Public health measures in the control of viral hepatitis: a World Health Organization perspective for the next millennium

Hepatitis C virus antibodies are absent among high risk group of health care workers in Damascus Hospital

BACKGROUND AND STUDY AIMS

Liver disease caused by hepatitis C virus (HCV) is one of the most serious health issues worldwide. The prevalence of HCV among health care workers (HCWs) is higher than normal population. Our aim is to determine the seroprevalence of HCV among this high-risk group in Damascus Hospital, Syria in 2016.

SUBJECTS AND METHODS

During March 2016, anonymous testing for HCV was offered to 150 residents and physicians from different departments (Surgery, otolaryngology, gastroenterology, anaesthesiology and laboratory) in Damascus Hospital using fourth-generation enzyme-linked immunosorbent assay (ELISA). In addition, each participant was interviewed and answered a comprehensive questionnaire which includes questions on potential hazards, risk factors and the level of awareness about the disease and its ways of transmission.

RESULTS

Surprisingly, all samples tested negative for anti-HCV antibodies, though many participants were already exposed to many risk factors especially as HCWs.

CONCLUSION

HCV is not a main issue regarding its prevalence among HCWs in Damascus Hospital. Nevertheless, it is still necessary to develop a mandatory well-organized program to increase the awareness among HCWs and develop stricter prevention policies especially about bloodborne diseases transmitted occupationally.

Seroprevalence of hepatitis B and C virus infections among health students and health care workers in the Najran region, southwestern Saudi Arabia: the need for national guidelines for health students

Background

The objectives of the study were to study the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among health college students (HS) and health care workers (HCWs) in the Najran Region of south-western Saudi Arabia and to study the students’ knowledge of occupational exposure to blood-borne viral infections.

Methods

A cross-sectional study of a representative sample of 300 HS and 300 HCWs was conducted.

Results

An overall seroprevalence of HBV of 1.7% and 8.7% was found among HS and HCWs, respectively. Two-thirds of HS (66.7%, 200) and 23.3% (70) of HCWs lack anti-HBs and are susceptible to HBV infection. An overall seroprevalence of HCV of 0% and 0.3% was found among the HS and HCWs, respectively. The present study indicates poor knowledge among HS and moderate knowledge among HCWs regarding occupationally transmitted blood-borne diseases, safe injection practices, and standard precautions to prevent occupationally transmitted blood-borne infections.

Conclusion

It is mandatory to develop a structured program to raise awareness among HS, and current health colleges’ curricula should be upgraded to address these issues early. The HS should be considered new recruits to health services in terms of their initial screening for blood-borne infections and vaccination against HBV. The development of a novel continuing medical education and pre-employment awareness program for HCWs is recommended to address the following: blood-borne diseases transmitted occupationally, standard precautions to prevent occupationally transmitted blood borne infections, and safe injection practices.

Behavior and major barriers faced by non-injectable drug users with HBV/HCV seeking treatment for hepatitis and drug addiction in Rio de Janeiro, Brazil

Drug users (DU) are a marginalized group and at risk for viral hepatitis, who seldom access health services. A cross-sectional survey was conducted with 111 DU with chronic HBV/HCV and 15 in-depth interviews with health professionals/policymakers in Rio de Janeiro, Brazil. Most interviewees were male, non-white, with a low educational background, unemployed and/or living on less than $245 a month (minimun wage). In the last 6 months, 61.8% of interviewees snorted cocaine, 64.7% at least once a week. Half of the interviewees had a stable partner and 38.3% of those with occasional partners never/almost never using condoms. Addiction treatment seeking was found to be associated with: being white (OR:5.5), high-school degree (OR:8.7), and employment (OR:5.7). Hepatitis treatment seeking was high (80.9%), and access to low-threshold, user-friendly health services was key for treatment seeking behaviors (OR:3.6). Missed opportunities for hepatitis treatment seem to be associated with structural (uneven political/financial support to hepatitis programs) and patient-related barriers (severe addiction and non-adherence). Those most in need were less likely to access treatment, calling for renewed strategies, in order to curb hepatitis among impoverished drug users and their sexual partners.

Distribution of Hepatitis B virus genotypes among healthy blood donors in eastern part of North India

AIM

We evaluated the distribution HBV genotypes among non-remunerated healthy blood donors in eastern North India.

MATERIALS AND METHODS

During screening of donated blood, 176 consecutive HBsAg positive, samples comprised the study. HBV-DNA was quantitative detected in 150 samples by PCR. HBV genotype was determined by identifying genotype-specific DNA band using nested PCR.

RESULTS

Majorities were of age group 31-40 yrs (65.3%). Males (92.7%) outnumbered females (7.3%) and were HbeAg-negative HBsAg carriers. Over all, genotype-A was the most prevalent (54%) followed by D (21.3%). We did not find genotype-G and H. Districts under study, divided into four zones: Zone-I genotype-A was most common (62.3%) followed by D (18.8%); Zone-II genotype-C (41.2%) was more frequent followed by D (20.6% and A (17.7%). Zone-III in adjoining Bihar state close to Zone-I, A was more prevalent (81.8%) followed by B and C (9.1%). In Zone-IV adjoining Zone- II had genotype-A (100%) only. Genotype-D had more sporadic distribution. Genotype-E and F were prevalent in Zone I and II (3/150, 2%).

