Hepatitis B and C: neglected diseases among health care workers in Cameroon

Cross-sectional hospital-based study on the seroprevalence of hepatitis B virus markers among healthcare workers, NWR, Cameroon

BACKGROUND

Hepatitis B virus (HBV) infection is a major public health issue worldwide, with about 257 million people reported to be chronic carriers by the WHO fact sheet updated in 2018. HBV can be contracted via direct contact with infected body fluid and infection is almost always asymptomatic. Although healthcare workers (HCWs) are at high risk of HBV infection, little is known about the prevalence of the various HBV markers among HCWs in Cameroon. The present study was taken to evaluate the prevalence of different HBV serological markers among HCWs in the North-West Region of Cameroon.

METHODS

This cross-sectional hospital-based study was carried out between April and September 2017 during which 395 HCWs were recruited. The serum of the HCWs were tested for the presence of HBV core antibody, hepatitis B surface antibody, hepatitis B e antibody and hepatitis B surface antigen using Monalisa ELISA kits produced by BIO-RAD laboratories. Data were analysed using SPSS V.20.0.

RESULTS

Among the 395 participants, 270 (68.4%) of them were females, 187 (47.3%) had been exposed to HBV, 145 (36.7%) had resolved the infection, 42 (10.6%) were current HBV carriers, 10 (2.5%) were infective, 36 (9.1%) were vaccinated and 172 (43.5%) were still susceptible. Exposure to HBV, past infection and susceptibility were significantly associated with age while the rate of vaccination was significantly associated with the job of the HCW in the health facilities.

CONCLUSION

The prevalence of HBV exposure and infection among HCWs obtained in this study was high while the level of vaccination in this at-risk population was low. Adequate steps should be taken to sensitise this population on HBV and the vaccination procedure.

Hepatitis B and C virus infection among healthcare workers in Africa: a systematic review and meta-analysis

BACKGROUND

Healthcare workers are at risk of acquiring hepatitis B and C virus infections through patients' blood and bodily fluids exposure. So far, there is no pooled data that shows the prevalence of HBV and HCV among health care workers in Africa. This study aimed to determine the pooled prevalence of hepatitis B and C infections among health care workers in Africa.

METHODS

Studies reporting the prevalence of HBV and HCV were identified from major databases and gray literature. PubMed, CINAHL, POPLINE, ScienceDirect, African Journals Online (AJOL), and Google Scholar were systematically searched to identify relevant studies. A random-effect model was used to estimate the pooled prevalence of hepatitis B and C among health care workers in Africa. The heterogeneity of studies was assessed using Cochran Q statistics and I2 tests. Publication bias was assessed using Begg's tests.

RESULT

In total, 1885 articles were retrieved, and 44 studies met the inclusion criteria and included in the final analysis. A total of 17,510 healthcare workers were included. The pooled prevalence of hepatitis B virus infection among health care workers in Africa is estimated to be 6.81% (95% CI 5.67-7.95) with a significant level of heterogeneity (I2 = 91.6%; p < 0.001). While the pooled prevalence of hepatitis C virus infection using the random-effects model was 5.58% (95% CI 3.55-7.61) with a significant level of heterogeneity (I2 = 95.1%; p < 0.001).

CONCLUSION

Overall, one in fifteen and more than one in twenty healthcare workers were infected by HBV and HCV, respectively. The high burden of HBV and HCV infections remains a significant problem among healthcare workers in Africa.

Vaccination status and prevalence of hepatitis B virus infection among health-care workers in a tertiary health institution, Enugu State, Nigeria

Background:

Hepatitis B virus (HBV) infection is a major global health concern. The prevalence among health-care workers (HCWs) is about 13% in Nigeria. Although the vaccine has been found to be effective in preventing infection in 90–95% of recipients, its uptake among HCW is low. The objective of this study was to determine the prevalence and vaccination status of HCW in a tertiary health facility in Southeast Nigeria.

Methods:

The study was conducted at Enugu State University Teaching Hospital (ESUTH) to mark the 2018 World Hepatitis Day. The HCWs were sensitised through handbills, posters, memo to the different departments and an awareness walk. HCWs who presented voluntarily were screened. Data were collected using a pro forma and analysed.

Results:

Out of the 1720 staff at ESUTH, 241 (14.0%) were screened; 33.2% were classified as clinical staff, 43.9% worked in clinical departments and 25.3% and 6.6% had been previously screened and vaccinated, respectively. Only 2.1% were positive for hepatitis B surface antigen. Previous screening for hepatitis B, working in clinical departments and being a core clinical health worker were factors that were significantly associated with previous vaccination status. Positive predictors included previous screening and working in clinical departments.

