatersrand, Johannesburg 2000, South Africa
- National Health Laboratory Service, Johannesburg 2000, South Africa
| | - Omphile E. Simani
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Tongai G. Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7602, South Africa
| | - Patrick Arbuthnot
- Wits/SAMRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, Infectious Diseases and Oncology Research Institute (IDORI), University of the Witwatersrand, Johannesburg 2000, South Africa
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Vermeulen M, Swanevelder R, Van Zyl G, Lelie N, Murphy EL. An assessment of hepatitis B virus prevalence in South African young blood donors born after the implementation of the infant hepatitis B virus immunization program: Implications for transfusion safety. Transfusion 2021; 61:2688-2700. [PMID: 34173987 PMCID: PMC8939844 DOI: 10.1111/trf.16559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/16/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The prevalence of hepatitis B surface antigen is estimated to be 6.7% in the South African population and in April 1995 the nation introduced universal hepatitis B virus (HBV) vaccination for newborns and infants. We studied the temporal association of this program with HBV prevalence in young blood donors and the contemporary HBV incidence and residual risk of transfusion-transmitted HBV infection (TT-HBV). METHODS We used blood donation data from January 2011 to December 2019. Estimation of HBV prevalence donations made by first-time blood donors were analyzed by birth cohort and covariates. To estimate the incidence and residual risk of TT-HBV, mathematical models used data from both first time and repeat donors. RESULTS HBV prevalence in first-time donors decreased from 0.84% (95% confidence interval [CI] 0.78-0.90) in 2011 to 0.66% (95% CI 0.61-0.70) in 2019. The post-1995 birth cohort had a significantly lower HBV prevalence of 0.14% (95% CI 0.13-0.15) than the pre-1985 birth cohort of 1.29% (95% CI 1.25-1.33) and the odds of HBV infection were reduced in a multivariable model (odds ratio [OR] = 0.28, 95% CI 0.24-0.34). The residual risk of TT-HBV occurring from window-period, occult, and possible vaccine breakthrough infections were estimated at 36.9, 5.8, and 2.2 per million red blood cell transfusions, respectively. CONCLUSION Donors born after the start of routine HBV immunization had significantly lower prevalence of HBV infection, supporting the effectiveness of the vaccination program. The contemporary residual risk of TT-HBV has decreased and should decline further as more vaccinated young people join the donor pool.
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Affiliation(s)
- Marion Vermeulen
- Operations and Medical Division, The South African National Blood Service, Roodepoort, Gauteng, South Africa
| | - Ronel Swanevelder
- Operations and Medical Division, The South African National Blood Service, Roodepoort, Gauteng, South Africa
| | - Gert Van Zyl
- Division of Medical Virology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Nico Lelie
- Lelie Research, Alkmaar, The Netherlands
| | - Edward L. Murphy
- Department of Laboratory Medicine and Epidemiology/Biostats, University of California San Francisco, San Francisco, California, USA,Vitalant Research Institute, San Francisco, California, USA
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Burnett RJ, Dramowski A, Amponsah-Dacosta E, Meyer JC. Increasing hepatitis B vaccination coverage of healthcare workers - global lessons for South Africa. Curr Opin Immunol 2021; 71:6-12. [PMID: 33819774 DOI: 10.1016/j.coi.2021.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/22/2022]
Abstract
Healthcare workers (HCWs) are at high risk of contracting hepatitis B (HB), a severe blood-borne vaccine-preventable disease, caused by HB virus (HBV) infection. Low HB vaccine (HepB) coverage has resulted in suboptimal protection and high HBV infection rates in South African HCWs. Studies from Africa have identified cost; unavailability/lack of access to HepB; and lack of awareness/knowledge of HB and HepB, as barriers to HCW uptake. Studies from Europe show little difference in HepB coverage between countries mandating versus recommending HepB. Providing easy and sustained access to free HepB to student HCWs, together with education about HB and HepB, are recommended to create demand for HepB. Only if this fails should mandatory vaccination be considered.
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Affiliation(s)
- Rosemary Joyce Burnett
- Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa; South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - Angela Dramowski
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Johanna Catharina Meyer
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa; Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Tamandjou Tchuem C, Cotton MF, Nel E, Tedder R, Preiser W, Violari A, Bobat R, Hovind L, Aaron L, Montepiedra G, Mitchell C, Andersson MI. Viral hepatitis B and C in HIV-exposed South African infants. BMC Pediatr 2020; 20:563. [PMID: 33357228 PMCID: PMC7758927 DOI: 10.1186/s12887-020-02479-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background Whilst much attention is given to eliminating HIV mother-to-child transmission (MTCT), little has been done to ensure the same for hepatitis B virus (HBV) transmission. The introduction of HBV immunization at six weeks of age has reduced HBV horizontal transmission in South Africa. However, in order to eliminate HBV MTCT, further interventions are needed. The risk of hepatitis C virus (HCV) MTCT in HIV-infected (HIV+) African women is not yet well described. This study aimed to determine the rate of HBV and HCV vertical transmission in HIV-exposed infants in South Africa. Methods Serum samples from infants enrolled in an isoniazid prevention study (P1041) were screened for HBV and HCV serology markers; screening was performed on samples collected at approximately 60 weeks of age of the infants. HBV DNA was quantified in HBsAg positive samples and HBV strains characterized through gene sequencing. All HCV antibody samples with inconclusive results underwent molecular testing. Results Three of 821 infants were positive for both HBsAg and HBV DNA. All HBV strains belonged to HBV sub-genotype A1. The rtM204I mutation associated with lamivudine resistance was identified in one infant, a second infant harboured the double A1762T/G1764A BCP mutation. Phylogenetic analysis showed clustering between mother and infant viral genomic sequences. Twenty-one of 821 HIV-exposed infants tested had inconclusive HCV antibody results, none were HCV PCR positive. Conclusions This study suggests that HBV vertical transmission is likely to be occurring in HIV-exposed infants in South Africa.. A more robust strategy of HBV prevention, including birth dose vaccination, is required to eradicate HBV MTCT. HCV infection was not detected.
