Epidemiology,
Transmission, and Prevention Issues
H. J. Guerrero; W. Gosbee; C. Fullmer
Problem:
Seventy percent of all Hepatitis C Virus (HCV) positive
individuals are unaware that they are infected. The Hepatitis C Virus (HCV) is
four times more prevalent than HIV. It is estimated that 4-5 million people are
living with HCV in the
In 2007, the St. Luke’s Texas Liver Coalition
performed 1,500 screenings at a total of 18 health fairs and Town Hall-style
community lectures. The return results were a 2.7% positive rate.
New
Approach:
In response we decided we needed to approach screening
in a more effective way. Through extensive research, The Texas Liver Coalition
piloted a way to increase the percent positive rate through partnerships in the
HIV and recovery communities as well as community-based clinics. We began by
inviting community based organizations and clinics to a dinner and talk on
hepatitis C to educate them and let them know about our services (Liver Line,
free screening and
Results:
Through partnerships with community-based
organizations we were able to increase our screening percent positive rate from
2.7% to 37%. We have identified a methodology that leverages the best practices
forged through the HIV community.
Conclusions:
Utilizing this method of partnership with community
based organizations the liver disease community can now offer free screenings
in clinics, recovery centers, HIV community organizations or even
941.
Perception of Chronic Hepatitis B in Asian Communities of the
D. Salinas-Garcia; M. C. Conti; H. Tang
Background:
Chronic hepatitis B (
Method:
Computer aided in-language
telephone interviews were conducted using a structured questionnaire. A total
of 600 surveys were conducted. Key participation criteria include:
self-identified as Chinese, Korean or Vietnamese; age between18-65; first
generation immigrants or, if born in US, able to read or write native language
“natively” or “very well”.
Results:
Overall Hepatitis B (HBV) awareness is high but not a
top of mind disease: HBV specific unaided mention is below 20% and it ranks
under diabetes (43%), hypertension (40%) and cancer (21%). The great majority
agrees that hepatitis B has serious consequences and requires attention (80%
agree that
Conclusion:
The overall awareness of the disease is relatively
high among Asians living in the
936. Hepatitis B
Seroprevalence and Disease Characteristics in Asian Immigrants
M. K. Dhamija; S. S. Wong; A. Bartram; F. Siqueira; T. J. Layden; S.
Cotler
Chronic hepatitis B virus (HBV) infection is prevalent
in Asian immigrants, affecting 9%-15% who were self-selected for screening (Hepatology
2007;46:1034-40; MMWR 2006;55:505-9). The aim of this
study was to evaluate the seroprevalence and to characterize HBV in patients
who presented to a large
Methods:
Records were reviewed from 4,671 adult patients who
had at least one office visit from 1/06-12/07. Data collection consisted of
demographic information and laboratories including HBsAg, HBeAg,
With regard to HBeAg- patients, 23% (19/84) with
virologic data had HBV
Conclusions:
The HBsAg seroprevalence of Asian immigrants
presenting for general medical care was quite high (11%) and was greater in
patients under age 50. A majority (73%) of HBsAg+ patients were HBeAg-.
Although only one measurement was available, 59% of HBeAg+ cases and 17% of
HBeAg- cases had both HBV
853. Estimated Prevalence of Chronic
Hepatitis B (
S. Welch; B. Chiang; P.
Shadday; C. L. Brosgart
Background:
Centers for Disease Control (CDC) report that <0.5%
of the
Methods:
US Census data were used to estimate the number of FB
persons from 93 countries/regions living in the
Results:
The number of FB with
Conclusions:
The number of FB living with
Prevalence
of foreign-born
E.
Wiseman; M. A. Fraser; S. Holden; A. L. Glass; B. Kidson; L. G. Heron; M.
Maley; A. Ayres; S. Locarnini; M. Levy
Introduction:
Infants born to
women who have replicating hepatitis B virus (HBV) infection have up to a 90%
risk of perinatal transmission if left untreated. Passive-active immunoprophylaxis,
with hepatitis B immunoglobulin (HBIG) and hepatitis B vaccination, reduces the
risk but does not remove it. Data from overseas cohorts report transmission
rates varying from 2-27% despite passive-active immune prophylaxis.