Conclusion/Recommendation:

This study revealed low HBV screening and vaccination uptake among HCWs in Enugu state University Teaching hospital, and also low disease prevalence. Though the prevalence of HBV infection was low, organising more awareness-raising activities in the facility will improve prevention and further reduce prevalence.

A Systematic Review and Meta-analysis on the Prevalence of HBsAg in Health Care Workers from Eastern Mediterranean and Middle Eastern Countries

BACKGROUND

The present study aimed to determine the prevalence of HBsAg in Health Care Workers (HCWs) in Eastern Mediterranean Region Office (EMRO) and Middle Eastern countries from 2000 to 2016.

METHODS

In a meta-analysis study, the databases of PubMed, ISI, Ovid, Scopus, Google Scholar, and Persian databases were searched for relevant articles on the prevalence of HBsAg in HCWs in EMRO and Middle Eastern countries. Homogeneity was assessed based on Cochran's Q-test results.

RESULTS

A total of 43 articles (110,179 people) were included. The pooled prevalence of HBsAg in HCWs of EMRO and Middle East countries was found 2.77% (95%CI: 2.64-2.83). The specific prevalence of HBsAg was 2.84% (95% CI: 2.6-3.11) in EMRO and 2.22% (95%CI: 2.13-2.31) in Middle Eastern countries. The highest and lowest prevalence rates of HBsAg among HCWs for countries with more than one study were 6.85% (95% CI: 5.74%-8.16%) in Sudan and 1.00% (95% CI: 0.94%-1.07%) in Turkey, respectively. The trends of HBsAg prevalence among HCWs decreased from 2000 to 2016.

CONCLUSIONS

Based on the World Health Organization classification of HBV prevalence, intermediate HBsAg prevalence rates were detected in HCWs of EMRO and Middle East countries during 2000-2016.

Prevalence and vaccination coverage of Hepatitis B among healthcare workers in Cameroon: A national seroprevalence survey

Hepatitis B virus (HBV) infection is hyperendemic in Cameroon, and healthcare workers (HCWs) are at high risk of infection. We aimed to assess prevalence, risk factors and vaccine coverage of HBV infection among HCWs in Cameroon. We conducted a cross-sectional study in 16 hospitals across all regions of Cameroon. HCWs were tested for HBV using rapid diagnostic tests (RDT). We collected data on socio-demographics and HBV vaccination status. We estimated prevalence of HBV and used Poisson regression models with robust standard errors to model the prevalence ratios of HBV positivity between covariates. We enrolled 1824 of 1836 eligible HCWs (97.5%). The mean age was 34 (SD: 10) years, 65.3% (n = 1787) were women, and 11.4% (n = 1747) had three or more doses of the HBV vaccine. Overall, we found a HBV prevalence of 8.7% (95% CI: 5.2%-14.3%). Patient transporters had the highest crude prevalence (14.3%; 95%CI: 5.4%-32.9%), whereas medical doctors had the lowest (3.2%; 95%CI: 0.8%-12.1%). The Far North Region had the highest prevalence of HBV (24.0%; 95%CI: 18.3%-30.8%). HBV prevalence decreased with increasing doses of the HBV vaccine (10.3% for no doses vs 3.5% for three or more doses; P < 0.001). In conclusion, approximately 1 in 12 HCWs in Cameroon have evidence of HBV infection, yet fewer than 1 in 6 have been fully vaccinated. Our results illustrate the urgent need to scale up systematic HBV screening and targeted vaccination of HCWs in the region.

Hepatitis B Virus (HBV) Infection and Re-activation During Nucleos(t)ide Reverse Transcriptase Inhibitor-Sparing Antiretroviral Therapy in a High-HBV Endemicity Setting

Background

We monitored the evolution of markers of hepatitis B virus (HBV) infection in virologically suppressed HIV-positive patients switching to nucleoside reverse transcriptase inhibitor (NRTI)–sparing antiretroviral therapy within a randomized trial in Cameroon.

Methods

 HBV surface antigen (HBsAg), HBV DNA, and antibodies against surface (anti-HBs), core (total anti-HBc), and e-antigen (anti-HBe) were measured retrospectively in samples collected at study entry and over 48 weeks after NRTI discontinuation.

