1
|
Mangowi I, Mirambo MM, Kilonzo SB, Mlewa M, Nyawale H, Majinge D, Hyera F, Jaka H, Mtemisika C, Michael F, Mshana SE. Hepatitis B virus infection, associated factors, knowledge and vaccination status among household contacts of hepatitis B index cases in Mwanza, Tanzania. IJID REGIONS 2024; 10:168-173. [PMID: 38317663 PMCID: PMC10840095 DOI: 10.1016/j.ijregi.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 02/07/2024]
Abstract
Objectives To determine the prevalence of hepatitis B virus (HBV) infection, knowledge regarding HBV, vaccination status, and associated factors among household contacts of HBV index cases in Mwanza, Tanzania. Methods Between July and August 2023, a cross-sectional study involving 97 index cases and 402 household contacts was conducted. Data were collected using pre-tested structured questionnaire and blood samples were collected from household contacts for HBV surface antigen (HBsAg) testing. Results The prevalence of HBV among household contacts was 5.4% (95% confidence interval, 2.9-9.0) with a significantly high proportion observed in > 45 years (16.6%) and in males (9.9%). A total of 40.0% of the household contacts had completed the full HBV vaccination series. On multivariate analysis, being male was significantly associated with HBsAg positivity (odds ratio: 7.16, 95% confidence interval: 1.81-28.2, P = 0.005). Conclusion About one-tenth of adults' male household contacts were HBsAg positive. In addition, the majority of household contacts had poor to fair knowledge regarding HBV infection with more than half being unvaccinated against HBV. There is a need to enhance awareness and education regarding HBV infection among household contacts in Tanzania and other low- and middle-income countries.
Collapse
Affiliation(s)
- Ivon Mangowi
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mariam M. Mirambo
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Semvua B. Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania
| | - Mathias Mlewa
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Helmut Nyawale
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | - Hyasinta Jaka
- Department of Internal Medicine, Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania
| | | | - Fausta Michael
- Ministry of Health, Immunization and Vaccine Development Program, Dodoma, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| |
Collapse
|
2
|
Han B, Liu W, Yang S, Wang S, Du J, Liu Y, Cui F. Association between self-monitoring of blood glucose and hepatitis B virus infection among people with diabetes mellitus: a cross-sectional study in Gansu Province, China. BMJ Open 2021; 11:e048463. [PMID: 34620657 PMCID: PMC8499280 DOI: 10.1136/bmjopen-2020-048463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose was to explore the association between self-monitoring of blood glucose (SMBG) and hepatitis B virus (HBV) infection among people with diabetes. DESIGN A cross-sectional comparative study. SETTING Six township hospitals in Gansu Province, China in October 2018. PARTICIPANTS 408 patients with diabetes were systematically recruited, and based on their characteristics 408 people without diabetes were randomly matched 1:1. INTERVENTIONS Venous blood was collected for HBV serological testing and blood glucose testing. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was comparison of hepatitis B surface antigen (HBsAg) positive rates between the two groups. The secondary outcome was the relationship between frequency of SMBG and HBsAg positivity. RESULTS HBsAg positive rate in people without diabetes was 2.0% and in those with diabetes was 4.2%. Whether in people without diabetes or patients with diabetes, higher frequency of SMBG was associated with higher HBsAg positive rate. Increases in the duration of diabetes were correlated with increasing rates of HBsAg. Compared with people without diabetes, logistic regression identified an association between diabetes and HBV infection (OR=2.8; 95% CI 1.0 to 7.6), but impaired fasting glucose was not (OR=2.3; 95% CI 0.5 to 9.9). CONCLUSION Routine blood glucose monitoring at home was associated with HBV infection, which meant people with diabetes may be at high risk of HBV infection. China is a country with high prevalence of both HBsAg and diabetes, and the increased risk of HBV infection in populations with diabetes needs more attention.