Aim:
To determine the rate
of HBV perinatal transmission in an Australian setting and to identify maternal
virological factors that are associated with greatest risk of transmission.
Patients and
Methods:
HBsAg positive
pregnant women were identified during antenatal screening. Eighty-seven of 298
(29.2%) HBsAg positive women were HBeAg positive and 202 (67.8%) HBV
Results:
Three cases of
transmission were identified. All 3 mothers had very high HBV
Conclusion:
In this cohort, HBV
perinatal transmission was restricted to HBeAg positive mothers with very high
HBV
839. Identifying
Transmission Pairs in Hepatitis B Source and Contact Tracing: Agreement of
epidemiological and phylogenetic analysis in the multi-ethnic community of
I. K. Veldhuijzen; T. H. Mes; M. C. Mostert; H. G. Niesters; S. D. Pas; J. J. Voermans; R. A. De Man; H. M. Götz; G. J. van Doornum; J. Richardus
Molecular and
epidemiological data typically give different types of information on the
transmission of hepatitis B virus (HBV). Because both types of information are
important for public health, the congruence of HBV sequence and epidemiological
data from acutely and chronically infected patients seen at the Municipal
Public Health Service in
Results:
HBV genotypes of 62
acute and 347 chronic HBV patients indicated that the acute infections were
predominantly with an endemic genotype (A2; 52%) and a non-endemic genotype (D;
32%). Chronic HBV infections largely involved non-endemic genotypes (A1, B, C,
D and E). Interestingly, while genotype A2 was least variable, which is
consistent with a frequent exchange of HBV in the homosexual community,
genotype D comprised multiple divergent groups of closely related sequences.
Forty (65%) of the 62 acute patients were included in clusters with identical
sequences, of which more than half (22) in a large cluster of genotype A2. In
total 15 clusters including 93 patients (range 2-39 patients per cluster) with
identical sequences were identified. Six of these clusters included
epidemiological transmission pairs. Epidemiological transmission pairs differed
greatly in the level of molecular support. Of 22 epidemiological clusters, six
could be refuted (three harbored multiple genotypes, three conflicted with the
epidemiological data in constrained analyses), four clusters received support
from the molecular analysis and the support for the remaining 12 was ambiguous.
Two of the four epidemiological pairs that also received molecular support had
diverged considerably (3 and 15 mutations respectively). This shows that levels
of divergence cannot be simply used as an indicator of the likelihood that
groups of sequences constitute transmission pairs. Instead, it is necessary to
assess the likelihood of a common origin of individuals in supposed
transmission groups given the variation in the local community.
Conclusion:
The combined
approach of source and contact tracing and molecular epidemiology provides
insight in the HBV transmission routes in a multi-ethnic community and allows a
refinement of the identification of transmission pairs.
G. Woo; M. Sherman; E.
Heathcote; M. Krahn
Background:
Over 400,000 individuals worldwide are infected with the hepatitis B
virus. Chronic hepatitis B (
Purpose:
To assess the health utility values and HRQOL of patients infected with
hepatitis B attending tertiary care centers in downtown
Methods: A convenience sample of individuals was approached during follow-up
visits in two downtown
Results:
Two hundred and sixty-eight patients, 195 patients with
Conclusion:
The data suggests that there is no significant difference in the HRQOL
between individuals infected with the hepatitis B virus in comparison to
population norms. The analysis suggests that there is a decline in HRQOL when
comparing
Mean Utilities and SF-36v2 Scores (95% CIs) of CHB and CC patients
|
|
|
CC
|
Population
Norms |
|
VAS |
0.81 (0.79-0.83) |
0.81 (0.78-0.84) |
|
|
HUI3 |
0.87 (0.85-0.89) |
0.81 (0.76-0.86) |
0.90 (0.90-0.91) |
|
EQ5D |
0.92 (0.90-0.94) |
0.90 (0.87-0.93) |
0.88 (0.88-0.89) |
|
SF36v2: |
53.2 (52.3-54.2) |
50.5 (48.8-52.3) |
51.3 (50.9-51.7) |
|
SF36v2: |
49.8 (48.2-51.3) |
50.1 (47.8-52.4) |
51.4 (51.0-51.8) |
L. Wah-Yun; C. Ng; W. Li-Ping;
M. Rosmawati
Objective:
Hepatitis B affects
the quality of life of patients. This paper compares the health-related quality
of life (HRQOL) between chronic hepatitis B patients with and those without
cirrhosis.
