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OuYang S, Chen Z, Peng T, Geng Y, Qiu J, Xiao Z, Pan CQ. Incidence and predictors of elevated postpartum alanine aminotransferase in chronic hepatitis B mothers: a prospective study protocol. BMC Gastroenterol 2023; 23:387. [PMID: 37951866 PMCID: PMC10640741 DOI: 10.1186/s12876-023-02966-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/20/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The majority of HBeAg-positive mothers with chronic hepatitis B have high levels of viremia and inactive disease with normal alanine aminotransferase (ALT) during pregnancy. In addition, postpartum disease activation and ALT flare have been reported in the range of 15 - 35%. However, the current International Association Guidelines have not provided clear recommendations and a risk-stratified monitoring schedule. Furthermore, data are lacking on the definition of normal ALT in the postpartum period in mothers with chronic hepatitis B. The clinical features and ALT flare patterns in HBeAg-positive mothers versus HBeAg-negative mothers are not fully explored. Thus, we design a cohort study to investigate the aforementioned area and generate data to assist healthcare providers in better managing mothers with hepatitis B. We aim to assess the frequency of postpartum ALT flares and predictors for such events. METHOD This study is a single-center and prospective cohort study (n = 360) that consists of two groups of patients including HBsAg-positive mothers (n = 120) and healthy mothers without HBV infection (n = 240). In HBeAg-positive mothers, antiviral therapy during late pregnancy is permitted to prevent Mother-to-child transmission (MTCT) but discontinued at delivery if there is no further indication for the treatment. Mothers are enrolled at the gestational weeks of 12-24. After delivery, both mothers and their infants will be followed up until postpartum week 24. Clinical and laboratory data are collected every 4 weeks during the study except there are no follow-up visits at the postpartum weeks 16 and 20. The primary objective is the proportion of patients with postpartum ALT flares. The secondary objectives are independent risk factors during pregnancy for predicting postpartum ALT flares and the normal range of postpartum ALT levels in healthy mothers. DISCUSSION The current study focuses on the incidence of postpartum ALT flares in mothers with chronic hepatitis B including subgroup analysis based on HBeAg status. The data will have several clinical implications, such as providing evidence for an appropriate monitoring schedule in CHB mothers after delivery. Further analyses on predictors of such events may assist clinicians in identifying mothers who might develop severe postpartum ALT flares. The data generated from healthy mothers have the potential to identify the patterns of ALT changes during pregnancy and postpartum, so we can gain a better understanding of the normal range of ALT in this subpopulation. TRIAL REGISTRATION NUMBER AT THE CHINESE CLINICAL TRIAL REGISTRY ChiCTR2200061130.
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Affiliation(s)
- Shi OuYang
- Department of Infectious Diseases, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510799, China
| | - Ziren Chen
- Department of Infectious Diseases, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510799, China
| | - Tingting Peng
- Department of Infectious Diseases, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510799, China
| | - Yawen Geng
- Department of Infectious Diseases, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510799, China
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Junchao Qiu
- Department of Obstetrics, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhirong Xiao
- Department of Obstetrics, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Calvin Q Pan
- Department of Infectious Diseases, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510799, China.
- Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, USA.