Results

Participants (n = 80, 75% females) had a plasma HIV-1 RNA <60 copies/mL, a median CD4 count of 466 cells/mm³, and undetectable HBsAg and HBV DNA at study entry. After NRTI discontinuation, 3/20 (15.0%) anti-HBc-negative patients showed evidence indicative or suggestive of incident HBV infection (163 cases/1000 person-years); 6/60 (10.0%) anti-HBc-positive patients showed evidence indicative or suggestive of HBV reactivation (109 cases/1000 person-years). In one case of reactivation, anti-HBs increased from 14 to >1000 IU/L; sequencing showed HBV genotype A3 and 3 escape mutations in surface (Y100C, K122R, Y161FY). Alongside new-onset detection of HBsAg or HBV DNA, 1 patient experienced acute hepatitis and 6 patients experienced mild or marginal increases in serum transaminase levels.

Conclusions

Evolving treatment strategies for sub-Saharan Africa must be accompanied by the formulation and implementation of policy to guide appropriate assessment and management of HBV status.

A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review

Background: Stigma, poverty, and lack of knowledge present barriers to the diagnosis and treatment of chronic infection, especially in resource-limited settings. Chronic Hepatitis B virus (HBV) infection is frequently asymptomatic, but accounts for a substantial long-term burden of morbidity and mortality. In order to improve the success of diagnostic, treatment and preventive strategies, it is important to recognise, investigate and tackle stigma. We set out to assimilate evidence for the nature and impact of stigma associated with HBV infection, and to suggest ways to tackle this challenge. Methods: We carried out a literature search in PubMed using the search terms 'hepatitis B', 'stigma' to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa. Results: We identified a total of 32 articles, of which only two studies were conducted in Africa. Lack of knowledge of HBV was consistently identified, and in some settings there was no local word to describe HBV infection. There were misconceptions about HBV infection, transmission and treatment. Healthcare workers provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive measures. Stigma negatively impacted on help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment, and had potential negative impacts on mental health, wellbeing, employment and relationships. Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet we highlight a 'blind spot', representing a lack of data and limited recognition of this challenge. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma, and to inform collaborative efforts between patients, clinical services, policy makers, traditional healers, religious leaders, charity organisations and support groups.

Vaccine uptake and immune responses to HBV infection amongst vaccinated and non-vaccinated healthcare workers, household and sexual contacts to chronically infected HBV individuals in the South West Region of Cameroon

Background

HBV infection affects about 257 million people globally and Sub-Saharan Africa has the highest burden. The disease still constitutes a major public health problem despite the advent of preventive measures like the HBV vaccine. This study was aimed at identifying factors that influence vaccine uptake and the efficacy of administered vaccines among people at high risk of HBV infection.

Methods

This was a cross-sectional study conducted between January 2016 and December 2017. A pretested semi-structured questionnaire was used to capture information on sociodemographic and vaccination status from healthcare workers, household and sexual contacts to HBV infected people. HBV serological panel as well as quantitative anti-HBs ELISA test was done for all participants. Additional information was obtained from the institutions that administered the vaccines.

Results

A total of 265 participants with a mean age of 32.1±8.7 were enrolled. Eighty (30.2%) of them had received at least 1 dose of the HBV vaccine while 185 (69.8%) were unvaccinated. Healthcare workers were the most vaccinated (37%). Ignorance, negligence, fear of injection and the cost of the vaccine all contributed to poor vaccine uptake in the study population. Natural immunity was seen in 9 (3.4%) of the participants. Only 64.9% of the vaccinated participants attained the desirable level of anti-HBs (≥10mIU/ml) 1–2 months after ≥ 3 doses of the vaccine. Age, gender, obesity, alcohol and smoking were not significantly associated with poor immune responses. No standardized protocol was followed by the institutions administering the vaccine.

Conclusion

This study revealed very poor vaccine uptake and poor immune responses to the HBV vaccine in the study population and this should urge the health sector in Cameroon to intensify their sensitization on HBV vaccine, standardize the protocol for storing and administering the vaccine, subsidize the cost of the vaccine especially amongst healthcare workers and encourage anti-HBs post vaccination testing.

Seroprevalence of hepatitis C virus infection in Cameroon: a systematic review and meta-analysis

OBJECTIVE

Better knowledge of hepatitis C virus (HCV) seroprevalence at the national level can help to implement pertinent strategies to address the HCV-related burden. The aim of this paper was to estimate the seroprevalence of HCV infection in Cameroon.

DESIGN

Systematic review and meta-analysis.

