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Vasić SB, Svitlica BB, Milutinović D, Stevanović G, Maletić JS, Savić N, Aranđelović B, Ružić M. Factors predicting the level of vaccine protection against hepatitis B virus infection among physicians and nurses in Šabac, Serbia. Arh Hig Rada Toksikol 2024; 75:191-199. [PMID: 39369330 PMCID: PMC11456225 DOI: 10.2478/aiht-2024-75-3828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/01/2024] [Accepted: 09/01/2024] [Indexed: 10/07/2024] Open
Abstract
As healthcare workers run a high and constant occupational risk of hepatitis B virus (HBV) infection through exposure to biological material, vaccination is mandatory as well as the monitoring of antibody levels one to two months after complete immunisation. The aim of this descriptive cross-sectional study was to determine HBV vaccine coverage of 200 primary and secondary healthcare workers (100 each) from Šabac, Serbia and their blood anti-HBs titre. We also wanted to identify factors that could predict the titre. Anti-HBV vaccination covered all participants, of whom 89.5 % were fully vaccinated, and 85 % had a protective antibody titre. We found a statistically significant association between antibody titre and the number of received vaccine doses, chronic jaundice, autoimmune disease, and cancer in our participants. The fact that 15 % did not achieve the protective antibody titre confirms the necessity of its control after immunisation, which is not routinely carried out in most countries, Serbia included. It is, therefore, necessary to develop a detailed strategy for monitoring vaccination and serological status of healthcare workers in order to improve their safety at work. An important role should also be given to continuous education of healthcare workers from the beginning of schooling to the end of their professional career.
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Affiliation(s)
| | - Branislava Brestovački Svitlica
- University of Novi Sad Faculty of Medicine, Novi Sad, Serbia
- Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | | | - Goran Stevanović
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
- University Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Stojčević Maletić
- University of Novi Sad Faculty of Medicine, Novi Sad, Serbia
- University Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Nikola Savić
- Dr Miša Pantić Secondary School of Medicine, Valjevo, Serbia
- Singidunum Faculty of Health and Business Studies, Valjevo, Serbia
| | | | - Maja Ružić
- University of Novi Sad Faculty of Medicine, Novi Sad, Serbia
- University Clinical Centre of Vojvodina, Novi Sad, Serbia
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Basimane Bisimwa P, Koyaweda GW, Bihehe Masemo D, Ayagirwe RBB, Birindwa AB, Bisimwa PN, Kikuni Besulani G, Kashosi TM, Mugisho Matabishi C, Mitima Misuka B, Mukonkole JPM, Bisimwa Nachega J, Mukwege Mukengere D, Komas NPJ. High prevalence of hepatitis B and HIV among women survivors of sexual violence in South Kivu province, eastern Democratic Republic of Congo. PLoS One 2024; 19:e0292473. [PMID: 38959256 PMCID: PMC11221749 DOI: 10.1371/journal.pone.0292473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/08/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Limited data are available on the prevalence rates of hepatitis B and acquired immunodeficiency syndrome (AIDS) among women survivors of sexual violence (WSSV) in South Kivu province, in the eastern part of the Democratic Republic of Congo (DRC), where armed conflicts persist. Here, we aimed to assess the prevalence of these two infections in this vulnerable local population. METHODS A total of 1002 WSSV, aged from 18 to 70 years old were enrolled from May 2018 to May 2020 at three healthcare facilities (Panzi, Mulamba and Bulenga hospitals), which are called "The One-Stop Centre Care Model" for the management of sexual violence in South Kivu. Blood samples were collected and tested for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) antigens and antibodies using enzyme-linked immunoassay (ELISA) methods. Subsequently, viral load quantification for HBV and HIV were performed using the GeneXpert. Univariate and multivariate logistic regression models were used to assess factors associated with HIV-positive and HBV-positive status. RESULTS For HBV, overall prevalence was 8.9% (95% CI; 7.2-10.8%), 32.1% (95% CI; 29.3-35.0%), and 14.5% (95% CI; 12.3-16.8%) for HBsAg, anti-HBc and anti-HBs antibodies, respectively. Among the 89 HBsAg-positive patients, 17 (19.1%) were HBeAg-positive. The median age of individuals with a positive HBsAg test was higher than those with a negative test (median: 40 years (IQR 30-52) compared to 36 years (IQR 24-48)). Risk factors for HBV infection were age (≥35 years) (AOR = 1.83 [1.02-3.32]; p = 0.041), having no schooling (AOR = 4.14 [1.35-12.62]; p = 0.012) or only primary school-level (AOR = 4.88 [1.61-14.75]; p = 0.005), and multiple aggressors (AOR = 1.76 [1.09-2.84], p = 0.019). The prevalence of HIV was 4.3% [95% CI: 3.1-5.7%]. HIV/HBV co-infection occurred only in 5 individuals (0.5%). The HBV viral load was detectable (> 1 log10 UI/mL) in 61.8% of HBsAg-positive subjects and 64.8% HIV-positive subjects had a high viral load (≥ 3 log10 copies/mL). CONCLUSION This study revealed a high prevalence of HBV and HIV infections among WSSV in South Kivu. The results generated highlight the urgent need for systematic screening of HBV and HIV by integrating fourth-generation ELISA tests in HIV and HBV control programs.