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Nartey YA, Okine R, Seake-Kwawu A, Ghartey G, Asamoah YK, Senya K, Duah A, Owusu-Ofori A, Amugsi J, Suglo D, Bampoh SA, Hiebert L, Njuguna H, Ward JW, Plymoth A, Roberts LR, Bockarie AS, Awuku YA, Obiri-Yeboah D. A nationwide cross-sectional review of in-hospital hepatitis B virus testing and disease burden estimation in Ghana, 2016 - 2021. BMC Public Health 2022; 22:2149. [PMID: 36419017 PMCID: PMC9686031 DOI: 10.1186/s12889-022-14618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS Data are needed to inform hepatitis B virus (HBV) testing and treatment policies in Ghana to make progress towards achieving the 2030 WHO elimination targets. This study investigated testing patterns for HBV and described the age, sex, and region-specific prevalence of HBV infection in Ghana using hospital data. METHODS A nationwide multi-centre cross-sectional study was performed where hospital-based registers were reviewed. These included review of 139,966 laboratory, 169,048 blood bank, and 83,920 delivery register entries from 22 healthcare institutions in Ghana. Frequencies and proportions, and crude and pooled estimates reported. Chi squared test was used for tests of independence. Logistic regression was used to identify factors associated with a positive test result. RESULTS The crude HBsAg seroprevalence was 8.48% (95%CI 8.25-8.57%) with pooled estimate of 11.40% (95%CI 10.44-12.35). HBsAg seroprevalence among children under 5 years was 1.87% (95%CI 1.07-3.27) and highest age-specific seroprevalence was in those 40-49 years. The highest region-specific seroprevalences was in the Savannah (22.7%). Predictors of a positive HBsAg RDT test included female sex (OR 0.81 95% CI 0.74-0.88), and age (OR 1.005 95%CI 1.002-1.007). The proportion of parturient women receiving HBsAg testing increased between 2017 (87.2%) and 2020 (94.3%) (p < 0.001). The crude HBsAg seroprevalence in parturient women was 6.14% (95% CI 5.97-6.31). Among blood donors the crude HBsAg seroprevalence was 5.69% (95%CI 5.58-5.80). Data from 2 teaching hospitals indicated that in 2020, although 1500 HBsAg positive tests were recorded only 746 serological profile and 804 HBV DNA tests were performed. HBV e antigen seroprevalence was 6.28% (95%CI 4.73-7.84). CONCLUSION AND RECOMMENDATIONS Ghana remains a country with high HBV burden. There is an unequal distribution, with higher HBsAg seroprevalence in the north of the country. Furthermore, PCR testing is not widely available outside of large teaching hospitals, which limits diagnostic work-up. Hepatitis reporting systems and registers should be improved to facilitate data capture of indicators and standardised across the country to allow for comparability. Furthermore, where gains have been made in testing among pregnant women, there is a need for linkage to appropriate care.
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Affiliation(s)
- Yvonne Ayerki Nartey
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden ,Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Rafiq Okine
- World Health Organisation, Country Office, Accra, Ghana
| | - Atsu Seake-Kwawu
- grid.434994.70000 0001 0582 2706National Viral Hepatitis Control Program, Ghana Health Service, Accra, Ghana
| | - Georgia Ghartey
- grid.8652.90000 0004 1937 1485Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Ghana
| | - Yaw Karikari Asamoah
- grid.8652.90000 0004 1937 1485Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Ghana
| | - Kafui Senya
- World Health Organisation, Country Office, Accra, Ghana
| | - Amoako Duah
- grid.8652.90000 0004 1937 1485Department of Internal Medicine, University of Ghana Medical Centre, Accra, Ghana
| | - Alex Owusu-Ofori
- grid.415450.10000 0004 0466 0719Clinical Microbiology Unit, Komfo-Anokye Teaching Hospital, Kumasi, Ghana
| | - James Amugsi
- Internal Medicine and Out-patient Department, Sandema District Hospital, Sandema, Ghana
| | | | - Sally Afua Bampoh
- Department of Internal Medicine, Greater Accra Regional Hospital, Accra, Ghana
| | - Lindsey Hiebert
- grid.507439.c0000 0001 0104 6164Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA USA
| | - Henry Njuguna
- grid.507439.c0000 0001 0104 6164Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA USA
| | - John W. Ward