Collapse
Affiliation(s)
- Bingfeng Han
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Wu Liu
- Jingyuan County Center for Disease Control and Prevention, Gansu, China
| | - Shubo Yang
- Jingyuan County Center for Disease Control and Prevention, Gansu, China
| | - Shuai Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Department of Laboratorial Science, Peking University School of Public Health, Beijing, China
| | - Yaqiong Liu
- Department of Laboratorial Science, Peking University School of Public Health, Beijing, China
| | - Fuqiang Cui
- Department of Laboratorial Science, Peking University School of Public Health, Beijing, China
| |
Collapse
|
3
|
Al-Busafi SA, Al-Harthi R, Al-Naamani K, Al-Zuhaibi H, Priest P. Risk Factors for Hepatitis B Virus Transmission
in Oman. Oman Med J 2021; 36:e287. [PMID: 34405055 PMCID: PMC8358403 DOI: 10.5001/omj.2021.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/29/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives Hepatitis B virus (HBV) is a major public health problem worldwide. The prevalence of HBV is dependent on the modes of transmission. Chronic hepatitis B (CHB) infection can progress to liver cirrhosis and hepatocellular carcinoma. Oman is regarded as an intermediate endemic region and has had a neonatal vaccine against HBV since 1990. However, little research has been conducted regarding risk factors for HBV transmission. Our study aimed to identify the prevalence of major risk factors for acquiring HBV in Oman. Methods We conducted a retrospective chart review of all adult Omani patients diagnosed with CHB at two tertiary hospitals in Oman, Sultan Qaboos University Hospital and Armed Forces Hospital, between February 2009 and July 2013. The prevalence of major risk factors was identified by interviewing CHB patients using a standard questionnaire during their follow-up visits to the hepatology clinic at both hospitals. The risk factor frequency was stratified by age, gender, and educational level. Results A total of 274 patients were interviewed; 52.2% of the participants were males. The median age for men was 35.9 years and 35.1 years for women, with 75.5% aged 20–39 years old. The antenatal screening was the most common means of identifying HBV infection in females, and pre-blood donation screening was the most common in males. Intra-familial contact with HBV infected persons and behavioral risks such as body piercing (females) and barber shaving (males) were more common than nosocomial risk factors. Knowledge about HBV infection was scarce among our participants. More than half of the participants had a positive family history of HBV infection. There was a significant association between HBV infection and age groups, and educational levels (p < 0.050 and p < 0.001, respectively). Among those who were infected due to intra-familial contact or behavioral risk, there was a significant difference between the two sexes (p < 0.020) and between the three age groups (< 23, 23–28, >28) of HBV positive mothers (33.3%, 14.3%, and 6.6%, respectively; p < 0.050). There was also a statistically significant difference among different educational levels (p < 0.050). Conclusions Direct contact of infected individuals within a family and exposure to high-risk behaviors such as piercing and barber shaving are the main reported risk factors for HBV infection in Omani patients. Reducing the vertical and horizontal transmission of HBV in Oman could be improved by implementing routine antenatal screening of pregnant women and a greater focus on contact screening, respectively.
Collapse
Affiliation(s)
- Said A Al-Busafi
- Gastroenterology and Hepatology Unit, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rahma Al-Harthi
- Surgical Residency Program, Oman Medical Speciality Board, Muscat, Oman
| | | | - Haifa Al-Zuhaibi
- Gastroenterology and Hepatology Unit, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Patricia Priest
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
4
|
Tracing back hepatitis B virus genotype D introduction and dissemination in South Brazil. INFECTION GENETICS AND EVOLUTION 2020; 82:104294. [DOI: 10.1016/j.meegid.2020.104294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/04/2020] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
|
5
|
A Systematic Review of the Current Hepatitis B Viral Infection and Hepatocellular Carcinoma Situation in Mediterranean Countries. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7027169. [PMID: 32626758 PMCID: PMC7305551 DOI: 10.1155/2020/7027169] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/04/2020] [Accepted: 02/22/2020] [Indexed: 12/13/2022]
Abstract
Viral hepatitis B is a global public health problem affecting nearly two billion subjects; 3.3% of whom are from the WHO (World Health Organization) Eastern Mediterranean Region (EMRO). It induces both acute and chronic hepatic disorders with subsequent liver cirrhosis and hepatocellular carcinoma (HCC) in a considerable percentage of patients based on the age of exposure. In this review, hepatitis B virus (HBV) and HCC prevalence, distribution and prevalence of different genotypes, and male/female infection frequencies in relation to the vaccination status in the Mediterranean countries were reported. Study Design. This systematic review describes the prevalence of hepatitis B infection, genotype distribution of hepatitis B virus, and prevalence and incidence of hepatocellular carcinoma in Mediterranean countries belonging to three different continents: Southern Europe (Spain, France, Italy, Croatia, and Greece), North Africa (Morocco, Algeria, Tunisia, Libya, and Egypt), and the Near East region (Syria, Lebanon, Turkey, Israel, and Palestine). We tried to collect new data from electronic databases: PubMed, ScienceDirect, ResearchGate, Google Scholar, and public health reports between 1980 and 2019. For each publication, we recorded reference, publication year, study characteristics (date, locations, sample size, and study population), and participant characteristics (population group, year, age, and sex). No language limitation was imposed, and articles or reports from non-peer-reviewed sources were not considered for this analysis. The main keywords were HBV prevalence, hepatitis B infection, HBV genotype, and HCC. Inclusion and Exclusion Criteria. Healthy population-based studies included the following sample populations: (i) voluntary blood donors, (ii) pregnant women, (iii) community studies, (iv) hemodialysis patients, (v) hospitalized patients, (vi) healthcare workers, (vii) sex workers, (viii) drug abusers, and (ix) prisoners. We excluded studies from the following special groups who were assumed to be at a special high risk: patients from sexually transmitted disease clinics and thalassemia clinics and professional or paid blood donors.