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Affiliation(s)
- Parvine Basimane Bisimwa
- Viral Hepatitis Laboratory, Institut Pasteur de Bangui, Bangui, Central African Republic
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
- Molecular Biology Laboratory, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- International Center Advanced for Research and Training (ICART)/Panzi Fondation, Bukavu, Democratic Republic of Congo
| | | | - Dieudonné Bihehe Masemo
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
| | | | - Ahadi Bwihangane Birindwa
- Molecular Biology Laboratory, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
| | - Patrick Ntagereka Bisimwa
- Molecular Biology Laboratory, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
| | - Georges Kikuni Besulani
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
| | - Théophile Mitima Kashosi
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
| | | | - Bienfait Mitima Misuka
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
| | - Jean Paulin Mbo Mukonkole
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
| | - Jean Bisimwa Nachega
- Departments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, United States of America
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Denis Mukwege Mukengere
- Faculty of Medecine, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
- Panzi General Referral Hospital, Internal Medicine, Bukavu, Democratic Republic of Congo
- Molecular Biology Laboratory, Université Evangélique en Afrique (UEA), Bukavu, Democratic Republic of Congo
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Soumbara T, Bonnet C, Hamed CT, Veten F, Hemeyine M, Fall-Malick FZ, El Yezid MM, Diallo A, Mounah MM, Houmeida A. Genetic variation of TLR3 gene is associated with the outcome of hepatitis b infection in mauritanian patients: case control study. BMC Infect Dis 2024; 24:616. [PMID: 38907187 PMCID: PMC11191147 DOI: 10.1186/s12879-024-09503-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 06/12/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Toll-Like receptors (TLRs) play an important role in the immune response during hepatitis B virus (HBV) infection. In this study, we evaluated the association between two SNP variants (TLR3 rs3775290 and TLR4 rs4986790) and susceptibility to chronic HBV infection in Mauritania. SUBJECTS AND METHODS A total of 188 subjects were recruited for this study: 102 chronically infected patients and 86 individuals with spontaneously resolved HBV infection who were considered controls. Targeted PCR products were sequenced using Sanger sequencing. RESULTS We found that TLR3 rs3775290 was significantly more frequent in patients with chronic HBV than in the control population (p = 0.03). However, no association was found between the TLR4 rs3775290 polymorphism and chronic infection. CONCLUSION Our results suggest that the TLR3 rs3775290 polymorphism may be a risk factor for susceptibility to chronic HBV infection in the Mauritanian population.
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Affiliation(s)
- Tetou Soumbara
- Research Unit on Biomarkers in the Mauritanian Population, Faculty of Sciences and Technology, University of Nouakchott, Nouakchott, Mauritania
- National Institute of Hepato- Virology (INHV), Nouakchott, Mauritania
| | - Crystel Bonnet
- Institute of Hearing, Pasteur Institute, INSERM, Paris, 75012, France
| | | | - Fatimetou Veten
- National Institute of Hepato- Virology (INHV), Nouakchott, Mauritania
| | - Mohamed Hemeyine
- National Institute of Hepato- Virology (INHV), Nouakchott, Mauritania
| | | | | | - Aichetou Diallo
- National Institute of Hepato- Virology (INHV), Nouakchott, Mauritania
| | | | - Ahmed Houmeida
- Research Unit on Biomarkers in the Mauritanian Population, Faculty of Sciences and Technology, University of Nouakchott, Nouakchott, Mauritania.
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Chai Y, Tang J, Su Y, Xuan K, Xu L, Hao J, Lu Z, Wang B, Chen X, Luo X, He J, Zhu L. Hepatitis B antibody levels after different doses of hepatitis B vaccination: a retrospective study based on hospitalized children. Epidemiol Infect 2023; 151:e186. [PMID: 37881897 PMCID: PMC10644064 DOI: 10.1017/s0950268823001747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/24/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
Many studies have investigated the positivity rate of hepatitis B surface antibody (HBsAb) after hepatitis B vaccine (HepB) immunization. However, the antibody level, assessed monthly or at more frequent intervals after each of the three doses, particularly within the first year after birth, has not been previously reported. To elucidate the level of antibody formation at various times after vaccination, the current study used the available detection data of HBsAb in hospitalized children to analyze the HBsAb level after immunization combined with their vaccination history. Both the positivity rate and geometric mean concentration (GMC) increased sequentially with immunization doses, reaching their peaks earlier after the third dose than after the first two doses, and the rate of HBsAb positivity was able to reach 100% between 11 and 90 days after completing the three doses of HepB. Within one year after receiving the three doses, the antibody positivity rate and GMC were maintained above 90% and 100 mIU/mL, respectively, and subsequently steadily declined, reaching the lowest value in the 9th and 10th years. The current findings reveal, in more detail, the level of antibody formation at different times following each dose of HepB in hospitalized children, particularly in the age group up to one year after vaccination. For the subjects of this study, we prefer to believe that the proportion of HBsAb non-response should be less than 5% after full immunization with HepB, provided that the appropriate time for blood collection is chosen.