- grid.507439.c0000 0001 0104 6164Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA USA
| | - Amelie Plymoth
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Lewis Rowland Roberts
- grid.66875.3a0000 0004 0459 167XDepartment of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN USA
| | - Ansumana Sandy Bockarie
- grid.413081.f0000 0001 2322 8567Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Yaw Asante Awuku
- grid.449729.50000 0004 7707 5975Department of Medicine, University of Health and Allied Science, Ho, Ghana
| | - Dorcas Obiri-Yeboah
- grid.413081.f0000 0001 2322 8567Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Milanzi E, Mwapasa V, Joseph J, Jousset A, Tchereni T, Gunda A, Phiri J, Reece JC. Receipt of infant HIV DNA PCR test results is associated with a reduction in retention of HIV-exposed infants in integrated HIV care and healthcare services: a quantitative sub-study nested within a cluster randomised trial in rural Malawi. BMC Public Health 2020; 20:1879. [PMID: 33287772 PMCID: PMC7720620 DOI: 10.1186/s12889-020-09973-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Retention of HIV-infected mothers in integrated HIV and healthcare facilities is effective at reducing mother-to-child-transmission (MTCT) of HIV. In the context of Option B+, we examined maternal and HIV-exposed infant retention across three study arms to 18 months postpartum: mother-and-infant clinics (MIP), MIP with short-messaging service (MIP + SMS) and standard of care (SOC). In particular, we focused on the impact of mothers receiving an infant’s HIV PCR test result on maternal and infant study retention. Methods A quantitative sub-study nested within a cluster randomised trial undertaken between May 2013 and August 2016 across 30 healthcare facilities in rural Malawi enrolling HIV-infected pregnant mothers and HIV-exposed infants on delivery, was performed. Survival probabilities of maternal and HIV-exposed infant study retention was estimated using Kaplan-Meier curves. Associations between mother’s receiving an infant’s HIV test result and in particular, an infant’s HIV-positive result on maternal and infant study retention were modelled using time-varying multivariate Cox regression. Results Four hundred sixty-one, 493, and 396 HIV-infected women and 386, 399, and 300 HIV-exposed infants were enrolled across study arms; MIP, MIP + SMS and SOC, respectively. A total of 47.5% of mothers received their infant’s HIV test results < 5 months postpartum. Receiving an infant’s HIV result by mothers was associated with a 70% increase in infant non-retention in the study compared with not receiving an infant’s result (HR = 1.70; P-value< 0.001). Receiving a HIV-positive result was associated with 3.12 times reduced infant retention compared with a HIV-negative result (P-value< 0.001). Of the infants with a HIV-negative test result, 87% were breastfed at their final study follow-up. Conclusions Receiving an infant’s HIV test result was a driving factor for reduced infant study retention, especially an infant’s HIV-positive test result. As most HIV-negative infants were still breastfed at their last follow-up, this indicates a large proportion of HIV-exposed infants were potentially at future risk of MTCT of HIV via breastfeeding but were unlikely to undergo follow-up HIV testing after breastfeeding cessation. Future studies to identify and address underlying factors associated with infant HIV testing and reduced infant retention could potentially improve infant retention in HIV/healthcare facilities. Trial registration Pan African Clinical Trial Registry: PACTR201312000678196. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09973-y.
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Affiliation(s)
- Elasma Milanzi
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.,Victorian Centre for Biostatistics, Melbourne, Victoria, Australia
| | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jessica Joseph
- Clinton Health Access Initiative (CHAI), MA, Boston, USA
| | | | | | - Andrews Gunda
- Clinton Health Access Initiative (CHAI), Lilongwe, Malawi
| | - Jennipher Phiri
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Jeanette C Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia. .,The University of Melbourne Centre for Cancer Research, The University of Melbourne, Parkville, Victoria, Australia.