Collapse
|
6
|
Tfifha M, Kacem S, Ben Rejeb M, Naija S, Boujaafar N, Abroug S, Trabelsi A. Evaluation of antibody persistence after a four-dose primary hepatitis B vaccination and anamnestic immune response in children under 6 years. J Med Microbiol 2019; 68:1686-1693. [PMID: 31592765 DOI: 10.1099/jmm.0.001086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction. Tunisia is an intermediate hepatitis B virus (HBV) endemic country. The vaccination against hepatitis B was introduced in 1995 including four doses with a first dose administrated at birth. Decreasing the level of antibodies against hepatitis B surface antigen (anti-HBs) over time can be alarming. This study was conducted to explore the anti-HBV immune response among children under 6 years old, vaccinated according to the national vaccination schedule, by evaluating the immunological response to primary vaccination and by exploring the anamnestic immune response to a booster dose.Methods. We conducted a cross-sectional prospective study from June 2016 to June 2017 (n=180), based on voluntary participation. Children were recruited from the public pediatric ward sectors in Sahloul University Hospital of Sousse in Central Tunisia. An anti-HB titre was determined based on electro-chemiluminescence micro-particle immunoassay (ECLIA), using Elecsys Anti-HBs II kit, Roche.Results. Mean age at the time of enrollment in the study was 33±14.8 months. The seroprotection rate was 77.2 %. The anti-HB titre differed significantly between the different age groups (P=0.002). The predicting variable for having no seroprotective antibody level was older age. Children with anti-HB levels <10 IU l- 1 were offered an additional dose of HBV vaccine. Anamnestic response 1 month after the challenge dose was observed in 100 % of subjects. The probability of developing a high antibody response, following the booster dose increased in conjunction with an increased pre-booster antibody level.Conclusion. The response to a booster dose suggests the persistence of immune memory in almost all vaccinated individuals. Although a booster dose increases substantially anti-HB titre, the clinical relevance of such an increase remains unknown.
Collapse
Affiliation(s)
- Miniar Tfifha
- Pediatric department, Sahloul University Hospital, 4054 Sousse, Tunisia
| | - Saoussen Kacem
- LR14SP02, Epidemiology and Immunogenetics of Human Viral Infections, Laboratory of Microbiology, Sahloul University Hospital, 4054 Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, Sahloul University Hospital, 4054 Sousse, Tunisia
| | - Said Naija
- LR14SP02, Epidemiology and Immunogenetics of Human Viral Infections, Laboratory of Microbiology, Sahloul University Hospital, 4054 Sousse, Tunisia
| | - Noureddine Boujaafar
- Laboratory of Microbiology, Sahloul University Hospital, 4054 Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Saoussen Abroug
- Pediatric department, Sahloul University Hospital, 4054 Sousse, Tunisia
| | - Abdelhalim Trabelsi
- LR14SP02, Epidemiology and Immunogenetics of Human Viral Infections, Laboratory of Microbiology, Sahloul University Hospital, 4054 Sousse, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| |
Collapse
|
7
|
Ben Hadj M, Bouguerra H, Saffar F, Chelly S, Hechaichi A, Talmoudi K, Bahrini A, Chouki T, Hazgui O, Hannachi N, Letaief H, Bellali H, Bahri O, Ben-Alaya-Bouafif N. Observational study of vaccine effectiveness 20 years after the introduction of universal hepatitis B vaccination in Tunisia. Vaccine 2018; 36:5858-5864. [PMID: 30145100 DOI: 10.1016/j.vaccine.2018.08.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The objectives of this study were to estimate the national prevalence of hepatitis B infection in Tunisia using data from a nationwide survey, to compare results with those obtained in 1996 survey and to evaluate the impact of vaccination twenty years after its introduction. METHODS A National household-based cross sectional and serological survey was undertaken in 2015 from randomly selected districts using two-stage sampling. Data collection was performed using standardized and pretested questionnaires and collected blood samples were tested for markers of hepatitis B virus infection. RESULTS National point prevalence of Hepatitis B surface antigen was 1.7% (95% CI [1.6-1.9%]). The highest prevalence was found in the Center and South regions with respectively 2.3% (95% CI [2.0-2.7%]) and 2.2% (95% CI [1.8-2.8%]). Vaccine effectiveness (VE) was 88.6% (95% CI [81.5-93.0%]) and was higher among population aged less than 20 years 96.1% (95% CI [70.1-99.5%]) than those aged more than 20 years 59.0% (95% CI [32.0-75.3%]). VE was 85.6% (95% CI [65.8-93.9%]) is hyper-endemic areas and 89.1% (95% CI [80.3-94.0%]) in meso-endemic and hypo-endemic areas. CONCLUSIONS The prevalence of Hepatitis B surface antigen decreased compared to previous estimations and classify Tunisia as a low endemic country as result to the introduction of vaccination since 1995.