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Affiliation(s)
- Yu Chai
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Jihai Tang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Yin Su
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Kun Xuan
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Lili Xu
- Children’s Hospital of Fudan University Anhui Hospital, Heifei, China
| | - Jiayan Hao
- Children’s Hospital of Fudan University Anhui Hospital, Heifei, China
| | - Zhijian Lu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - BinBing Wang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Xia Chen
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Xianwei Luo
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Jiali He
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Lijuan Zhu
- Children’s Hospital of Fudan University Anhui Hospital, Heifei, China
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BEHZADIFAR MEYSAM, AZARI SAMAD, SHIRKHANI SOMAYEH, GHOLAMREZAEI SHIRIN, SHAHABI SAEED, DOSHMANGIR LEILA, EHSANZADEH SEYEDJAFAR, MARTINI MARIANO, BRAGAZZI NICOLALUIGI, BEHZADIFAR MASOUD. Hepatitis B vaccination in Iran: Historical policies and programs. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E618-E624. [PMID: 36891002 PMCID: PMC9986976 DOI: 10.15167/2421-4248/jpmh2022.63.4.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/29/2022] [Indexed: 03/10/2023]
Abstract
Hepatitis B virus (HBV) infection is a main challenge of the health system worldwide. Health policymakers in most countries attempt to help HBV patients by implementing support programs in addition to controlling HBV in their community so that the economic burden caused by HBV do not deprive the patients of accessing health services and reducing their quality of life. There are several health interventions for the prevention and control of HBV. Providing the first dose of the HBV vaccine within 24 hours after the infant is born is the most cost-effective way to prevent and control HBV. The purpose of this study is to review the nature of HBV, its epidemiology in Iran and worldwide, and to review the various policies and programs in Iran regarding the prevention and control of HBV, especially the use of vaccination. One of the goals of Sustainable Development Goals (SDGs) is to consider hepatitis as a threat to human health. In this regard, one of the top priorities of WHO is the prevention and control of HBV. In connection with the prevention of HBV, it is claimed that vaccination is the most effective and best intervention. Thus, vaccination in the safe's program of countries is highly recommended. According to the Ministry of Health and Medical Education (MOHME) reports, Iran has the lowest prevalence of HBV among the countries in Eastern Mediterranean Region Organization (EMRO). There is a hepatitis unit in MOHME whose responsibility is to coordinate and implement the hepatitis prevention and control programs. The HBV vaccine has been officially included in the vaccination program for children in Iran since 1993, and three doses of the vaccine are given to all infants. In 2007, during a large-scale program in Iran, 17-year-olds received the HBV vaccine, followed by adolescents born in 1990 and 1991. In recent years, the health system in Iran has made significant progress in preventing and controlling HBV. Over 95% coverage of the HBV vaccination is one of the achievements that have had a great impact on reducing the trend of HBV infection. In order to achieve the 2030 goals, the Iranian government, in addition to paying more attention to HBV elimination programs, should encourage other organizations to cooperate more effectively with MOHME.