Method:
A cross-sectional
study was utilized. 483 patients with chronic Hepatitis B who
were followed-up at the hepatology clinic of a tertiary hospital in
Results:
Of the 483 chronic
hepatitis B patients, 74 (15%) of them were diagnosed with cirrhosis (with or
without hepatocellular carcinoma). Cirrhosis is diagnosed either
histologically, or clinically (US evidence of nodular or shrunken liver, or
presence of portal hypertension). The remaining 409 (85%) of them did not have
histological or clinical evidence of cirrhosis. Patients with cirrhosis were
significantly older (mean 54 ± 12.87 years) than patients who are not cirrhotic
(mean 44.86 ± 14.62 years). Mean duration from the time of diagnosis of hepatitis
B was 12 years (sd 8.8 years).
Overall SF-36V
scores (mean ± sd) were: physical functioning
(90.31±17.42), role physical (87.83±19.89), bodily pain (83.27±20.00), general
health (65.58±19.14), vitality (66.21±17.30), social functioning (88.89±17.36),
role emotional (89.22±19.14), mental health (75.98±16.61), physical component
score (52.77±6.51), and mental health component score (75.98±16.61).
Mean scores for the
SF-36V domains between patients with cirrhosis vs. without were: physical
functioning (87.49 vs. 90.82), role physical (85.81 vs. 88.20), bodily pain
(84.99 vs. 82.97), general health (63.74 vs. 65.91), vitality (66.30 vs.
66.19), social functioning (88.68 vs. 88.94), role emotional (88.63 vs. 89.32),
mental health (75.13 vs. 76.14), physical component score (52.16 vs. 52.88),
mental health component score (50.67 vs. 50.73). No significantly differences
were shown between patients with cirrhosis and those without in SF-36V domains,
and the two main summary scores.
Conclusion:
Patients with
hepatitis B showed a good quality of life, but HRQOL between chronic Hepatitis
B patients with and without cirrhosis were no different.
1098. Prevalence of HBsAg in Pregnant Women
in
E. Nguyen-Khac;
D. Capron; S. Delmas-Lanta; H. Robillard; J. Merlin; G. Dubois; A. Braillon
Rationale
and objectives:
In
Methods:
In 2006, 22,595 deliveries were registered in the 20
maternity clinics (public and private-sector). Three methods were used to
investigate the prevalence of HBsAg: (i) from HBsAg screening results in a
sample of 1,198 hospital case files, which were randomized and stratified on
the number of births; (ii) from HBsAg assay reimbursements for all pregnancies
recorded by the main regional health insurance system (URCAM); (iii) we also
looked for mothers with viral liver diseases and for neonates with hepatitis B
immune globulin and vaccine administration from the medico-administrative
databases (
Results:
Based on the sample of hospital case files, the
prevalence of HBsAg during pregnancy in
Conclusions:
The prevalence of HBsAg in pregnant women in
Denis et al. Bulletin Epidémiologique Hebdomadaire
2003; 33:157-9.