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Affiliation(s)
- Cynthia Tamandjou Tchuem
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Mark Fredric Cotton
- Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, FAM-CRU, Stellenbosch University, Cape Town, South Africa
| | - Etienne Nel
- Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Tedder
- Blood Borne Viruses Unit, Virus Reference Department, Public Health England, London, UK
| | - Wolfgang Preiser
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Raziya Bobat
- Department of Paediatrics, Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Laura Hovind
- Frontier Science and Technology Research Foundation, New York, USA
| | - Lisa Aaron
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Grace Montepiedra
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Charles Mitchell
- Department of Paediatrics, School of Medicine, University of Miami Miller, Miami, USA
| | - Monique Ingrid Andersson
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Prabdial-Sing N, Makhathini L, Smit SB, Manamela MJ, Motaze NV, Cohen C, Suchard MS. Hepatitis B sero-prevalence in children under 15 years of age in South Africa using residual samples from community-based febrile rash surveillance. PLoS One 2019; 14:e0217415. [PMID: 31150445 PMCID: PMC6544234 DOI: 10.1371/journal.pone.0217415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/10/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction and methods Hepatitis B is a vaccine preventable disease and is notifiable in South Africa. Hepatitis B vaccination was incorporated into the Expanded Programme on Immunisation in South Africa in 1995. We used a convenience sample from community-based febrile rash surveillance in 2013 to estimate hepatitis B sero-prevalence. Of samples serologically negative for acute measles infection, 450 samples spanning nine provinces of South Africa were tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and hepatitis B core antibody (anti-HBc). Results Two children (2/450; 0.4%) tested positive for HBsAg. Three hundred and three children (67.3%) had evidence of vaccine induced immunity. Vaccine induced immunity was present in 80.2% of 1–5 year olds, but only 60.3% of 10–14 year olds. Natural immunity, indicating exposure to circulating hepatitis B, was present in 13/450 (2.9%) children. Conclusion Chronic hepatitis B in South African has decreased in prevalence from highly endemic levels prior to vaccine introduction to approximately 0.4% in this sample, demonstrating impact of a successful vaccination programme 18 years after introduction. Decreased vaccine-induced immunity with increasing age may reflect waning antibody titres over time.
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Affiliation(s)
- Nishi Prabdial-Sing
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lillian Makhathini
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sheilagh Brigitte Smit
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Morubula Jack Manamela
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nkengafac Villyen Motaze
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health,Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Melinda Shelley Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
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8
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Davis S, Toledo C, Lewis L, Maughan-Brown B, Ayalew K, Kharsany ABM. Does voluntary medical male circumcision protect against sexually transmitted infections among men and women in real-world scale-up settings? Findings of a household survey in KwaZulu-Natal, South Africa. BMJ Glob Health 2019; 4:e001389. [PMID: 31263584 PMCID: PMC6570991 DOI: 10.1136/bmjgh-2019-001389] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Male circumcision (MC) confers partial protection to men against HIV and, in research settings, some sexually transmitted infections (STIs). It is also associated with protection from some STIs among female partners. However, real-world data on changes in STI transmission associated with large-scale public African medical male circumcision (MMC) conducted for HIV prevention are lacking and would improve estimates of the health impact of MMC. METHODS The HIV Incidence Provincial Surveillance System is a community-based surveillance platform for HIV prevalence, incidence and intervention coverage trends in KwaZulu-Natal province, South Africa. HIPPS collected cross-sectional self-reported data on circumcision status (from men), partner circumcision status for past three partners (from women) and demographic characteristics and behavioural risk factors; and tested participants for HIV, herpes simplex virus type 2 (HSV-2), syphilis, hepatitis B, N eisseria gonorrhoeae, C hlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium. Bivariable and multivariable analyses were performed on associations between own (men) or partner's (women) circumcision status and each STI. Multivariable analyses adjusted for age, demographic characteristics and behavioural risk factors, and incorporated false discovery rate (FDR) correction. RESULTS Among men, MMC had a protective association with HSV-2 (OR 0.66, 95% CI 0.50 to 0.86), hepatitis B (OR 0.53, 95% CI 0.30 to 0.95), HIV (OR 0.50, 95% CI 0.38 to 0.65) and M. genitalium (OR 0.53, 95% CI 0.32 to 0.88). Among women, partner circumcision had a protective association with HSV-2 (OR 0.71, 95% CI 0.53 to 0.95) and HIV (OR 0.66, 95% CI 0.49 to 0.90). Associations with HIV and HSV-2 remained significant for men and all women after FDR correction. CONCLUSION These real-world data, supporting protective associations between MMC conducted for HIV prevention and STIs in men and women, can help clarify the full impact of MMC and support a role in broader sexual health programming.