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Mekue LM, Nkenfou CN, Dambaya B, Fotso I, Nguefack F, Fainguem N, Lobè EE, Kuiaté JR, Ndjolo A. IMPLICATION OF FIVE AIDS RELATED GENES IN MOTHER-TO-CHILD TRANSMISSION AND ACQUISITION OF HUMAN IMMUNODEFICIENCY VIRUS 1 IN CAMEROON. Afr J Infect Dis 2018; 13:1-10. [PMID: 30596191 PMCID: PMC6305080 DOI: 10.21010/ajid.v13i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Genetic variants in the mother and/or infant have been described with evidence to be associated with mother-to-child transmission of HIV, but somehow with contradictory results depending on ethnic or geographic populations. We aimed at looking at the association between the allelic frequency of some genes with vertical transmission or acquisition of HIV in Cameroon. METHODOLOGY A total of 262 mothers (212 HIV-infected and 50 HIV non-infected) with their babies (270 in total, 42 HIV exposed-infected, 178 HIV exposed non-infected and 50 HIV non-exposed) were recruited in Yaounde-Cameroon. Their genotypes for CCR5-Delta32, CCR5 promoter59029A/G, CCR2-64I, SDF1-3'A and TRIM5α-136Q were analyzed using polymerase chain reaction and restriction fragment length polymorphisms. RESULTS Allelic frequencies were 14.7%, 41.9%, 9.5% and 14.7% for CCR2-64I, CCR5-59029-A/G, TRIM5α-136Q, SDF1-3'A respectively in the mothers and 18.8%, 35.9%, 11.3% and 20.5% in the babies. No delta 32 mutation in the CCR5 gene was found. The mutant genotype was most significantly frequent in the non-transmitter than in the transmitter (p= 0.005) for the SDF-1 3'A. SDF1-3'A [Odd ratio = 1.69; 95% confidence interval: 0.1158 to 0.7277); was associated to MTCT, P = 0.008.The homozygote mutants for the CCR5-59029-G were significantly higher in the infected than in the exposed uninfected babies (p=0.04). The mutations in the other genes were neither implicated in the acquisition nor in the transmission. CONCLUSION SDF1-3'A was associated to the reduction of MTCT. The CCR5-59029-A/G favored acquisition of HIV by babies. Our study showed that polymorphisms in chemokine ligand may be involved in MTCT.
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Affiliation(s)
- Linda Mouafo Mekue
- Faculty of Science, University of Dschang, P.O. Box 56, Dschang, Cameroon,Chantal BIYA International Reference Centre, P.O. Box 3077, Yaounde, Cameroon
| | - Céline Nguefeu Nkenfou
- Chantal BIYA International Reference Centre, P.O. Box 3077, Yaounde, Cameroon,Higher Teacher Training College, University of Yaounde I, P.O. Box 47, Yaounde, Cameroon,Corresponding Author’s E-mail:
| | - Beatrice Dambaya
- Chantal BIYA International Reference Centre, P.O. Box 3077, Yaounde, Cameroon
| | - Idriss Fotso
- Chantal BIYA International Reference Centre, P.O. Box 3077, Yaounde, Cameroon
| | - Felicitée Nguefack
- Chantal BIYA Foundation’ Mother and Child Center, P.O. Box 1936, Yaounde, Cameroon
| | - Nadine Fainguem
- Chantal BIYA International Reference Centre, P.O. Box 3077, Yaounde, Cameroon
| | - Elise Elong Lobè
- Chantal BIYA International Reference Centre, P.O. Box 3077, Yaounde, Cameroon
| | - Jules Roger Kuiaté
- Faculty of Science, University of Dschang, P.O. Box 56, Dschang, Cameroon
| | - Alexis Ndjolo
- Chantal BIYA International Reference Centre, P.O. Box 3077, Yaounde, Cameroon,Faculty of Medicine and Biomedical Science, University of Yaounde I, P.O Box 1364, Yaounde, Cameroon
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Brites C, Nóbrega I, Luz E, Travassos AG, Lorenzo C, Netto EM. Raltegravir versus lopinavir/ritonavir for treatment of HIV-infected late-presenting pregnant women. HIV Clin Trials 2018; 19:94-100. [PMID: 29629852 DOI: 10.1080/15284336.2018.1459343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Late-presenting pregnant women pose a challenge in the prevention of HIV-1 mother-to-child-transmission. We compared the safety and efficacy of raltegravir and lopinavir/ritonavir for this population. Methods We did a single-center, pilot, open-label, randomized trial in Brazil (N = 44). We randomly allocated late-presenting HIV-infected pregnant women (older than 18 years with a plasma HIV-1 RNA >1000 copies/mL) to receive raltegravir 400 mg twice a day or lopinavir/ritonavir 400/100 mg twice a day plus zidovudine and lamivudine (1:1). The primary endpoint was virological suppression at delivery (HIV-1 RNA <50 copies per mL), in all patients who received at least one dose of study drugs (modified intention-to-treat analysis). Missing information was treated as failure. We assessed safety in all patients. Results We enrolled and randomly assigned treatment to 33 patients (17 in raltegravir group) between June 2015 and June 2017. The study was interrupted by the IRB because a significant difference between arms was detected in an interim analysis. All patients completed follow up at delivery. At delivery, virological suppression was achieved by 13/17 (76.5%) of patients in raltegravir group, versus 4/16 (25.0%) in lopinavir/ritonavir group (RR 3.1, 95% CI: 1.3-7.4). Patients in raltegravir group had significantly higher proportion of virological suppression at 2, 4, and 6 weeks than lopinavir/ritonavir group. Adverse events were most of mild intensity, but patients in lopinavir/ritonavir group had significantly more gastrointestinal adverse events. There was neither discontinuation nor deaths in this trial. Conclusion Raltegravir might be a first-line option for treatment of HIV-infected late-presenting pregnant women.
