Molecular analysis of the interspousal transmission of hepatitis B virus in two Japanese patients who acquired fulminant hepatitis B after 50 and 49 years of marriage

Long-read deep sequencing analysis of hepatitis B virus quasispecies in two elderly cases of interspousal transmission

Hepatitis B virus (HBV) can be transmitted within a family, but an interspousal transmission in elderly cases is rare and the change of viral quasispecies during the event is unclear. We experienced two acute hepatitis B males (AH1 and AH2, 67 and 71 years old, respectively) whose HBV was transmitted from their wives with chronic HBV infection (CH1 and CH2, 67 and 66 years old, respectively). To clarify the characteristics of HBV quasispecies in such cases, we performed long-read deep sequencing of HBV preS1/preS2/S domain using samples from the 2 couples. HBV full-genome sequences determined with direct sequencing showed that the HBV sequences belonged to subgenotype B1. AH1 was 98.0-99.2 % identical to CH1, and AH2 was 98.5-99.5 % identical to CH2, whereas the identity between AH1 and AH2 was 96.9 %. The long-read deep sequencing of amplicons including preS1/preS2/S domains with PacBio Sequel IIe showed the numbers of nucleotides with >5 % substitution frequencies in AH1, AH2, CH1 and CH2 were 0 (0 %), 4 (0.31 %), 39 (3.06 %) and 28 (2.20 %), respectively, indicating that CH1 and CH2 were more heterogeneous than AH1 and AH2. From a phylogenetic analysis based on the deep sequencing, minor CH1/CH2 clones that were close to AH1/AH2 clones were considered to be substantially distinct from the major populations in CH1/CH2. The major population formed during chronic infection under the immune pressure might not be suitable to establish new infection and this might be one of the reasons why the transmission had not occurred for a long time after marriage.

The high prevalence of occult hepatitis B infections among the partners of chronically infected HBV blood donors emphasizes the potential residual risk to blood safety

A small percentage of couples who regularly donated blood in China tested positive for HBsAg. Although it is well known that blood donors can acquire hepatitis B virus (HBV) infection from a chronically infected sexual partner, the prevalence of occult hepatitis B infections (OBIs) among blood donations from partners of HBV-infected chronically infected spouses and the risk to blood safety remain poorly understood. Among 212 763 blood donors, 54 pairs of couples (108 donations) were enrolled because one partner tested positive for HBsAg. Several molecular and serological examinations were conducted. The origin of HBV transmission between sexual partners was investigated further. Also evaluated was the potential risk of HBV infection with OBIs. We identified 10 (10/54, 18.6%) sexual partners of chronically infected HBV donors who were positive for HBV DNA, including five samples (9.3%) with OBIs, of which 3 (3/54, 5.6%, 1 in 70 921 donations) passed the routine blood screening tests. Seven of the 10 HBV-DNA-positive couples contracted the virus possibly through sexual or close contact. Among infected couples, immune escape mutations were observed. A high prevalence of OBIs was found among the partners of chronically infected HBV blood donors, posing a potential threat to blood safety.

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

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

Acute Liver Failure Caused by the Transmission of Hepatitis B Virus from the Spouse after 38 Years of Marriage

A 65-year-old man presented with acute liver failure and grade IV coma caused by hepatitis B virus (HBV) infection in 2017. The patient died on day 12 from the disease onset. The HBV isolated from the patient was genotype/subgenotype B/B1 and had multiple genomic mutations. The patient's wife was hepatitis B surface antigen (HBsAg)-positive when she delivered her first daughter in 1979. The HBV isolates of the patient and the wife shared 100% similarity over the entire genome. Because the patient's HBsAg value had been negative one year earlier, we considered the source of HBV transmission to be his wife.

Risk factors of hepatitis B virus infection between vaccinated and unvaccinated groups among spouses in 2006 and 2014: a cross-sectional study in Beijing

Objectives: To assess the prevalence of hepatitis B virus (HBV) infection among married individuals and to analyze the associated risk factors of HBV infection in vaccinated and unvaccinated groups in 2006 and 2014.

Methods: Information of married individuals aged over 16 y with a clear HBV vaccination status was extracted from the database constructed by the Beijing Center for Disease Prevention and Control from population-based investigation.

A structured questionnaire was employed to collect demographic information, vaccinated history, and other related influence information of HBV of participants. Pearson chi-square test, Fisher's test, and logistic regression were used to explore the risk factors of HBV infection.

Results: A total of 2874 individuals in 2006 and 1622 individuals in 2014 were enrolled in our study. The mean age of individuals was 49.30 and 46.68 y in 2006 and 2014, respectively. The overall positive rates of HBsAg, anti-HBc, and single anti-HBs were 4.80%, 43.01%, and 5.78% in 2006, which were 4.69%, 38.22%, and 14.18% in 2014, respectively. For vaccinated individuals, age was significantly correlated with anti-HBc in 2014 (40 < age ≤50 versus age ≤30, relative risk (RR) = 3.03, 95% confidence interval (95%CI) = 1.04–8.84). Gender [male versus female, RR = 0.60, 95%CI = 0.36–1.00 (2006); RR = 0.71, 95%CI = 0.52–0.97 (2014)] and age (in 2006) were found to be significantly associated with single anti-HBs.

For unvaccinated individuals, HBsAg positivity was statistically significant correlated with gender [RR = 1.47, 95%CI = 1.04–2.06, in 2006], residence (urban versus rural, RR = 0.40, 95%CI = 0.24–0.67, in 2006; RR = 0.58, 95%CI = 0.34–0.99, in 2014), sharing syringes [RR = 3.75, 95%CI = 1.33–10.63 (in 2006); RR = 2.07, 95%CI = 1.26–3.41 (in 2014)], infected wives (RR = 1.97, 95%CI = 1.28–3.05, in 2006), and infected husbands (RR = 2.19, 95%CI = 1.25–3.82, in 2006). Anti-HBc positivity was significantly associated with gender [RR = 1.19, 95%CI = 1.10–1.30 (in 2006); RR = 1.24, 95%CI = 1.09–1.40 (in 2014)], age (in 2006 and 2014), endoscopic medicine treatment [RR = 1.16, 95%CI = 1.03–1.32 (in 2006), RR = 1.21, 95%CI = 1.01–1.45 (in 2014)], sharing syringes (RR = 1.43, 95%CI = 1.25–1.64, in 2014), body piercing (RR = 0.84, 95%CI = 0.75–0.93, in 2006), infected wives (RR = 1.32, 95%CI = 1.18–1.47, in 2006), and infected husbands (RR = 1.39, 95%CI = 1.22–1.59, in 2006). Anti-HBs positivity was associated with age (in 2006 and 2014).

Conclusions: Prevalence of HBV infection was lower in 2014 than in 2006 according to HBsAg and anti-HBc positivity. Unvaccinated individuals faced much more risk of HBV infection than those of vaccinated.