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Affiliation(s)
- Stephanie Davis
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lara Lewis
- Nelson R. Mandela School of Medicine, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa
| | - Kassahun Ayalew
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Durban, South Africa
| | - Ayesha B M Kharsany
- Nelson R. Mandela School of Medicine, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
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9
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McNaughton AL, Lourenço J, Hattingh L, Adland E, Daniels S, Van Zyl A, Akiror CS, Wareing S, Jeffery K, Ansari MA, Klenerman P, Goulder PJR, Gupta S, Jooste P, Matthews PC. HBV vaccination and PMTCT as elimination tools in the presence of HIV: insights from a clinical cohort and dynamic model. BMC Med 2019; 17:43. [PMID: 30786896 PMCID: PMC6383254 DOI: 10.1186/s12916-019-1269-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sustainable Development Goals set a challenge for the elimination of hepatitis B virus (HBV) infection as a public health concern by the year 2030. Deployment of a robust prophylactic vaccine and enhanced interventions for prevention of mother to child transmission (PMTCT) are cornerstones of elimination strategy. However, in light of the estimated global burden of 290 million cases, enhanced efforts are required to underpin optimisation of public health strategy. Robust analysis of population epidemiology is particularly crucial for populations in Africa made vulnerable by HIV co-infection, poverty, stigma and poor access to prevention, diagnosis and treatment. METHODS We here set out to evaluate the current and future role of HBV vaccination and PMTCT as tools for elimination. We first investigated the current impact of paediatric vaccination in a cohort of children with and without HIV infection in Kimberley, South Africa. Second, we used these data to inform a new parsimonious model to simulate the ongoing impact of preventive interventions. By applying these two approaches in parallel, we are able to determine both the current impact of interventions, and the future projected outcome of ongoing preventive strategies over time. RESULTS Existing efforts have been successful in reducing paediatric prevalence of HBV infection in this setting to < 1%, demonstrating the success of the existing vaccine campaign. Our model predicts that, if consistently deployed, combination efforts of vaccination and PMTCT can significantly reduce population prevalence (HBsAg) by 2030, such that a major public health impact is possible even without achieving elimination. However, the prevalence of HBV e-antigen (HBeAg)-positive carriers will decline more slowly, representing a persistent population reservoir. We show that HIV co-infection significantly reduces titres of vaccine-mediated antibody, but has a relatively minor role in influencing the projected time to elimination. Our model can also be applied to other settings in order to predict impact and time to elimination based on specific interventions. CONCLUSIONS Through extensive deployment of preventive strategies for HBV, significant positive public health impact is possible, although time to HBV elimination as a public health concern is likely to be substantially longer than that proposed by current goals.
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Affiliation(s)
- Anna L. McNaughton
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - José Lourenço
- Department of Zoology, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Louise Hattingh
- Department of Paediatrics, Kimberley Hospital, Kimberley, 8300 South Africa
| | - Emily Adland
- Department of Paediatrics, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Samantha Daniels
- Department of Paediatrics, Kimberley Hospital, Kimberley, 8300 South Africa
| | - Anriette Van Zyl
- Department of Paediatrics, Kimberley Hospital, Kimberley, 8300 South Africa
| | - Connie S. Akiror
- Global Healthcare Public Foundation, Makindu Lane, Kololo, Kampala, Uganda
| | - Susan Wareing
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
| | - Katie Jeffery
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
| | - M. Azim Ansari
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Paul Klenerman
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
| | - Philip J. R. Goulder
- Department of Paediatrics, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Sunetra Gupta
- Department of Zoology, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
| | - Pieter Jooste
- Department of Paediatrics, Kimberley Hospital, Kimberley, 8300 South Africa
| | - Philippa C. Matthews
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
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10
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Dlamini SK, Madhi SA, Muloiwa R, Von Gottberg A, Moosa MYS, Meiring ST, Wiysonge CS, Hefer E, Mulaudzi MB, Nuttall J, Moorhouse M, Kagina BM. Guidelines for the vaccination of HIV-infected adolescents and adults in South Africa. South Afr J HIV Med 2018. [DOI: 10.4102/sajhivmed.v19i1.839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
No abstract available.
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11
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Burnett RJ, Mmoledi G, Ngcobo NJ, Dochez C, Seheri LM, Mphahlele MJ. Impact of vaccine stock-outs on infant vaccination coverage: a hospital-based survey from South Africa. Int Health 2018; 10:376-381. [DOI: 10.1093/inthealth/ihy036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/21/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rosemary J Burnett
- South African Vaccination and Immunisation Centre, Department of Virology, Sefako Makgatho Health Sciences University
| | - Gloria Mmoledi
- South African Medical Research Council/Sefako Makgatho Health Sciences University Diarrhoeal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University
| | | | - Carine Dochez
- Network for Education and Support in Immunisation, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - L Mapaseka Seheri
- South African Medical Research Council/Sefako Makgatho Health Sciences University Diarrhoeal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University
| | - M Jeffrey Mphahlele
- South African Vaccination and Immunisation Centre, Department of Virology, Sefako Makgatho Health Sciences University
- South African Medical Research Council/Sefako Makgatho Health Sciences University Diarrhoeal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University
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12
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Vermeulen M, Swanevelder R, Chowdhury D, Ingram C, Reddy R, Bloch EM, Custer BS, Murphy EL. Use of Blood Donor Screening to Monitor Prevalence of HIV and Hepatitis B and C Viruses, South Africa. Emerg Infect Dis 2018; 23:1560-1563. [PMID: 28820374 PMCID: PMC5572879 DOI: 10.3201/eid2309.161594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Among 397,640 first-time blood donors screened in South Africa during 2012–2015, HIV prevalence was 1.13%, hepatitis B virus prevalence 0.66%, and hepatitis C virus prevalence 0.03%. Findings of note were a high HIV prevalence in Mpumalanga Province and the near absence of hepatitis C virus nationwide.