Funding: DHOS (FMESPP programme),
1101. Prevention of HBV Infection
by GPs Among Migrant People in
J. Aubert; A. Di Pumpo; P.
Santana; A. Gervais
Context:
In 2004, 22% of French citizens were vaccinated
against hepatitis B virus (HBV), 7,3% had previously
been protected by a contact with HBV, and 0,65% were carriers of HBV. Those
rates are not known among migrant people, above all if they have no social
security. It is not known whether those people follow accurate personal
strategies of prevention
Aims and
Method:
To assess the effectiveness of an
internet-accessible expert system in helping the GP to determine the most
accurate strategy of prevention, related to the serologic HBV profile of each
patient, and to apply this strategy, among migrant people coming from Sub-Saharan
Africa and
Results:
From 5.11 to 31.12.2007, 26 GPs included 373 migrant
people. 11% are HBV carriers, 36% have been protected by a contact with HBV,
28% are vaccinated, and 25% have had no contact with virus nor
vaccination. A full accurate preventive information strategy could be carried
out with help of the expert system, respectively among 81% of HBV carriers,
100% of vaccinated people, 89% of people protected b HBV contact, and 84% of
people who had no marker. A vaccination has been started among 79% of people
who required it. For people whose only marker of HBV infection was anti HBc,
68% only of accurate preventive strategy was found, this lower result can be
related to a lack of accuracy in international guidelines in this situation.
Conclusion:
Prevalence of contact with HBV is much higher in
migrant people coming from Sub-Saharan Africa and
990.
Epidemiology of Hepatitis B Virus (HBV) Infection in
A. F.
Constantino; H. M. Proenca; T. Rodrigues; L. Nicolau; M. C. de Moura
Background:
Data on epidemiology of HBV infection in sub-Saharan
Objectives:
To assess the prevalence of HBV infection and risk
factors in a primary health care setting in
Methods:
1,103 black individuals born
and resident in
Results:
Female gender was predominant, both in the global
sample 856 (77.6%) and in the HBsAg positive population (65%). The most
frequent risk factor was unprotected sex -98, 5%. Both
Conclusion:
HBsAg was positive in 13% of cases. Unprotected sex
was the predominant risk factor. The high percentage of HBsAg in children
suggests an early infection in life. The high proportion of AgHBe negative
cases (79, 5 %) may indicate a change in the serologic profile of HBV infection
in
U. B.
Hellstrom; S. P. Sylvan; K. Madalinski
PreS-containing vaccines have been shown to induce
rapid and enhanced anti-HBs responses when used in newborns, children and
adults. However, the fine specificity of the preS1 and preS2 responses induced
by third generation hepatitis B vaccines and its relation to the anti-HBs
response has so far not been elucidated.
Using two site-specific peptide based ELISA we
analysed, after a full vaccination schedule of the Sci-B-Vac vaccine in 28
newborns, the antibody reactivity towards aa 21-47 of
the preS1 and aa 131-140 of the preS2.
Fourteen newborns, who exhibited antibody reactivity
towards the preS2 peptide which mimics aa 131-140 of the preS2 protein, had an
anti-HBs response after vaccination which was significantly lower (p<0.025)
compared with those newborns (n=14) who lacked the preS2(131-140) reactivity.
Conclusion:
The highest anti-HBs levels were found in a newborn
who exhibited reactivity towards the aa 21-47 of the
preS1 but lacked anti-preS2 (131-140) reactivity. Accessibility of preS1
antigens which mimics the hepatocyte receptor binding sites (21-47) to B- and
T- cells is thus critical to elicit a strong anti-HBs response after
vaccination with the Sci-B-Vac vaccine. The recognition of the so-called
polymerized albumin receptor (131-140) of the preS2 on the other hand seemed to
have suppressive effects on the anti-HBs response.
Disclosure:
This study was partly financed by SciGen Ltd,
878.
Co-delivery of Hepatitis B Virus Surface Antigen and GM-CSF by Hydrogel
Overcomes Non-responsiveness to Hepatitis B Vaccine Through
Recruitment and Activation of Dendritic Cells
H.