Collapse
Affiliation(s)
- Meriem Ben Hadj
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia.
| | - Hind Bouguerra
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Farah Saffar
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Souhir Chelly
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Aicha Hechaichi
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Khouloud Talmoudi
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Asma Bahrini
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Takoua Chouki
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Olfa Hazgui
- Laboratory of Microbiology, Farhat Hachad Hospital, Sousse, Tunisia
| | - Naila Hannachi
- Laboratory of Microbiology, Farhat Hachad Hospital, Sousse, Tunisia
| | - Hajer Letaief
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia
| | - Hedia Bellali
- Department of Epidemiology and Statistics, Abderrahmen Mami Hospital, Ariana, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007 Tunis, Tunisia
| | - Olfa Bahri
- Laboratory of Microbiology and Virology, Aziza Othmana Hospital, Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007 Tunis, Tunisia
| | - Nissaf Ben-Alaya-Bouafif
- National Observatory of New and Emerging Diseases, 1002 Tunis, Tunisia; University of Tunis El Manar, Faculty of Medicine of Tunis, 1007 Tunis, Tunisia
| |
Collapse
|
8
|
Decreasing the hepatitis B burden in Tunisia need more attention to adults for vaccination. Epidemiol Infect 2017; 145:1510-1511. [PMID: 28215204 DOI: 10.1017/s0950268817000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
9
|
Ciccozzi M, Chaouch H, Lo Presti A, Taffon S, Villano U, Equestre M, Bruni R, Marcantonio C, Tritarelli E, Cella E, Blasi A, Aouni M, Letaief A, Ciccaglione AR. Evolutionary dynamics of HBV-D7 subgenotype in Tunisia. J Med Virol 2016; 89:469-475. [PMID: 27543368 DOI: 10.1002/jmv.24665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 12/11/2022]
Abstract
Hepatitis B virus (HBV) is the main cause of diseases liver related infecting more than 200 milion persons worldwide. HBV infection shows high level of prevalence in South-East Europe and in Mediterranean basin. In Tunisia, a country with an intermediate level endemicity, HbsAg prevalence ranges from 2 to 5%. Most of the HBV isolates from Tunisia were classified as subgenotype D7 whose circulation is restricted to a specific area of North Africa including Maghreb region. In this paper, the phylogeny of HBV-D7 isolated from 38 Tunisian patients was investigated by analyzing the S gene region of HBV. A Bayesian coalescent-based framework was used to estimate the origin of the HBV-D7 in the country. The Tunisian D7 isolates were found to share a common ancestor whose origin was traced back to 1958. Population dynamics indicated that HBV-D7 epidemic in Tunisia grew exponentially from 1960s to 1990s. After that, the curve reached a plateau around the years 2000 likely due to the implementation of the infant vaccination program in 1996. Epidemiological data suggested that the exponential growth phase was likely sustained by intra-familial transmission events occurring during infancy. Further characterization of HBV-D7 isolates should be performed to evaluate, in the post-vaccination era, the emergence of new transmission routes, and to monitor the efficacy of the vaccination program. J. Med. Virol. 89:469-475, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Massimo Ciccozzi
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Epidemiology Unit, Istituto Superiore di Sanità, Rome, Italy.,University Hospital Campus Bio-Medico, Rome, Italy
| | - Houda Chaouch
- Department of Infectious Diseases, Viral Hepatitis Research Unit (UR12SP35), University Hospital Farhat Hached, Sousse, Tunisia.,Faculty of Pharmacy, Laboratory of Infectious Diseases and Biological Agents, University of Monastir, Monastir, Tunisia
| | - Alessandra Lo Presti
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Epidemiology Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Taffon
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Viral Hepatitis Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Umbertina Villano
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Viral Hepatitis Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Michele Equestre
- Department of Cell Biology and Neurosciences, Clinical Diagnostics and Therapy of Degenerative Diseases of the Central Nervous System Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Bruni
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Viral Hepatitis Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Cinzia Marcantonio
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Viral Hepatitis Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Elena Tritarelli