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13
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Seri B, Minga A, Gabillard D, Dembele B, Konate S, Le Carrou J, Dohoun L, Abo Y, Karcher S, Coffie P, N'Dri-Yoman T, Attia A, Eholié SP, Danel C, Lacombe K, Anglaret X, Boyd A. Twenty-Year Evolution of Hepatitis B Virus and Human Immunodeficiency Virus Prevalence and Incidence in Voluntary Blood Donors in Côte d'Ivoire. Open Forum Infect Dis 2018; 5:ofy060. [PMID: 29644251 PMCID: PMC5888498 DOI: 10.1093/ofid/ofy060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/15/2018] [Indexed: 12/14/2022] Open
Abstract
Background Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share common risk factors. The parallel description of their frequency over time may help capture their similarities and differences. Methods Using data from the National Transfusion Center of Abidjan, we estimated the following over a 20-year period: (1) the prevalence of HIV and hepatitis B surface antigen (HBsAg) positivity at first contact; and (2) the incidence of HIV and HBsAg seroconversion in negative first-time blood donors. Results Between 1992 and 2012, 422319 donors (men [M] = 74%) provided 1063825 blood donations. For first-time donors, HIV prevalence decreased from 7.1% (M = 5.9%, women [W] =11.0%) in 1992-1994 to 1.1% (M = 0.8%, W = 2.0%) in 2010-2012. Prevalence of HBsAg positivity remained stable at 10.8% (M = 11.7%, W = 7.3%) in 1992-1994 to 11.1% (M = 12.5%, W = 7.1%) in 2010-2012. Among regular donors (N = 129256), the incidence of becoming HIV or HBsAg positive, respectively, decreased from 4.9 per 100 (M = 4.5, W = 8.6) and 7.3 per 100 person-years (M = 7.8, W = 2.3) in 1992-1994 to 0.07 (M = 0.06, W = 0.11) and 0.2 per 100 person-years (M = 0.2, W = 0.2) in 2010-2012. Conclusions Human immunodeficiency virus prevalence and incidence decreased dramatically over time, whereas HBV prevalence remained stable. Incidence of HBsAg seroconversion, although decreasing, still reached unexpected levels, suggesting that the risk of HBV infection in adults may be higher than expected. Hepatitis B surface antigen-negative blood-donors should be offered HBV vaccination.
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Affiliation(s)
- Benjamin Seri
- INSERM, UMR 1219, University of Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire
| | - Albert Minga
- INSERM, UMR 1219, University of Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire.,Centre Médical de Suivi des Donneurs de Sang, Treichville, Abidjan, Côte d'Ivoire
| | - Delphine Gabillard
- INSERM, UMR 1219, University of Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire
| | - Bamori Dembele
- National Blood Transfusion Center, Abidjan, Côte d'Ivoire
| | - Seidou Konate
- National Blood Transfusion Center, Abidjan, Côte d'Ivoire
| | - Jérôme Le Carrou
- INSERM, UMR 1219, University of Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire
| | - Lambert Dohoun
- Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire.,Centre Médical de Suivi des Donneurs de Sang, Treichville, Abidjan, Côte d'Ivoire
| | - Yao Abo
- Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire.,Centre Médical de Suivi des Donneurs de Sang, Treichville, Abidjan, Côte d'Ivoire
| | - Sophie Karcher
- INSERM, UMR 1219, University of Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire
| | - Patrick Coffie
- INSERM, UMR 1219, University of Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire.,Department of Infectious and Tropical Diseases, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Thérèse N'Dri-Yoman
- Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire.,Department of Gastro-Entero-Hepatology, Yopougon University Hospital, Abidjan, Côte d'Ivoire
| | - Alain Attia
- Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire.,Department of Gastro-Entero-Hepatology, Yopougon University Hospital, Abidjan, Côte d'Ivoire
| | - Serge P Eholié
- INSERM, UMR 1219, University of Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire.,Department of Infectious and Tropical Diseases, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Christine Danel
- INSERM, UMR 1219, University of Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire
| | - Karine Lacombe
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Xavier Anglaret
- INSERM, UMR 1219, University of Bordeaux, France.,Programme PAC-CI, ANRS Research Site, Abidjan, Côte d'Ivoire
| | - Anders Boyd
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint Antoine, Paris, France
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14