PARTICIPANTS

People residing in Cameroon.

DATA SOURCES

Electronic databases including PubMed/MEDLINE, AJOL, WHO-Afro Library, Africa Index Medicus, National Institute of Statistics and National AIDS Control Committee, Cameroon from 1 January 2000 to 15 December 2016 were searched. English and French languages papers were considered. Two independent investigators selected studies. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale.

RESULTS

31 studies including 36 407 individuals were finally considered. There was no national representative study. The overall pooled prevalence was 6.5% (95% CI 4.5% to 8.8%; I²=98.3%). A sensitivity analysis of individuals at low risk of HCV infection showed a pooled prevalence of 3.6% (95% CI 2.3% to 5.2%, I²=97.7%, 18 studies) among 22 860 individuals (general population, blood donors and pregnant women), which was higher than for a high-risk population (healthcare workers and people with other identified comorbidities), 12.2% (95% CI 4.9% to 22.2%; I²=98.3%, 13 studies); p=0.018. The prevalence was higher in the East region, in rural settings, and when using an enzyme immunoassay technique for detecting HCV antibodies. Sex, sites, study period, sample size, timing of data collection and methodological quality of studies were not sources of heterogeneity.

LIMITATION

One-third of studies (29.0%) had a low risk bias in their methodology and most were facility-based (87.1%).

CONCLUSION

The seroprevalence of HCV infection in Cameroon indicates the need for comprehensive and effective strategies to interrupt HCV transmission in the Cameroonian population. Specific attention is needed for the East region of the country, rural settings and high-risk populations. A national representative study is needed to provide better estimates.

Hepatitis B virus seroprevalence among Malawian medical students: A cross-sectional study

BACKGROUND

Hepatitis B virus (HBV) predominantly spreads through contact with infected blood or other body fluids and causes liver disease. HBV vaccination for students at the College of Medicine, University of Malawi, is done without screening for the virus. It is important to assess the prevalence of HBV antigens among foundation-year students in order to consolidate evidence in support of HBV screening before vaccination. The aim of this study was to determine the seroprevalence of HBV antigens among 2013-2014 foundation-year students at the University of Malawi College of Medicine.

METHODS

A prospective cross-sectional descriptive study was conducted among 2013-2014 foundation year students at the Malawi College of Medicine. Out of the 234 foundation-year students, written consent was obtained from 89 students. Venous blood samples were collected and tested for HBV surface antigen using SD Bioline immunochromatographic rapid assays.

RESULTS

Out of the 62 (69.7%) male students, none tested HBV-positive, and out of 27 (30.3%) female students, none were seropositive. This suggested the absence of HBsAg among students or presence of HBsAg levels below detectable limits.

CONCLUSIONS

This study showed levels of HBsAg below detectable limits among healthy young adults in Malawi. HBV screening for medical students should further be assessed to ensure adequate protection before they are assigned clinical duties. These findings provide enough grounds to agitate for further surveys to support the establishment of a universal HBV immunisation programme in Malawi.

Seroprevalence of hepatitis B virus infection in Cameroon: a systematic review and meta-analysis

OBJECTIVE

Better knowledge of hepatitis B virus (HBV) infection prevalence at the national level can help to implement pertinent strategies to address HBV related burden. The aim was to estimate the seroprevalence of HBV infection in Cameroon.

DESIGN

Systematic review and meta-analysis.

PARTICIPANTS

People residing in Cameroon.

DATA SOURCES

Electronic databases including PubMed/MEDLINE, African Journals Online (AJOL), ScienceDirect, WHO-Afro Library, WHO-IRIS, African Index Medicus, National Institute of Statistics and National AIDS Control Committee, Cameroon; regardless of language and from 1 January 2000 to 30 September 2016. This was completed with a manual search of references of relevant papers. Risk of bias in methodology of studies was measured using the Newcastle-Ottawa Scale.

RESULTS

Out of 511 retrieved papers, 44 studies with a total of 105 603 individuals were finally included. The overall pooled seroprevalence was 11.2% (95% CI 9.7% to 12.8%) with high heterogeneity between studies (I²=97.9%). Egger's test showed no publication bias (p=0.167). A sensitivity analysis excluding individuals at high risk of HBV infection and after adjustment using trim and fill method showed a pooled seroprevalence of 10.6% (95% CI 8.6% to 12.6%) among 100 501 individuals (general population, blood donors and pregnant women). Sources of heterogeneity included geographical regions across country and setting (rural 13.3% vs urban 9.0%), and implementation of HBV universal immunisation (born after 9.2% vs born before 0.7%). Sex, site, timing of data collection, HBV screening tools and methodological quality of studies were not sources of heterogeneity.