Chou; P. Wu; M. Tao
Nonresponsiveness to hepatitis B vaccine, composed
mainly the major hepatitis B surface antigen (HBsAg), has been described in
approximately 5-10% of healthy immunocompetent subjects. The underlying
cellular and molecular events for the nonresponsiveness are not completely
understood, but are likely associated with impaired T helper cell responses to
HBsAg in subjects with particular HLA-DR alleles. In this study, we describe a
novel formulation of HBsAg vaccine containing GM-CSF, one of the most potent
cytokines that can mediate the maturation and function of dendritic cells, in a
thermosensitive biodegradable copolymer (Hydrogel) system, acting as a
sustained-release matrix for the loaded proteins. In responder inbreed or
outbreed mouse strains, Hydrogel/HBsAg+GM-CSF vaccine elicited higher titers of
anti-HBsAg antibody and strong T-cell proliferative responses than other
vaccine preparations. Most importantly, a single injection of
Hydrogel/HBsAg+GM-CSF vaccine was sufficient in the induction of significant
anti-HBs antibody and T-cell immune responses in B10.M mice, a mouse strain
with H-2 gene-linked HBsAg nonresponsive phenotypes. Repeated immunization with
alum contained commercial HBsAg vaccine did not induce detectable anti-HBs
antibody and T-cell immune responses in this nonresponding population. Local
and sustained release of GM-CSF is required for its immunostimulatory function
in nonresponder mice, because administration of Hydrogel/HBsAg and
Hydrogel/GM-CSF in separate locations or a free mixture of HBsAg and GM-CSF
failed to induce comparable humoral and cellular immune responses. Analysis of
draining lymph nodes of Hydrogel/HBsAg+GM-CSF-treated mice revealed an elevated
number of CD11c+ dendritic cells (DCs) with enhanced expression of
costimulatory molecules,
Conclusion:
These results suggest that the local adjuvant activity
of GM-CSF creating a favorable microenvironment for antigen presentation by
promoting DCs maturation and migration into the draining lymph nodes, leading
to generation of T helper cells, which subsequently provide help for B cells to
produce anti-HBs antibodies. Therefore this Hydrogel/HBsAg+GM-CSF vaccine
provide an alternative vaccination strategy to human nonresponders to improve
the seroconversion rate of hepatitis B vaccination. And this effective
immunization approach may also be applicable to apply for design of vaccines
for a variety of other diseases.
971.
Evaluation and Management of Hepatitis B in Pregnancy: A Survey of AASLD
Members
S. B.
Salem; N. N. Shah; S. M. Cohen; J. Ahn
Background:
Data on the safety of oral antiviral therapy for
hepatitis B (HBV) in pregnancy is limited. Treatment guidelines have not been
definitive but have suggested individualization of treatment decisions. In the
absence of data and clear guidelines, we sought to evaluate the practice
patterns of AASLD members in managing these patients.
Methods:
An 18-question survey was electronically sent to all
AASLD members addressing diagnosis and management of HBV during pregnancy.
Responses were gathered over a 4-week period.
Results:
226 (9.3% of those surveyed) AASLD members responded.
156 (69%) characterized their specialty as hepatology, 60 (26.5%)
gastroenterology, and 10 (4.4%) other. 141 (62.4%) were academic-based and 85
(37.6%) were community-based physicians. The average years in practice was 13.3
(1-45). With regard to comfort level in managing these patients, 68 (30.1%)
were “very comfortable”, 69 (30.5%) were “comfortable”, 52 (23%) were “somewhat
comfortable”, and 37 (16.4%) were “not comfortable”.117 (51.8%) would initiate
antiviral therapy in women newly diagnosed with HBV during pregnancy. Of those
who would not initiate antiviral therapy during pregnancy, 64 (58.7%) cited an
absence of guidelines, and 42 (38.5%) a lack of evidence to support efficacy or
safety. For patients already on antivirals who become pregnant, 169 (74.8%)
would continue antiviral therapy. With respect to breastfeeding, 130 (57.5%)
would recommend breast feeding, 64 (28.3%) would not, and 32 (14.2%) were
unsure. If antivirals were used, 69 (30.5%) would recommend breastfeeding, 100
(44.2%) would not, and 57 (25.2%) were unsure. Except for the timing of
antiviral therapy initiation, there were no statistically significant
differences between academic-based and community-based physicians and between
hepatologists and gastroenterologists with regard to diagnostic modalities,
choice of antiviral drugs, and treatment duration. Academic-based physicians
were more likely to wait until after delivery to initiate antivirals as
compared to community-based physicians. (p=0.01).
Conclusion:
Based on this survey, it is clear that there is
significant heterogeneity in evaluation and management of pregnant women with
HBV. There were no differences in practice patterns and comfort levels between
academic-based and community-based physicians with the exception of the timing
of antiviral initiation. Additional research into the evaluation and management
of pregnant women with HBV that would lead to evidence-based guidelines is
needed.