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Haban H, Benchekroun S, Sadeq M, Benjouad A, Amzazi S, Oumzil H, Elharti E. Assessment of the HBV vaccine response in a group of HIV-infected children in Morocco. BMC Public Health 2017; 17:752. [PMID: 28962610 PMCID: PMC5622525 DOI: 10.1186/s12889-017-4776-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/20/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Since its development in the early 1980s, Hepatitis B virus (HBV) vaccine has been proven to be highly protective. However, its immunogenicity may be ineffective among HIV-infected children. In Morocco, HBV vaccine was introduced in 1999, and since then all infants, including vertically HIV-infected infants, have been following the vaccination schedule, implemented by the Moroccan ministry of health. An assessment of the immunization of these children is important to optimize efforts aimed at tackling Hepatitis B coinfection, within the country. METHODS Forty-nine HIV-infected children (HIV group) and 112 HIV uninfected children (control group) were enrolled in this study. Samples were tested by Elisa (Monolisa Anti-HBs, Biorad) to quantify the anti-HBs antibodies. The % of lymphocyte subsets i.e. CD4+ T cells, CD8+ T cells, B cells, and NK, was determined by flow cytometry, using CellQuest Pro software (Becton-Dickinson), and for HIV group, HIV viral load was measured by real time PCR assay (Abbott). All variables were statistically compared in the two groups. RESULTS The median age was 51 ± 35 months for the HIV group and 50 ± 36 months (p > 0.05) for the control group. Female represented 63% and 41% (p = 0.01), among the HIV group and the control group, respectively. Among HIV-infected children, 71.4% (35/49) were under HAART therapy at the enrollment in the study. Seroprotection titer i.e. anti-HBs ≥10mUI/ml among control group was 76% (85/112), and only 29% (14/49) among the perinatally HIV-infected children (p < 0.0001). Lower % of CD4 + T cells was observed in HIV-infected children with a poor anti-HBs response. CONCLUSION In this studied group, we have shown that despite the vaccination of HIV-children with HBV vaccine, 71% did not show any seroprotective response. These findings support the need for monitoring HBV vaccine response among HIV-infected children in Morocco, in order to revaccinate non-immunized children.
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Affiliation(s)
- Houda Haban
- National Reference Laboratory for HIV, Department of Virology, National Institute of Hygiene, Rabat, Morocco.,Immunology-Biochemistry Laboratory, Faculty of Sciences, University Mohammed Vth, Rabat, Morocco
| | - Soumia Benchekroun
- Pediatric Infectious Disease Clinic, Ibn Sina University Hospital, Rabat, Morocco
| | - Mina Sadeq
- Environmental Epidemiology Unit, National Institute of Hygiene, Rabat, Morocco
| | | | - Said Amzazi
- Immunology-Biochemistry Laboratory, Faculty of Sciences, University Mohammed Vth, Rabat, Morocco
| | - Hicham Oumzil
- National Reference Laboratory for HIV, Department of Virology, National Institute of Hygiene, Rabat, Morocco
| | - Elmir Elharti
- National Reference Laboratory for HIV, Department of Virology, National Institute of Hygiene, Rabat, Morocco.
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15
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Breakwell L, Tevi-Benissan C, Childs L, Mihigo R, Tohme R. The status of hepatitis B control in the African region. Pan Afr Med J 2017; 27:17. [PMID: 29296152 PMCID: PMC5745934 DOI: 10.11604/pamj.supp.2017.27.3.11981] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/10/2017] [Indexed: 01/05/2023] Open
Abstract
The World Health Organization (WHO) African Region has approximately 100 million people with chronic hepatitis B virus (HBV) infection. This review describes the status of hepatitis B control in the Region. We present hepatitis B vaccine (HepB) coverage data and from available data in the published literature, the impact of HepB vaccination on hepatitis B surface antigen (HBsAg) prevalence, a marker of chronic infection, among children, HBsAg prevalence in pregnant women, and risk of perinatal transmission. Lastly, we describe challenges with HepB birth dose (HepB-BD) introduction reported in the Region, and propose strategies to increase coverage. In 2015, regional three dose HepB coverage was 76%, and 16(34%) of 47 countries reported ≥ 90% coverage. Overall, 11 countries introduced HepB-BD; only nine provide universal HepB-BD, and of these, five reported ≥ 80% coverage. From non-nationally representative serosurveys among children, HBsAg prevalence was lower among children born after HepB introduction compared to those born before HepB introduction. However, some studies still found HBsAg prevalence to be above 2%. From limited surveys among pregnant women, the median HBsAg prevalence varied by country, ranging from 1.9% (Madagascar) to 16.1% (Niger); hepatitis B e antigen (HBeAg) prevalence among HBsAg-positive women ranged from 3.3% (Zimbabwe) to 28.5% (Nigeria). Studies in three countries indicated that the risk of perinatal HBV transmission was associated with HBeAg expression or high HBV DNA viral load. Major challenges for timely HepB-BD administration were poor knowledge of or lack of national HepB-BD vaccination guidelines, high prevalence of home births, and unreliable vaccine supply. Overall, substantial progress has been made in the region. However, countries need to improve HepB3 coverage and some countries might need to consider introducing the HepB-BD to help achieve the regional hepatitis B control goal of < 2% HBsAg prevalence among children < 5 years old by 2020. To facilitate HepB-BD introduction and improve timely coverage, strategies are needed to reach both facility-based and home births. Strong political commitment, clear policy recommendations and staff training on HepB-BD administration are also required. Furthermore, high quality nationally representative serosurveys among children are needed to inform decision makers about progress towards the regional control goal.