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Viral Hepatitis Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Eleonora Cella
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Epidemiology Unit, Istituto Superiore di Sanità, Rome, Italy.,Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Aletheia Blasi
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Epidemiology Unit, Istituto Superiore di Sanità, Rome, Italy.,University Hospital Campus Bio-Medico, Rome, Italy
| | - Mahjoub Aouni
- Faculty of Pharmacy, Laboratory of Infectious Diseases and Biological Agents, University of Monastir, Monastir, Tunisia
| | - Amel Letaief
- Department of Infectious Diseases, Viral Hepatitis Research Unit (UR12SP35), University Hospital Farhat Hached, Sousse, Tunisia
| | - Anna Rita Ciccaglione
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Viral Hepatitis Unit, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
10
|
Impact and long-term protection of hepatitis B vaccination: 17 years after universal hepatitis B vaccination in Tunisia. Epidemiol Infect 2016; 144:3365-3375. [PMID: 27535719 DOI: 10.1017/s0950268816001849] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) vaccination has been part of the Expanded Programme of Immunization (EPI) in Tunisia since 1995. The aim of this study was to evaluate, for the first time, the impact of mass vaccination in Tunisia 17 years after this programme was implemented, and in parallel, assess the long-term persistence of anti-HBs antibody in the vaccinated Tunisian population. A total of 1422 students were recruited (703 vaccinated, 719 non-vaccinated). HBV seromarkers were checked. None of the students from either group had positive HBsAg. The overall prevalence of anti-HBc was 0·8%. A Significantly higher prevalence of anti-HBc was noted in unvaccinated students than in vaccinated (1·4% vs. 0·3%, P = 0·02). The overall seroprotection rate (anti-HBs titre ⩾10 mIU/ml) was 68·9% in vaccinated subjects. Seroprotection rates and geometric mean titres decreased significantly with increasing age, reflecting waning anti-HBs titre over time. No significant difference was detected between seroprotection rates and gender or students' area of origin. Incomplete vaccination was the only factor associated with an anti-HBs titre <10 mIU/ml. This study demonstrates the excellent efficacy of the HBV vaccination programme in Tunisia 17 years after its launch. However, a significant decline of anti-HBs seroprotection has been observed in ⩾15-year-old adolescents which places them at risk of infection. Additional studies are needed in hyperendemic regions in Tunisia.
Collapse
|
11
|
Mhalla S, Kadri Y, Alibi S, Letaief A, Boukadida J, Hannachi N. Hepatitis D Virus Infection Among Hepatitis B Surface Antigen Carriers and in "Isolated anti-HBc" Antibodies Profile in Central Tunisia. HEPATITIS MONTHLY 2016; 16:e32354. [PMID: 27110257 PMCID: PMC4834381 DOI: 10.5812/hepatmon.32354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/31/2015] [Accepted: 12/04/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis D Virus (HDV) causes accelerated liver diseases in patients with Hepatitis B Virus (HBV) infection. There is lack of data about its prevalence, related risk factors and interaction with HBV carriers in our country. OBJECTIVES The aim of this study was to estimate the prevalence of hepatitis delta and associated risk factors among Hepatitis B surface antigen (HBsAg) and "isolated anti-HBc" profile carriers in central Tunisia. PATIENTS AND METHODS In this cross-sectional study, 540 patients with positive HBsAg and 109 "isolated anti-HBc" profile receiving care in a teaching hospital were tested for the presence of HDV serum-markers using commercially available enzyme immunoassay kit. HBV-DNA was detected by nested PCR in "isolated anti-HBc" profile group. RESULTS Prevalence of HDV was 8.1% in HBsAg carriers group, but it was significantly higher in active than inactive hepatitis (30.2% and 4.5%, respectively, OR = 9, 95% CI: [4.48-18.58]). There was no significant association between studied risk factors and HDV infection. In the "isolated anti-HBc" profile group, prevalence of HDV was 4.6% and HBV-DNA had negative result in all patients with positive results for HDV. CONCLUSIONS Although HDV had low prevalence in our area, it is vital to plan preventive strategies for HDV spread as well as HBV prevention. It is particularly important to suspect HDV infection in active HBV carriers to manage a particularly severe dual infection. HDV infection should be suspected even in negative HBsAg patients having "isolated anti-HBc" profile.