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Affiliation(s)
- Carlos Brites
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil
| | - Isabella Nóbrega
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil.,b Secretaria de Saúde do Estado da Bahia , CEDAP - Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa , Salvador , Brazil
| | - Estela Luz
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil
| | - Ana Gabriela Travassos
- b Secretaria de Saúde do Estado da Bahia , CEDAP - Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa , Salvador , Brazil.,c School of Medicine , UNEB-Universidade do Estado da Bahia , Salvador , Brazil
| | - Cynthia Lorenzo
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil.,b Secretaria de Saúde do Estado da Bahia , CEDAP - Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa , Salvador , Brazil
| | - Eduardo M Netto
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil
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Ropero Álvarez AM, Pérez-Vilar S, Pacis-Tirso C, Contreras M, El Omeiri N, Ruiz-Matus C, Velandia-González M. Progress in vaccination towards hepatitis B control and elimination in the Region of the Americas. BMC Public Health 2017; 17:325. [PMID: 28415981 PMCID: PMC5392937 DOI: 10.1186/s12889-017-4227-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/05/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Over recent decades, the Region of the Americas has made significant progress towards hepatitis B elimination. We summarize the countries/territories' efforts in introducing and implementing hepatitis B (HB) vaccination and in evaluating its impact on HB virus seroprevalence. METHODS We collected information about HB vaccination schedules, coverage estimates, and year of vaccine introduction from countries/territories reporting to the Pan American Health Organization/World Health Organization (PAHO/WHO) through the WHO/UNICEF Joint Reporting Form on Immunization. We obtained additional information regarding countries/territories vaccination recommendations and strategies through communications with Expanded Program on Immunization (EPI) managers and national immunization survey reports. We identified vaccine impact studies conducted and published in the Americas. RESULTS As of October 2016, all 51 countries/territories have included infant HB vaccination in their official immunization schedule. Twenty countries, whose populations represent over 90% of the Region's births, have included nationwide newborn HB vaccination. We estimated at 89% and 75%, the regional three-dose series and the birth dose HB vaccination coverage, respectively, for 2015. The impact evaluations of infant HB immunization programs in the Region have shown substantial reductions in HB surface antigen (HBsAg) seroprevalence. CONCLUSION The achievements of vaccination programs in the Americas suggest that the elimination of perinatal and early childhood HB transmission could be feasible in the short-term. Moreover, the data gathered indicate that the Region may have already achieved the 2020 WHO goal for HB control.