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Affiliation(s)
- Lucy Breakwell
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carol Tevi-Benissan
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Lana Childs
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard Mihigo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Rania Tohme
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Liu J, Lv J, Yan B, Feng Y, Song L, Xu A, Zhang L, Yan Y. Comparison between two population-based hepatitis B serosurveys with an 8-year interval in Shandong Province, China. Int J Infect Dis 2017; 61:13-19. [PMID: 28577994 DOI: 10.1016/j.ijid.2017.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Tremendous progress has been made in hepatitis B virus (HBV) prevention and control in the last 30 years in China, but it continues to be a major public health problem. The most recently reported population-based seroepidemiological survey on HBV in Shandong Province in China was published in 2006, and an updated baseline for HBV prevalence was badly needed in the province to identify the change in HBV epidemiology in the last decade. METHODS Two population-based cross-sectional serosurveys were performed among the population aged 1-59 years in the same sample areas in Shandong Province, China in 2006 and 2014, respectively. Data on demographic characteristics were collected. A blood sample was obtained from each person and was tested for hepatitis B surface antigen (HBsAg), antibody against HBsAg (anti-HBs), and antibody against hepatitis B core antigen (anti-HBc). RESULTS Overall, the prevalence rates of HBsAg, anti-HBs, and anti-HBc were 3.39% (95% confidence interval (CI) 2.51-4.26), 44.96% (95% CI 41.34-48.57), and 24.45% (95% CI 22.19-26.71), respectively, among the population aged 1-59 years in the 2006 serovsurvey; the corresponding prevalence rates were 2.49% (95% CI 1.81-3.17), 48.27% (95% CI 45.63-50.92), and 22.56% (95% CI 20.14-24.97), respectively, in 2014. The prevalence rates of HBsAg and anti-HBc were lower in 2014 than in 2006. Conversely, the prevalence of anti-HBs showed an increase. However, none of these differences were statistically significant (all p>0.05). The prevalence of HBsAg showed an increase among persons aged 20-24 years in 2014 (3.83%) compared with 2006 (2.98%) (t=0.45, p=0.67). Among all occupation groups, the prevalence of HBsAg was lower in 2014 than in 2006, while the prevalence of anti-HBc showed moderate increases in students and farmers (all p>0.05). The prevalence of HBsAg decreased more obviously in urban areas (65.49%) than rural areas (7.07%) from 2006 to 2014. CONCLUSIONS The epidemiology of HBV infection has changed in Shandong Province, China over the last decade. More attention should be paid to HBV infection among students and farmers.
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Affiliation(s)
- Jiaye Liu
- Department of Epidemiology, School of Public Health, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China; Academy of Preventive Medicine, Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Jingjing Lv
- Academy of Preventive Medicine, Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Bingyu Yan
- Academy of Preventive Medicine, Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Yi Feng
- Academy of Preventive Medicine, Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Lizhi Song
- Academy of Preventive Medicine, Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Aiqiang Xu
- Academy of Preventive Medicine, Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China..
| | - Li Zhang
- Academy of Preventive Medicine, Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China..
| | - Yongping Yan
- Department of Epidemiology, School of Public Health, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China.
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17
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Sharp CP, Gregory WF, Hattingh L, Malik A, Adland E, Daniels S, van Zyl A, Carlson JM, Wareing S, Ogwu A, Shapiro R, Riddell L, Chen F, Ndung'u T, Goulder PJR, Klenerman P, Simmonds P, Jooste P, Matthews PC. PARV4 prevalence, phylogeny, immunology and coinfection with HIV, HBV and HCV in a multicentre African cohort. Wellcome Open Res 2017; 2:26. [PMID: 28497124 PMCID: PMC5423528 DOI: 10.12688/wellcomeopenres.11135.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: The seroprevalence of human parvovirus-4 (PARV4) varies considerably by region. In sub-Saharan Africa, seroprevalence is high in the general population, but little is known about the transmission routes or the prevalence of coinfection with blood-borne viruses, HBV, HCV and HIV.
Methods: To further explore the characteristics of PARV4 in this setting, with a particular focus on the prevalence and significance of coinfection, we screened a cohort of 695 individuals recruited from Durban and Kimberley (South Africa) and Gaborone (Botswana) for PARV4 IgG and DNA, as well as documenting HIV, HBV and HCV status.
Results: Within these cohorts, 69% of subjects were HIV-positive. We identified no cases of HCV by PCR, but 7.4% were positive for HBsAg. PARV4 IgG was positive in 42%; seroprevalence was higher in adults (69%) compared to children (21%) (p<0.0001) and in HIV-positive (52%) compared to HIV-negative individuals (24%) (p<0.0001), but there was no association with HBsAg status. We developed an on-line tool to allow visualization of coinfection data (
https://purl.oclc.org/coinfection-viz). We identified five subjects who were PCR-positive for PARV4 genotype-3.
Ex vivo CD8+ T cell responses spanned the entire PARV4 proteome and we propose a novel HLA-B*57:03-restricted epitope within the NS protein.
Conclusions: This characterisation of PARV4 infection provides enhanced insights into the epidemiology of infection and co-infection in African cohorts, and provides the foundations for planning further focused studies to elucidate transmission pathways, immune responses, and the clinical significance of this organism.