Collapse
Affiliation(s)
- Salma Mhalla
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
- Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
- Corresponding Author: Salma Mhalla, Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia. E-mail:
| | - Yosr Kadri
- Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
| | - Sana Alibi
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
| | - Amel Letaief
- Department of Infectious Disease, F. Hached Teaching Hospital, University of Sousse, Sousse, Tunisia
| | - Jalel Boukadida
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
| | - Naila Hannachi
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
| |
Collapse
|
12
|
Ben Jemia R, Gouider E. Seroprevalency of transfusion-transmitted infections in first-time volunteer and replacement donors in Tunisia. Transfus Clin Biol 2014; 21:303-8. [PMID: 25458983 DOI: 10.1016/j.tracli.2014.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 10/01/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Replacement donors are considered as having a major risk of transmission of infections to recipients mainly by the World Health Organisation. STUDY DESIGN AND METHODS Seroprevalency of HBV, HCV, HIV and syphilis were determined in 19,783 whole blood donations collected in the Tunisian National Blood Transfusion Centre during the year 2010 (12,968 [65.55%] replacement donations and 6815 [34.44%] voluntary blood donations). For HBV, HCV and syphilis, we performed a univariate analysis to determine whether age, sex and type of donation were risk factors, then multivariate logistic regression, to see if these factors were independent. RESULTS Mean age of donors was 30.1 years (replacement donors 34.5 years, first time non-remunerated donors 34.5 years, P<0.001). The predominant age group was 30-39 years (35.51%) in replacement donors and 20-29 years (54.15%) in first time non-remunerated donors. Male gender was significantly predominant (73.00% men vs 27.00% women, P<10(-6)). There were significantly more men among replacement donors (82.27% vs 55.38%, P<10(-3)). There were more women in the age groups 18-19 and 20-29 years. Only one HIV seropositive donation was noted in a male first time non-remunerated donor aged 18. Replacement type of donation, male sex and age were three independent risk factors for the HBs Ag carriage. For anti-HCV antibodies and TPHA, only replacement type of donation and age were found out to be risk factors and only age was independent. CONCLUSION In Tunisia, replacement blood donors were at higher risk of infection transmission, but only for hepatitis B.
Collapse
Affiliation(s)
- R Ben Jemia
- Centre de traitement des hémophiles, hôpital Aziza-Othmana, place de la Kasbah, Bab Menara, Tunis 1008, Tunisia.
| | - E Gouider
- Centre de traitement des hémophiles, hôpital Aziza-Othmana, place de la Kasbah, Bab Menara, Tunis 1008, Tunisia; Service d'hématologie, hôpital Aziza-Othmana, place de la Kasbah, Bab Menara, Tunis 1008, Tunisia; Faculté de médecine de Tunis, université de Tunis El-Manar, rue Djebal-Lakhdar, 1006 Tunis, Tunisia
| |
Collapse
|
13
|
Hatzakis A, Van Damme P, Alcorn K, Gore C, Benazzouz M, Berkane S, Buti M, Carballo M, Cortes Martins H, Deuffic-Burban S, Dominguez A, Donoghoe M, Elzouki AN, Ben-Alaya Bouafif N, Esmat G, Esteban R, Fabri M, Fenton K, Goldberg D, Goulis I, Hadjichristodoulou C, Hatzigeorgiou T, Hamouda O, Hasurdjiev S, Hughes S, Kautz A, Malik M, Manolakopoulos S, Matičič M, Papatheodoridis G, Peck R, Peterle A, Potamitis G, Prati D, Roudot-Thoraval F, Reic T, Sharara A, Shennak M, Shiha G, Shouval D, Sočan M, Thomas H, Thursz M, Tosti M, Trépo C, Vince A, Vounou E, Wiessing L, Manns M, Manns M. The state of hepatitis B and C in the Mediterranean and Balkan countries: report from a summit conference. J Viral Hepat 2013; 20 Suppl 2:1-20. [PMID: 23827008 DOI: 10.1111/jvh.12120] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The burden of disease due to chronic viral hepatitis constitutes a global threat. In many Balkan and Mediterranean countries, the disease burden due to viral hepatitis remains largely unrecognized, including in high-risk groups and migrants, because of a lack of reliable epidemiological data, suggesting the need for better and targeted surveillance for public health gains. In many countries, the burden of chronic liver disease due to hepatitis B and C is increasing due to ageing of unvaccinated populations and migration, and a probable increase in drug injecting. Targeted vaccination strategies for hepatitis B virus (HBV) among risk groups and harm reduction interventions at adequate scale and coverage for injecting drug users are needed. Transmission of HBV and hepatitis C virus (HCV) in healthcare settings and a higher prevalence of HBV and HCV among recipients of blood and blood products in the Balkan and North African countries highlight the need to implement and monitor universal precautions in these settings and use voluntary, nonremunerated, repeat donors. Progress in drug discovery has improved outcomes of treatment for both HBV and HCV, although access is limited by the high costs of these drugs and resources available for health care. Egypt, with the highest burden of hepatitis C in the world, provides treatment through its National Control Strategy. Addressing the burden of viral hepatitis in the Balkan and Mediterranean regions will require national commitments in the form of strategic plans, financial and human resources, normative guidance and technical support from regional agencies and research.