LIMITATION

Only a third of the studies had low risk of bias in their methodology.

CONCLUSION

The seroprevalence of HBV infection in Cameroon is high. Effective strategies to interrupt the transmission of HBV are urgently required. Specific attention is needed for rural settings, certain regions and people born before the implementation of the HBV universal immunisation programme in Cameroon in 2005.

REGISTRATION

PROSPERO, CRD42016042654.

Low Coverage of Hepatitis B Vaccine and Determinants Among Health Professionals Working in Amhara Regional State Hospitals, Ethiopia

More than two billion people have been infected with hepatitis B virus (HBV), 360 million have chronic infection and 600,000 die each year from HBV-related liver disease or hepatocellular carcinoma. Each year more than 66,000 health professionals are infected by hepatitis b virus and vaccination against hepatitis B saves the life's of these health professionals. The aim of this study was to determine the prevalence and associated factors of hepatitis B vaccine coverage in a resource limited settings. A cross sectional study design was conducted. The study was conducted on 1184 health professionals at Amhara national regional state, Ethiopia. Simple random sampling technique was used. Structured questionnaire was used to collect the data. Descriptive statistics were used to identify the prevalence while Binary logistic regression was used to assess the determinants of hepatitis B vaccine coverage. The coverage of hepatitis B vaccine was 4%. Vaccination were affected by work load (AOR=0.19, 95%CI= 0.08-0.46; P<0.01), negligence (AOR=0.04, 95%CI=0.01-0.11: P<0.01), universal precaution training (AOR=14.75, 95%CI=5.66-38.44: P<0.01), perception that they are not at risk of infection (AOR=0.34, 95%CI=0.15-0.79: P=0.01), unaffordable cost (AOR=0.12, 95%CI=0.05-0.28: P<0.01), awareness about the vaccine (AOR=4.55, 95%CI=1.53-13.49: P<0.01), peer pressure (AOR=3.8, 95%CI=1.34-10.74: P=0.01), knowledge about where to get the vaccine (AOR=5.13, 95%CI=1.87-14.11: P=0.02), unavailability of the vaccine (AOR=0.25, 95%CI=0.1-0.63: P=0.03), year of experience (AOR=7.27, 95%CI=2.23-23.72: P<0.01). Low hepatitis B vaccine coverage was observed. The ministry of health should avail the vaccine to all those health professionals, develop awareness on HBV and improve the affordability of the vaccine.

Serological survey of hepatitis B immunity in healthcare workers in Catalonia (Spain)

Healthcare workers (HCW) are exposed to preventable infectious diseases, notably hepatitis B (HB). The aim of this study was to determine the immunity of HCW against hepatitis B. We made a seroprevalence study using a self-administered survey and obtained blood samples. Antibodies against the HB surface antigen (anti-HBs) and against the HB core antigen (anti-HBc) were studied. The odds ratio (OR) and 95% confidence intervals (CI) were calculated. The adjusted OR were calculated using logistic regression. Of the 644 HCW who participated (29.7% physicians, 38.7% nurses, 13.4% other clinical workers and 18.3% non-clinical workers), 46.4% were primary care workers and 53.6% hospital workers. The overall prevalence of anti-HBs was 64.4%. HCW aged <25 y had a significantly higher prevalence (86.7%) than those aged 35-44 y (adjusted OR 3.40; 95% CI 1.06-10.90). The prevalence of anti-HBc was 4.1%, and increased with age. Significant differences were found for HCW aged >44 y with respect to those aged 25-34 y. 75.6% of HCW stated they were vaccinated, but only 39.3% had a vaccination card. In HCW who stated they were unvaccinated, 10.8% had a vaccinated serological pattern (anti-HBc-negative and anti-HBs -positive). Written, updated vaccination records are essential to reliably determine the vaccination status.

A prominent role of Hepatitis D Virus in liver cancers documented in Central Africa

Background

Hepatocellular Carcinoma (HCC) is one of the commonest cancers in Central Africa, a region with the unusual peculiarity to be hyperendemic for infections with Hepatitis B, C and D viruses. However, data estimating the respective proportions of HCC cases attributable to these viruses are still limited in this area. The current study was undertaken to determine the role of these viruses in HCC compared to non-HCC Cameroonian patients.