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Affiliation(s)
- Colin P Sharp
- Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK.,Edinburgh Genomics, University of Edinburgh, Edinburgh, EH9 3FL, UK
| | | | - Louise Hattingh
- Kimberley Hospital, Kimberley, Northern Cape, 8301, South Africa
| | - Amna Malik
- Department of Paediatrics, University of Oxford, Oxford, OX1 3SY, UK
| | - Emily Adland
- Department of Paediatrics, University of Oxford, Oxford, OX1 3SY, UK
| | - Samantha Daniels
- Kimberley Hospital, Kimberley, Northern Cape, 8301, South Africa
| | - Anriette van Zyl
- Kimberley Hospital, Kimberley, Northern Cape, 8301, South Africa
| | | | - Susan Wareing
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Anthony Ogwu
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Roger Shapiro
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Lynn Riddell
- Northampton General Hospital NHS Trust, Northampton, NN1 5BD, UK
| | - Fabian Chen
- Royal Berkshire Hospital, Reading, RG1 5AN, UK
| | - Thumbi Ndung'u
- HIV Pathogenesis Program, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, 4041, South Africa
| | | | - Paul Klenerman
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK.,NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK
| | - Pieter Jooste
- Kimberley Hospital, Kimberley, Northern Cape, 8301, South Africa
| | - Philippa C Matthews
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, OX1 3SY, UK
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18
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Pinto FPD, Ferreira OC, Olmedo DB, Precioso PM, Barquette FRS, Castilho MC, Silva SGC, Pôrto LC. Prevalence of hepatitis B and C markers in a population of an urban university in Rio de Janeiro, Brazil: a cross-sectional study. Ann Hepatol 2016; 14:815-25. [PMID: 26436353 DOI: 10.5604/16652681.1171756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND RATIONALE Epidemics of hepatitis B and C are a public health burden, and their prevalence in Brazil varies among regions. We determined the prevalence of hepatitis markers in an urban university population in order to support the development of a comprehensive program for HBV immunization and HBV/HCV diagnosis. Students, employees, and visitors (n = 2,936, 31 years IQR 24.5-50, female = 69.0% and 81.1% with at least 12 years of education) were enrolled from May to November 2013. Antibodies against hepatitis B surface antigen (anti-HBs), against hepatitis B core antigen (anti-HBc), and hepatitis B surface antigen (HBsAg) were detected with enzyme immunoassays and anti-hepatitis C virus (anti-HCV) antibodies with a chemiluminescence immunoassay. The results were confirmed with polymerase chain reaction for HCV and nucleic acid amplification test for hepatitis B virus (HBV). RESULTS The overall prevalence of markers among the participants was 0.136% (95% confidence interval [CI]: 0.003-0.270) for HBsAg, 6.44% (95% CI: 5.55-7.33%) for anti-HBc, 50.8% (95% CI: 48.9-52.7%) for anti-HBs > 10 mIU/mL, and 0.44% (95% CI: 0.20-0.68) for anti-HCV. Almost 30.4% had anti-HBs titers > 100 mIU/mL. Participants with a detectable HCV viral load (n = 9) were infected with genotype 1a. CONCLUSIONS In an urban university population, in which 80% of participants had > 11 years of education, prevalence increased with age, and self-declared ethnicity for anti-HBc and with age, marital status and professional activity for anti-HCV antibodies. A periodical offer of HCV rapid testing should be implemented, and HBsAg rapid testing should be offered to individuals above 20 years of age.
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Affiliation(s)
- Félix P D Pinto
- Master Program in Health, Laboratory Medicine and Forensic Technology
| | - Orlando C Ferreira
- Molecular Virology Laboratory, Biology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Patrícia M Precioso
- Histocompatibility and Cryopreservation Laboratory, Roberto Alcantara Gomes Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Magda C Castilho
- Histocompatibility and Cryopreservation Laboratory, Roberto Alcantara Gomes Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Suely G C Silva
- Master Program in Health, Laboratory Medicine and Forensic Technology
| | - Luís Cristóvão Pôrto
- Histocompatibility and Cryopreservation Laboratory, Roberto Alcantara Gomes Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
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19
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Beghin JC, Ruelle J, Sokal E, Bachy A, Krishna M, Hall L, Goubau P, Van der Linden D. Effectiveness of the South African expanded program of immunization against hepatitis B in children infected with human immunodeficiency virus-1 living in a resource-limited setting of Kwazulu-Natal. J Med Virol 2016; 89:182-185. [DOI: 10.1002/jmv.24598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Christophe Beghin
- AIDS Reference Laboratory; Saint-Luc University Hospital; Catholic University of Louvain; Brussels Belgium
| | - Jean Ruelle
- AIDS Reference Laboratory; Catholic University of Louvain; Brussels Belgium
| | - Etienne Sokal
- Paediatric Hepatic and Gastro-Enterologic Diseases; Saint-Luc University Hospital; Catholic University of Louvain; Brussel Belgium
| | - Antoine Bachy
- Great Hospital of Charleroi-Notre Dame; Charleroi Belgium
| | | | - Leslie Hall
- Edendale Regional Hospital; Edendale South Africa
| | - Patrick Goubau
- AIDS Reference Laboratory; Saint-Luc University Hospital; Catholic University of Louvain; Brussels Belgium
| | - Dimitri Van der Linden
- Paediatric Infectious Diseases; General Paediatrics; Saint-Luc University Hospital; Catholic University of Louvain; Brussels Belgium
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20
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Stockdale AJ, Geretti AM. Chronic hepatitis B infection in sub-Saharan Africa: a grave challenge and a great hope. Trans R Soc Trop Med Hyg 2016; 109:421-2. [PMID: 26065660 DOI: 10.1093/trstmh/trv044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Anna Maria Geretti
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