Collapse
Affiliation(s)
- A Hatzakis
- National Retrovirus Reference Center, Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Ezzikouri S, Pineau P, Benjelloun S. Hepatitis B virus in the Maghreb region: from epidemiology to prospective research. Liver Int 2013; 33:811-9. [PMID: 23530901 DOI: 10.1111/liv.12135] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/28/2013] [Indexed: 12/21/2022]
Abstract
Hepatitis B virus (HBV) represents an important health problem in the Maghreb countries, Algeria, Libya, Mauritania, Morocco and Tunisia, but no detailed synthesis of its epidemiology is available. In this review, we systematically searched for data about HBV in the Maghreb in peer-reviewed databases and included in our analysis works written in English and French, as well as institutional reports and regional conference meeting abstracts. We estimated national and regional prevalence of chronic HBV infection. In addition, we discuss molecular features of the viral strains circulating in the region. Data analysis suggests that in the Maghreb region HBs antigen carriage concerns 1.8-4.9% of the population for an estimated number of 2.7 million persons. Genotype D, subtype D7, is predominant and mutations in the precore region of HBV genome are highly prevalent. This epidemiological situation requires obviously widespread active interventions for prevention and control. In addition, anti-hepatitis B vaccination programme should be applied with the utmost discipline in the five countries considered in this present review. This systematic review will, hopefully, increase knowledge at disposal of Public Health authorities, enabling better resource allocation and healthcare delivery. The present synthesis intends to stimulate policies aiming at preventing the spread of HBV, keeping in mind that eradication of the virus from Maghrebi populations should be the ultimate objective of Public Health authorities.
Collapse
Affiliation(s)
- Sayeh Ezzikouri
- Virology Unit, Viral Hepatitis Laboratory, Pasteur Institute of Morocco, Casablanca, Morocco.
| | | | | |
Collapse
|
15
|
Chan OK, Lao TT, Suen SSH, Lau TK, Leung TY. Correlation between maternal hepatitis B surface antigen carrier status with social, medical and family factors in an endemic area: have we overlooked something? Infection 2011; 39:419-26. [PMID: 21713427 DOI: 10.1007/s15010-011-0151-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 06/16/2011] [Indexed: 01/05/2023]
Abstract
PURPOSE Hepatitis B virus (HBV) infection is endemic in many countries, but the risk factors for HBV carriage in the obstetric population are unclear. METHODS A survey on 1,580 women attending the antenatal clinic in an endemic region was conducted in order to examine the prevalence of and factors associated with maternal HBV carriage, including socio-demographic, medical, and previous obstetrical and family history, by means of a questionnaire. RESULTS The prevalence of maternal HBV carriage was 9.1%, and 4.8% of women with a history of hepatitis B vaccination were found to be HBV carriers. Factors associated with maternal HBV carriage were residency status (adjusted odds ratio [aOR] 3.65 for immigrants; aOR 7.62 for non-residents), positive family history (aOR 3.72 for infected mother; aOR 5.36 for other family members), no previous vaccination (aOR 4.39) and having previous HBsAg testing (aOR 2.26). CONCLUSIONS The findings suggest that there was probably an overlooked role of horizontal transmission within the family setting in addition to perinatal transmission in determining the likelihood of HBV infection in our obstetric population. Reconfirmation of hepatitis B status might be necessary among individuals with a history of vaccination to ensure the effectiveness of their immunoprotection.