Methods

A case–control study was conducted in the Gastroenterology Unit of Central Hospital of Yaounde in collaboration with Centre Pasteur of Cameroon. Blood samples of all HCC cases (n = 88) and matched control individuals without known liver disease (n = 85) were tested for serological markers of Hepatitis B, C and D viral infections using commercially available enzyme immune-assay kits. Hepatitis B and C viral loads were quantified for positive patients by real-time PCR using commercial kits.

Results

The mean age was 46.0 ± 18 and 42.1 ± 16 years old for HCC-patients and controls, respectively for a 2.3 Male/Female sex ratio. The prevalence of hepatitis B surface antigen, antibody to HCV and antibody to HDV were significantly higher in HCC patients (65.90, 20.26 and 26 % respectively) than in control patients (9.23, 4.62 and 1 %) (P < 2.5 10⁻⁵). The risk factors analysis showed that both HBV and HCV infections were strongly associated with HCC development in Cameroon with crude odds ratios of 15.98 (95 % CI 6.19-41.25) and 7.33 (95 % CI 2.09-25.77), respectively. Furthermore, the risk of developing HCC increased even more significantly in case of HBV and HDV co-infections with the odd ratio of 29.3 (95 % CI, 4.1-1231). HBV-DNA level was significantly higher in HBsAg-positive HCC-patients than in HBsAg-positive controls with (6.3 Log IU/mL and 5.7 Log IU/mL) respectively (P < 0.05).

Conclusion

HBV and HCV infections are the mains factors of HCC development in Cameroon. Our results show that patients co-infected with HDV are at very high risk to develop HCC. An active surveillance program of patients and, foremost, an easier access to antivirals and primary prevention measures are crucial steps to reduce the incidence of HCC in this country. Due to the lack of truly efficient antiviral therapy, the fate of HDV-infected patients remains, however, particularly worrying.

Hepatitis B, HIV, and Syphilis Seroprevalence in Pregnant Women and Blood Donors in Cameroon

Objectives. We estimated seroprevalence and correlates of selected infections in pregnant women and blood donors in a resource-limited setting. Methods. We performed a cross-sectional analysis of laboratory seroprevalence data from pregnant women and voluntary blood donors from facilities in Cameroon in 2014. Rapid tests were performed to detect hepatitis B surface antigen, syphilis treponemal antibodies, and HIV-1/2 antibodies. Blood donations were also tested for hepatitis C and malaria. Results. The seroprevalence rates and ranges among 7069 pregnant women were hepatitis B 4.4% (1.1–9.6%), HIV 6% (3.0–10.2%), and syphilis 1.7% (1.3–3.8%) with significant variability among the sites. Correlates of infection in pregnancy in adjusted regression models included urban residence for hepatitis B (aOR 2.9, CI 1.6–5.4) and HIV (aOR 3.5, CI 1.9–6.7). Blood donor seroprevalence rates and ranges were hepatitis B 6.8% (5.0–8.8%), HIV 2.2% (1.4–2.8%), syphilis 4% (3.3–4.5%), malaria 1.9%, and hepatitis C 1.7% (0.5–2.5%). Conclusions. Hepatitis B, HIV, and syphilis infections are common among pregnant women and blood donors in Cameroon with higher rates in urban areas. Future interventions to reduce vertical transmission should include universal screening for these infections early in pregnancy and provision of effective prevention tools including the birth dose of univalent hepatitis B vaccine.

Protecting health workers from nosocomial Hepatitis B infections: A review of strategies and challenges for implementation of Hepatitis B vaccination among health workers in Sub-Saharan Africa

The Sub-Saharan region has the highest Hepatitis B virus (HBV) rates, and health workers are at an increased risk of contracting nosocomial HBV infection. Vaccination of health workers plays a critical role in protecting them from sequelae of HBV; however, health-worker vaccination remains a challenge for many countries. This study was conducted to review practices/measures and challenges in the Sub-Saharan region relating to vaccination of health workers against HBV. We performed a literature review of articles addressing any aspect of HBV vaccination of health workers in the Sub-Saharan region sourced from PubMed, Embase, and Web of Science, including a case study of Malawi policies and strategies in training institutions and facilities. Our findings indicated that HBV awareness and vaccination were relatively high, but vaccination rates were lower, with 4.6–64.4% of those “ever vaccinated” completing the vaccination regimen. There was also great variation in the proportion of health workers exhibiting natural immunity from previous exposure (positive for anti-Hepatitis B core antibodies; 41–92%). Commonly cited reasons for non-uptake of vaccine included cost, lack of awareness of vaccine availability, and inadequate information concerning the vaccine. Countries in this region will require locally relevant data to develop cost-effective strategies that maximize the benefit to their health workers due to the great diversity of HBV epidemiology in the region.