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21
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Chotun N, Nel E, Cotton MF, Preiser W, Andersson MI. Hepatitis B virus infection in HIV-exposed infants in the Western Cape, South Africa. Vaccine 2015; 33:4618-22. [DOI: 10.1016/j.vaccine.2015.06.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/31/2015] [Accepted: 06/19/2015] [Indexed: 12/22/2022]
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22
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Papastergiou V, Lombardi R, MacDonald D, Tsochatzis EA. Global Epidemiology of Hepatitis B Virus (HBV) Infection. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s11901-015-0269-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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23
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Nashibi R, Alavi SM, Yousefi F, Salmanzadeh S, Moogahi S, Ahmadi F, Farashahinejad M. Post-vaccination Immunity Against Hepatitis B Virus and Predictors for Non-responders Among Medical Staff. Jundishapur J Microbiol 2015; 8:e19579. [PMID: 25861435 PMCID: PMC4385250 DOI: 10.5812/jjm.19579] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 07/27/2014] [Accepted: 09/21/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) is a major cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). HB vaccination is an essential step in the prevention of the disease and its consequent complications. OBJECTIVES Immune status of medical personnel in teaching hospitals of Khuzestan is not well known. Since these personnel are usually at risk of needle stick and other high-risk events, some challenges exist in infection control committee with regard to managing these events. This study was conducted to assess post-vaccination immunity status and non-response to HBV vaccine as well as its predictors among medical staff in a teaching hospital affiliated to Ahvaz Jundishapur University of Medical Sciences (AJUMS) in Ahvaz, southwest Iran. PATIENTS AND METHODS In this retrospective cross-sectional study, the medical staff of a teaching hospital was evaluated for their immune response against HBV and factors affecting it. The study conducted in Razi Hospital, Ahvaz City, southwest of Iran, in 2013. Demographical, clinical, and laboratory data registered in medical files of hospital staff were analyzed by SPSS software version 16 using chi-square and Fisher exact tests. Differences with P value < 0.05 were considered significant. To identify predictors for non-responders, we used odds ratio (OR) with 95% confidence interval (CI). RESULTS Out of 239 participants, 43 (18 %) were men and 196 (82%) were women. Their mean age was 31.9 ± 18.1 years (range of 20 - 55 years). Fourteen (5.9%) participants were non-responders, 37 (15.5%) were poor responders, and 188 (78.6%) were good responders. The non-responders were older (> 50 years) than the responders (P = 0.0001), while the body mass index (BMI) was not significantly different (P = 0.37) between them. Diabetes mellitus (DM) (OR: 7.3, 95% CI, 1.3 - 41.7, P = 0.05), and using immunosuppressive drugs (ISD) (OR: 3.2, 95% CI, 1.1 - 11.5, P = 0.03) were two variables in association with non-response to HB vaccine. CONCLUSIONS Non-response rate to HB vaccine in our study was approximately 6%. Age over 50 years, DM, and receiving immunosuppressive drugs may be considered as predictors for non-response to HB vaccine in medical staff.
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Affiliation(s)
- Roohangiz Nashibi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Seyed Mohammad Alavi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding author: Seyed Mohammad Alavi, Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-6133387724, Fax: +98-6133335396, E-mail:
| | - Farid Yousefi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Shokrolah Salmanzadeh
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Sassan Moogahi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Fatemeh Ahmadi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mehdi Farashahinejad
- Department of Infectious Diseases, Razi Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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24
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Hepatitis B virus infection in post-vaccination South Africa: occult HBV infection and circulating surface gene variants. J Clin Virol 2014; 63:12-7. [PMID: 25600597 DOI: 10.1016/j.jcv.2014.11.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to investigate the prevalence of occult hepatitis B virus (HBV) infection and the HBV surface (S) gene variants circulating in the South African population after nearly two decades of universal hepatitis B vaccination. STUDY DESIGN From a previous serosurvey, 201 serum samples with serological evidence of exposure to HBV were identified and these were stratified into post- and pre-vaccine introduction populations. For all samples, HBV DNA was screened and quantified using a real-time PCR assay and results analysed together with HBV serological markers. Where HIV results were available, subset analysis was performed. The HBV S gene was PCR-amplified and sequences analysed for a total of 37 isolates. RESULTS The prevalence of occult HBV infection reduced from 70.4% in the pre-vaccine introduction era to 66.0% post-vaccine introduction. There was an association between HIV infection and an increase in prevalence of occult HBV infection within the post-vaccine introduction population, although this was not statistically significant. Furthermore, sequence analysis revealed the following HBV subgenotypes; A1 (n=34), A2 (n=2) and a rare D4 isolate. HBV S gene variants, including diagnostic escape mutants were isolated. CONCLUSION There was a decline in the prevalence of occult HBV infection in post-vaccination South Africa, although the disease burden remains significant in the HIV co-infected population. After nearly two decades of a universal hepatitis B vaccination programme, no positive selection of vaccine escape mutants were observed.
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