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Affiliation(s)
- Alba Maria Ropero Álvarez
- Unit of Comprehensive Family Immunization. Department of Family, Gender and Life Course, Pan American Health Organization (PAHO/WHO), 525 23rd St. Nw, Washington DC, 20037 USA
| | - Silvia Pérez-Vilar
- Current address: U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA
| | - Carmelita Pacis-Tirso
- Unit of Comprehensive Family Immunization. Department of Family, Gender and Life Course, Pan American Health Organization (PAHO/WHO), 525 23rd St. Nw, Washington DC, 20037 USA
| | - Marcela Contreras
- Unit of Comprehensive Family Immunization. Department of Family, Gender and Life Course, Pan American Health Organization (PAHO/WHO), 525 23rd St. Nw, Washington DC, 20037 USA
| | - Nathalie El Omeiri
- Unit of Comprehensive Family Immunization. Department of Family, Gender and Life Course, Pan American Health Organization (PAHO/WHO), 525 23rd St. Nw, Washington DC, 20037 USA
| | - Cuauhtémoc Ruiz-Matus
- Unit of Comprehensive Family Immunization. Department of Family, Gender and Life Course, Pan American Health Organization (PAHO/WHO), 525 23rd St. Nw, Washington DC, 20037 USA
| | - Martha Velandia-González
- Unit of Comprehensive Family Immunization. Department of Family, Gender and Life Course, Pan American Health Organization (PAHO/WHO), 525 23rd St. Nw, Washington DC, 20037 USA
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Fujiko M, Chalid MT, Turyadi, Ie SI, Maghfira, Syafri, Wahyuni R, Roni M, Patellongi I, Massi MN, Muljono DH. Chronic hepatitis B in pregnant women: is hepatitis B surface antigen quantification useful for viral load prediction? Int J Infect Dis 2015; 41:83-9. [PMID: 26571304 DOI: 10.1016/j.ijid.2015.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/20/2015] [Accepted: 11/04/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND New cases of hepatitis B virus (HBV) infection continue to occur worldwide. Most of these are due to mother-to-child transmission (MTCT), with maternal viraemia as the most important contributing factor. The hepatitis B surface antigen (HBsAg) level, which correlates positively with viral load, has been used for treatment monitoring in chronic hepatitis B. This study evaluated the usefulness of quantitative HBsAg for viral load prediction in HBsAg-positive pregnant women. METHODS A total of 943 pregnant women in Makassar, Indonesia, were screened for HBsAg. Sixty-four women were HBsAg-positive and investigated. HBsAg level and hepatitis B e antigen (HBeAg)/hepatitis B e antibody (anti-HBe) status were determined serologically. Viral load was measured by real-time PCR. HBV DNA was sequenced and analysed for identification of genotype and basal core promoter (BCP)/precore (PC) mutations. RESULTS Of 64 subjects, 12 (18.8%) were HBeAg-positive and 52 (81.3%) were HBeAg-negative. HBsAg and HBV DNA levels were significantly higher in the HBeAg-positive group (p<0.001). HBsAg and HBV DNA levels were positively correlated in the HBeAg-positive group (r = 0.659; p=0.02), but not in the HBeAg-negative group (r=0.194; p=0.168). Low HBsAg levels (<3.0 log10 IU/ml) corresponded with HBV DNA levels<6.0 log10 IU/ml (r=0.404; p=0.001), a recognized threshold for MTCT. Genotype C was more prevalent than genotype B, but not associated with HBsAg level, viral load, or HBeAg status. Two-thirds of HBeAg-negative subjects with high HBV DNA levels harboured BCP (A1762T/G1764A) and/or PC (G1896A) variants. CONCLUSIONS HBsAg levels provide a good viral load predictor in HBeAg-positive but not HBeAg-negative pregnant women. The HBeAg-negative group had a frequent occurrence of BCP/PC variants, which may have contributed to the lack of correlation observed. Samples with a low HBsAg level, which is associated with a low risk of MTCT, do not require HBV DNA measurement.
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Affiliation(s)
- Masita Fujiko
- Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Maisuri T Chalid
- Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Turyadi
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Susan I Ie
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Maghfira
- Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Syafri
- Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Ridha Wahyuni
- Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Martono Roni
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | | | - M Nasrum Massi
- Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - David H Muljono
- Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia; Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat 10430, DKI Jakarta, Indonesia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
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