Hepatitis B virus and hepatitis C virus infection in healthcare workers

Approximately 3 million healthcare workers per year receive an injury with an occupational instrument, with around 2000000 exposures to hepatitis B virus (HBV) and 1000000 to hepatitis C virus (HCV). Although an effective HBV vaccine has been available since the early eighties, and despite the worldwide application of universal vaccination programs started in the early nineties, HBV still remains a prominent agent of morbidity and mortality. There is no vaccine to limit the diffusion of HCV infection, which progresses to chronicity in the majority of cases and is a major cause of morbidity and mortality worldwide due to a chronic liver disease. Healthcare workers are frequently exposed by a mucosal-cutaneous or percutaneous route to accidental contact with human blood and other potentially infectious biological materials while carrying out their occupational duties. Mucosal-cutaneous exposure occurs when the biological material of a potentially infected patient accidentally comes in contact with the mucous membranes of the eyes or mouth or with the skin of a healthcare worker. Percutaneous exposure occurs when an operator accidentally injures himself with a sharp contaminated object, like a needle, blade or other sharp medical instrument. About 75% of the total occupational exposure is percutaneous and 25% mucosal-cutaneous, the risk of infecting a healthcare worker being higher in percutaneous than in mucosal-cutaneous exposure. All healthcare workers should be considered for HBV vaccination and should meticulously apply the universal prophylactic measures to prevent exposure to HBV and HCV.

Health care workers in Pearl River Delta Area of China are not vaccinated adequately against hepatitis B: a retrospective cohort study

BACKGROUNDS

Health-care workers' (HCWs) exposure to bodily fluids puts them at risk of hepatitis B virus HBV infection. This study investigated HBV vaccination practices and outcomes in HCWs and assessed postvaccination seroprotection across HCWs in different departments.

METHODS

A survey of HCWs in a Chinese public general hospital was carried out with a retrospective cohort of 1420 hospital HCWs (458 males and 962 females). HBV vaccination status (10-μg/dose used) was investigated in the cohort from vaccination records from the period of 1988 to 2008. Blood samples were collected and tested for hepatitis B surface antigen (HBsAg) and HBV antibodies (anti-HBs).

RESULTS

The overall vaccination (complete course) and HBsAg carrier rates among HCWs were 40.42 % (574/1420) and 6.13 % (87/1420), respectively. Vaccination rates differed by department, with HCWs in internal medicine (39.5 %) and emergency (42.0 %) departments having particularly low rates. The natural infection rate was 7.53 % (107/1420) among HCWs. HCWs in the department of infectious diseases (vaccination rate, 57.8 %) had the highest rate of antibody produced by natural infection (88.2 %).

CONCLUSION

The vaccination rate was a disappointingly low among HCWs in Pearl River Delta Area of China. HCWs working in infectious diseases departments and technicians were at particularly likely to have been infected with HBV. A concerted effort is needed to bring vaccination rates up among Chinese HCWs in Pearl River Delta Area of southern China.

The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial

OBJECTIVE

To examine the impact of providing rapid diagnostic tests for malaria on fever management in private drug retail shops where most poor rural people with fever present, with the aim of reducing current massive overdiagnosis and overtreatment of malaria.

DESIGN

Cluster randomized trial of 24 clusters of shops.

SETTING

Dangme West, a poor rural district of Ghana.

PARTICIPANTS

Shops and their clients, both adults and children.

INTERVENTIONS

Providing rapid diagnostic tests with realistic training.

MAIN OUTCOME MEASURES

The primary outcome was the proportion of clients testing negative for malaria by a double-read research blood slide who received an artemisinin combination therapy or other antimalarial. Secondary outcomes were use of antibiotics and antipyretics, and safety.

RESULTS

Of 4603 clients, 3424 (74.4%) tested negative by double-read research slides. The proportion of slide-negative clients who received any antimalarial was 590/1854 (32%) in the intervention arm and 1378/1570 (88%) in the control arm (adjusted risk ratio 0.41 (95% CI 0.29 to 0.58), P<0.0001). Treatment was in high agreement with rapid diagnostic test result. Of those who were slide-positive, 690/787 (87.8%) in the intervention arm and 347/392 (88.5%) in the control arm received an artemisinin combination therapy (adjusted risk ratio 0.96 (0.84 to 1.09)). There was no evidence of antibiotics being substituted for antimalarials. Overall, 1954/2641 (74%) clients in the intervention arm and 539/1962 (27%) in the control arm received appropriate treatment (adjusted risk ratio 2.39 (1.69 to 3.39), P<0.0001). No safety concerns were identified.