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Affiliation(s)
- MEYSAM BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SAMAD AZARI
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - SOMAYEH SHIRKHANI
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SHIRIN GHOLAMREZAEI
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - LEILA DOSHMANGIR
- Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - SEYED JAFAR EHSANZADEH
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
- Correspondence: Masoud Behzadifar, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran. Lorestan University of Medical Sciences, Anooshirvan Rezaei Square, Khorramabad, Lorestan, Iran. Tel.: +98-066-33302033 - E-mail: ;
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Dahlén E, Collin J, Hellman J, Norman C, Nauclér P, Ternhag A. The effect of absent or deferred antibiotic treatment on complications of common infections in primary care. Int J Infect Dis 2022; 124:181-186. [DOI: 10.1016/j.ijid.2022.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/08/2022] [Accepted: 09/30/2022] [Indexed: 10/31/2022] Open
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Cai Y, Dai Z, Wen S, Bhandari R. Risk factors associated with infection of blood-borne virus among people who used methamphetamine. BMC Infect Dis 2020; 20:742. [PMID: 33036558 PMCID: PMC7547473 DOI: 10.1186/s12879-020-05464-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 09/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The surge of methamphetamine use has been a complicating factor compounding the steeply increasing number of drug overdose deaths in the U.S. Infection from blood-borne viruses including hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV, related to methamphetamine use continue to grow. This study aims to examine the risk factors associated with HBV, HCV and HIV among people who used methamphetamine. METHODS People who ever used methamphetamine were identified from five National Health and Nutrition Examination Survey (NHANES) cohorts, 2007 to 2016. The outcome was either positive or negative for blood-borne viruses as identified from laboratory tests. Weighted statistics for the combined ten years of data were calculated by multiplying the weighted variable for laboratory measurements by 0.2. We examined the association of sexual activities (sexual partners, sexual identity), drug use behaviors (poly-drug use, injection drug use, frequency of drug use, age started using methamphetamine), demographics, and socio-economic status with blood-borne viruses using bivariate and multivariable logistic regression models. RESULTS There were 1132 participants representing approximately 11,996,319 persons who ever used methamphetamine in the U.S. Blood-borne viruses' positive rate was 13.0 per 100,000. Multivariable logistic regression analyses showed significant associations of blood-borne infections with age 40-49 years (vs. age 20-29 years, adjusted odds ratio 4.77, 95% CI 1.11-20.55), age 50-59 years (vs. age 20-29 years, 10.25, 2.40-43.82), living within poverty index 1-1.9 (vs. poverty index > = 2, 2.55; 1.19-5.49), living below the poverty threshold (vs. poverty index > = 2, 2.55; 1.11-5.86), having lower than high school education (vs. equal or higher than high school education, 3.13; 1.51-6.46), sexual identity as other than heterosexual (vs. heterosexual, 5.60; 1.72-18.28), using methamphetamine and heroin and cocaine (vs. using methamphetamine alone, 4.24; 1.06-16.92), injection drug use (vs. no injection drug use, 3.15; 1.61-6.16), and started using methamphetamine at age above 25 (vs. started using methamphetamine at age between 10 and 17, 2.09; 1.01-4.35). CONCLUSIONS Among people who use methamphetamine, those who use polysubstance, or who inject substances, are in urgent need for vaccination and interventions to avoid further harm from blood borne infections.
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Affiliation(s)
- Yilin Cai
- Department of Biostatistics, School of Public Health, West Virginia University, One Medical Center Drive, Morgantown, WV, 26506, USA
| | - Zheng Dai
- Department of Epidemiology, School of Public Health, West Virginia University, One Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, One Medical Center Drive, Morgantown, WV, 26506, USA
| | - Ruchi Bhandari
- Department of Epidemiology, School of Public Health, West Virginia University, One Medical Center Drive, Morgantown, WV, 26506, USA
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Kushner T, Chen Z, Tressler S, Kaufman H, Feinberg J, Terrault NA. Trends in Hepatitis B Infection and Immunity Among Women of Childbearing Age in the United States. Clin Infect Dis 2020; 71:586-592. [PMID: 31504302 PMCID: PMC7384310 DOI: 10.1093/cid/ciz841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The current opioid injection drug use epidemic has been associated with an increase in hepatitis C virus infections among women of childbearing age in the United States, but changes in hepatitis B virus (HBV) infections have not been studied. METHODS A retrospective analysis of HBV statuses among women of childbearing age nationally and by state was conducted, utilizing the Quest Diagnostics database. Rates of HBV in women born before and after the implementation of universal HBV vaccination recommendations were determined. RESULTS We identified 8 871 965 women tested for HBV from 2011-2017. Nationally, the annual rate of acute HBV infections was stable, but rates increased in Kentucky, Alabama, and Indiana (P < .03). The national prevalence of new, chronic HBV diagnoses decreased significantly, from 0.83% in 2011 to 0.19% in 2017 (P < .0001), but increased in Mississippi, Kentucky, and West Virginia (P ≤ .05). A declining prevalence of HBV seroprotection was evident over time, especially within the birth-dose cohort (which dropped from 48.5% to 38.5%; P < .0001). CONCLUSIONS National rates of newly diagnosed acute and chronic HBV infections declined or were stable overall, but increased significantly in specific Appalachian states. The HBV vaccine is effective in decreasing infections, but seroprotection wanes over time. These trends in new infections may be related to increased injection drug use and highlight potential gaps in HBV vaccine protection.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhen Chen
- Quest Diagnostics, Secaucus, New Jersey, USA
| | - Stacy Tressler
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | | | - Judith Feinberg
- Departments of Behavioral Medicine & Psychiatry, Neuroscience and Medicine, Division of Infectious Diseases, West Virginia University, Morgantown, USA
| | - Norah A Terrault
- Division of Gastroenterology/Hepatology, University of Southern California, Los Angeles, USA
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