CONCLUSIONS

Among blood donors HBV genotype-A followed by D was the most prevalent in eastern North India. Genotype-A had pattern of distribution signifying common focus, while D was more sporadic and C had single large pocket (Zone-II) probably common focus but restricting to particular area. Evidences are suggestive of association of HBV genotype in liver dysfunction. An effective treatment and preventive strategies based of genotypes will reduce the disease burden and increase the blood safety.

Prevalence of hepatitis A virus infection in Afro-Brazilian isolated communities in Central Brazil

To investigate hepatitis A virus (HAV) infection rates among isolated African-descendant communities in Central Brazil, 947 subjects were interviewed about demographic characteristics in all 12 isolated Afro-descendant communities existing in the state of Mato Grosso do Sul, Central Brazil, between March 2002 and November 2003. Blood samples were collected and sera were tested for HAV antibodies (total and IgM anti-HAV) by enzyme-linked immunosorbent assay. The overall prevalence of HAV infection was 75.6% (95% CI: 72.7-78.3), ranging from 55.4 to 97.3%, depending on the communities studied. The prevalence of anti-HAV increased significantly with age, from 13.8% in the age 0-5 age group to 96.6% in those older than 40 years. The findings point out an intermediate endemicity of HAV infection in some Afro-Brazilian isolated communities in Central Brazil. In addition, the high proportion of susceptible young subjects could be target of future HAV vaccination programs.

Community-based epidemiology of hepatitis B virus infection in West Bengal, India: prevalence of hepatitis B e antigen-negative infection and associated viral variants

BACKGROUND AND AIMS

There is a paucity of population-based epidemiological information regarding hepatitis B virus (HBV) infection in India. The present study was planned to outline the magnitude and pattern of HBV infection, hepatitis B e antigen (HBeAg)-negative infection and the associated viral mutants in India.

METHODS

A community-based epidemiological study of HBV infection was carried out in West Bengal, India. Serological markers of infection and potential risk factors for HBV transmission were determined. Among the infected individuals, HBV-DNA, genotypes and mutations in the precore (PC) stop codon and basal core promoter (BCP) regions were determined by DNA sequencing and polymerase chain reaction (PCR) restriction fragment length polymorphism methods.

RESULTS

Of the 7653 people included in the study, 227 (2.97%) tested positive for hepatitis B surface antigen (HBsAg), of whom 204 (90%) were HBeAg-negative and hepatitis B e antibody (anti-HBe)-positive, and 78% had normal alanine aminotransferase (ALT) levels. HBV-DNA could be detected by PCR in only 32% of people. G1896A PC stop codon mutants were present in 12% of people, BCP mutants in 18% and the remainder (70%) of the HBeAg-negative infections were associated with wild type sequences in these regions.

CONCLUSIONS

This first general population-based epidemiological study of HBV infection from India suggests that HBV acquisition starts in early childhood and peaks in adulthood. Most infections in the community are e-negative and inactive. The point prevalence of PC stop codon and BCP mutants is low in this primarily inactive and asymptomatic HBV-infected population sample in eastern India.

Intravascular immune surveillance by CXCR6+ NKT cells patrolling liver sinusoids

We examined the in vivo behavior of liver natural killer T cells (NKT cells) by intravital fluorescence microscopic imaging of mice in which a green fluorescent protein cDNA was used to replace the gene encoding the chemokine receptor CXCR6. NKT cells, which account for most CXCR6(+) cells in liver, were found to crawl within hepatic sinusoids at 10-20 microm/min and to stop upon T cell antigen receptor activation. CXCR6-deficient mice exhibited a selective and severe reduction of CD1d-reactive NKT cells in the liver and decreased susceptibility to T-cell-dependent hepatitis. CXCL16, the cell surface ligand for CXCR6, is expressed on sinusoidal endothelial cells, and CXCR6 deficiency resulted in reduced survival, but not in altered speed or pattern of patrolling of NKT cells. Thus, NKT cells patrol liver sinusoids to provide intravascular immune surveillance, and CXCR6 contributes to liver-based immune responses by regulating their abundance.

Hepatitis A and B seropositivity among medical students

OBJECTIVE

Health science students are commonly exposed to some infectious agents, including hepatitis A virus (HAV) and hepatitis B virus (HBV), which may cause substantial morbidity and even deaths. The identification of prevalence and risk factors is essential for implementing efficacious preventive measures. A serological survey was performed among medical students of Adnan Menderes University Medical Faculty to determine the prevalence of antibodies against HAV and HBV, and, as a secondary objective, to determine risk factors for acquisition of these infections.

METHODS

Nearly all students were included in the study. All participants completed a structured questionnaire that assessed demographic and socio-economic characteristics. Anti-HAV IgG, anti-HBc IgG, HbsAg and anti-HBs were tested using commercially available Elisa kits.

RESULTS

A total of 247 students, 146 (59.1%) male and 101 (40.9%) female, were included in the study. The prevalence of anti-HAV IgG was detected as 64%. Number of siblings and place of residence were detected as independent factors affecting the anti-HAV seropositivity. The prevalence of anti-HBc IgG was detected as 7.3%. Among the students positive for anti-HBc IgG, 5 (2%) students were HBsAg positive and the other 13 (5.3%) were anti-HBs positive. HBV infection in household members, risky sexual behaviour and vaccination were independent factors affecting the prevalence of anti-HBc IgG positivity.

CONCLUSIONS

The high susceptibility of medical students and their increased risk of clinical HAV and HBV infection identify a need for primary prevention through the administration of vaccination in this group in western Turkey.