CONCLUSIONS

Most patients with fever in Africa present to the private sector. In this trial, providing rapid diagnostic tests for malaria in the private drug retail sector significantly reduced dispensing of antimalarials to patients without malaria, did not reduce prescribing of antimalarials to true malaria cases, and appeared safe. Rapid diagnostic tests should be considered for the informal private drug retail sector.Registration Clinicaltrials.gov NCT01907672.

Hepatitis B and C seroprevalence among health care workers in a tertiary hospital in Rwanda

Background

Hepatitis B (HBV) and hepatitis C (HCV) are significant global public health challenges with health care workers (HCWs) at especially high risk of exposure in resource-poor settings. We aimed to measure HBV and HCV prevalence, identify exposure risks and evaluate hepatitis-related knowledge amongst Rwandan tertiary hospital HCWs.

Methods

A cross sectional study involving tertiary hospital employees was conducted from October to December 2013. A pre-coded questionnaire was used to collect data on HCWs' socio-demographics, risk factors and knowledge of blood-borne infection prevention. Blood samples were drawn and screened for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies.

Results

Among 378 consenting HCWs, the prevalence of HBsAg positivity was 2.9% (11/378; 95% CI: 1.9 to 4.6%) and anti-HCV positivity 1.3% (5/378; 95% CI: 0.7 to 2.7%). Occupational exposure to blood was reported in 57.1% (216/378). Of the 17 participants (4.5%; 17/378) who reported having received the HBV vaccine, only 3 participants (0.8%) had received the three-dose vaccination course. Only 42 HCWs (42/378; 11.1%) were aware that a HBV vaccine was available. Most HCW (95.2%; 360/378) reported having been tested for HIV in the last 6 months.

Conclusions

Despite their high workplace exposure risk, HBV and HCV sero-prevalence rates among HCWs were low. The low HBV vaccination coverage and poor knowledge of preventative measures among HCWs suggest low levels of viral hepatitis awareness despite this high exposure.

Hepatitis B and C status among health care workers in the five main hospitals in eastern Libya

The aim of the present study was to determine the frequency of hepatitis B and C transmission to health care workers (HCWs) in five major hospitals in eastern Libya and to analyze how the risk of these infections are affected by the type of occupation, hospital work place and working period. From July 2008 to June 2009, 601 HCWs (mean age: 32.90 ± 8.85 years) were tested for HBV and HCV markers using ELISA techniques. Polymerase chain reaction (PCR) was performed on all positive samples of HBsAg and Anti-HCV antibody to determine the level of HBV-DNA and HCV-RNA viremia, respectively. The overall frequency of HBsAg positivity was 1.8%. Anti-HBc, HBeAg and Anti-HBe antibodies were found in 8.5%, 0.7% and 8.0% of samples, respectively. The HBV-DNA level was positive in 55% of all HBsAg-positive samples. Approximately half of the HCWs (51.4%) were Anti-HBs antibody positive. The overall positivity rate of Anti-HCV antibodies was 2.0%, and HCV-RNA was positive in 33.3% of these samples. Overall, 52% of HCWs reported receiving full vaccination doses (three doses) against HBV infection. Among them, anti-HBs positivity was approximately 98.0%. 3.9% of those who never received any HBV vaccination dose were HBsAg positive, compared to 1.3% HBsAg positive in those HCWs who had received one or two doses of hepatitis B vaccine (p=0.01 for all comparisons). Nurses and nurse-aides had the highest rates of both HBsAg and Anti-HCV among the studied HCWs (HBsAg: 2.1% and 3.2%; Anti-HCV: 3.2% and 4.9%, respectively). It is noteworthy that doctors also had a relatively high prevalence rate of Anti-HCV (2.2%). Obstetric wards, isolation room, dialysis units and dentist work places had higher frequencies of HBV. HCV was found to be higher in the medical and surgical wards (the prevalence varied between 3% and 5.6%). There was no significant difference between HBsAg status and the work period of HCWs. In conclusion, universal precautions should be applied for the care of all patients by all HCWs. Further, HBV vaccines should be more readily available for Libyan HCWs by reinforcing current vaccination programs.