Collapse
Affiliation(s)
- O K Chan
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | | | | | | | | |
Collapse
|
16
|
Bawazir AA, Parry CM, Hart CA, Sallam TA, Beeching N, Cuevas LE. Seroepidemiology and risk factors of hepatitis B virus in Aden, Yemen. J Infect Public Health 2011; 4:48-54. [PMID: 21338959 DOI: 10.1016/j.jiph.2010.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 11/21/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND There is little published data concerning hepatitis B virus (HBV) infection in Aden and no data concerning risk factors for infection. This study aimed to determine the prevalence of HBV infection and risk factors for infection in Aden, Yemen. METHODS A prospective cross sectional survey of individuals attending primary health care facilities was stratified by age and population size. Five hundred and thirty five participants were interviewed and serum was screened for the presence of Immunoglobin G HBV core antibodies (antiHBc). AntiHBc positive participants were tested for antibodies to hepatitis B surface antigen (HBsAg). A case-control analysis of risk factors for HBV was undertaken comparing risk factors between antiHBc positive cases and seronegative controls. RESULTS The age-standardized seroprevalence for antiHBc was 16.2% (95% confidence interval (CI) 13.1-19.3) and for HBsAg was 1.5% (95% CI 0.5-2.5). The seroprevalence of antiHBc and HBsAg was estimated to range from 5.5% and 0% in infants to 40% and 4.6% in adults, respectively (p<0.001). Age (AOR=1.03, 95% CI=1.01-1.05), household size (>5-9 members, AOR=2.9, 95% CI=1.1-7.6) and ownership of a landline telephone (AOR=2.8, 95% CI=1.3-5.8) were independent risk factors for HBV infection. CONCLUSIONS HBV is still a public health problem in this community, with older individuals having much higher prevalence than younger generations. The results of this study would categorise Aden as a low HBV endemic zone. Perinatal transmission does not seem to be a major route of transmission.
Collapse
Affiliation(s)
- Amen Ahmed Bawazir
- Medical Faculty, Aden University, P.O. Box 6336, Khormaksar, Aden, Yemen.
| | | | | | | | | | | |
Collapse
|
17
|
Hannachi N, Fredj NB, Bahri O, Thibault V, Ferjani A, Gharbi J, Triki H, Boukadida J. Molecular analysis of HBV genotypes and subgenotypes in the Central-East region of Tunisia. Virol J 2010; 7:302. [PMID: 21050489 PMCID: PMC2989323 DOI: 10.1186/1743-422x-7-302] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/04/2010] [Indexed: 12/17/2022] Open
Abstract
Background In Tunisia, country of intermediate endemicity for Hepatitis B virus (HBV) infection, most molecular studies on the virus have been carried out in the North of the country and little is known about other regions. The aim of this study was to determine HBV genotype and subgenotypes in Central-East Tunisia. A total of 217 HBs antigen positive patients were enrolled and determination of genotype was investigated in 130 patients with detectable HBV DNA. HBV genotyping methods were: PCR-RFLP on the pre-S region, a PCR using type-specific primers in the S region (TSP-PCR) and partial sequencing in the pre-S region. Results Three genotypes (D, B and A) were detected by the PCR-RFLP method and two (D and A) with the TSP-PCR method, the concordance between the two methods was 93%. Sequencing and phylogenetic analysis of 32 strains, retrieved the same genotype (D and A) for samples with concordant results and genotype D for samples with discordant results. The sequences of discordant genotypes had a restriction site in the pre-S gene which led to erroneous result by the PCR-RFLP method. Thus, prevalence of genotype D and A was 96% and 4%, respectively. Phylogenetic analysis showed the predominance of two subgenotypes D1 (55%) and D7 (41%). Only one strain clustered with D3 subgenotype (3%). Conclusions Predominance of subgenotype D7 appears to occur in northern regions of Africa with transition to subgenotype D1 in the East of the continent. HBV genetic variability may lead to wrong results in rapid genotyping methods and sequence analysis is needed to clarify atypical results.
Collapse
Affiliation(s)
- Naila Hannachi
- Laboratoire de Microbiologie-Immunologie, UR02SP13, Hôpital Farhat Hached, Sousse, Tunisia.
| | | | | | | | | | | | | | | |
Collapse
|