Hepatitis B chronic infection among pregnant women attending the antenatal care in Bor State Referral Hospital, South Sudan

Introduction: Hepatitis B virus (HBV) is a major public health problem affecting 400 million people worldwide, and is a common cause of chronic liver failure (cirrhosis) and hepatocellular carcinoma. Sixty-eight percent of infected people are from the African and Pacific regions. Vertical transmission from mother to newborn baby is one of the mechanisms by which chronic hepatitis virus infection spreads, besides infections from contaminated needles and syringes and sexual contact. Hepatitis B chronic infection is endemic in many poor countries, especially in Africa. Method: A cross-sectional study was conducted between July and August 2021. Pregnant women attending the antenatal care (ANC) in Bor State referral hospital, South Sudan, were interviewed to collect information on their socio-demographic characteristics and risk factors for hepatitis B infection. The objective was to determine the seroprevalence of hepatitis B chronic infection through blood testing. Prevalence ratios for certain risk factors were calculated. Results: Two hundred pregnant women were enrolled. The Prevalence Rate for chronic infection with hepatitis B virus, diagnosed using the rapid immune-chromatographic assay for Hepatitis B surface antigen (HBsAg), was 8.5%. (95% CI; 4.7% - 12.3%). None of the suspected risk factors studied were found to be significantly associated with testing positive for HBV, except for a history of previous jaundice. Conclusion: The prevalence of HBV chronic infection among pregnant women in Bor, Jonglei State, is high hence there is a need for established public health interventions that can lead to a reduction of HBV vertical transmission. Treatment of pregnant women with HBV chronic infection using anti-viral medications during pregnancy might curb the vertical transmission rates.

Persistence follow-up of immune memory to hepatitis B vaccine among infants with non- and low-response to primary vaccination after revaccination with three doses / 中华预防医学杂志

This study followed up the immune memory after 3-dose revaccination among infants with non-and low-response following primary hepatitis B (HepB) vaccination. About 120 children without self-booster doses were finally included who had anti-HBs<10 mIU/ml (anti-HBs negative) at the time of follow-up, of whom 86 children completed blood sampling and anti-HBs testing. Before the challenge dose, all 86 children were negative for anti-HBs, and the GMC of anti-HBs was<10 mIU/ml. The seropositive conversion rate of anti-HBs was 100% and the GMC of anti-HBs was 886.11 (95%CI: 678.15-1 157.84) mIU/ml after the challenge dose. Compared with those with GMC<7 mIU/ml before the challenge dose, infants with GMC>7 mIU/ml had a higher anti-HBs level after the challenge dose. The β value (95%CI) was 0.82 (0.18-1.46) (P=0.012). Compared with those with GMC<1 000 mIU/ml at primary vaccination, infants with GMC≥1 000 mIU/ml had a higher anti-HBs level after the challenge dose. The β value (95%CI) was 0.78 (0.18-1.38)(P=0.012). The results showed a stronger immune memory was found at 9 years after revaccination among infants with non-and low-response to HepB.

Epidemiological survey of hepatitis B and analysis of hepatitis B vaccine coverage rate among children aged 1-14 years in Lhasa in 2006, 2014 and 2020 / 中华预防医学杂志

In 2006, 2014 and 2020, the positive rates of HBsAg in 560, 384 and 402 children aged 1 to 14 years were 4.5%, 2.6% and 2.5%, respectively, with no statistically significant differences (P>0.05). The positive rate of anti-HBs was highest in 2014 (57.8%) and lowest in 2006 (34.1%) (P<0.05). The positive rate of anti-HBc was highest in 2006 (15.7%), and decreased in 2014 (7.8%) and 2020 (5.7%) (P<0.001). The timely rate of the first dose of hepatitis B vaccine for children in Lhasa in 2006, 2014 and 2020 was 7.7% (43/560), 50.3% (193/384) and 94.8% (381/402), respectively. The overall vaccination rates were 15.4% (86/560), 35.2% (135/384) and 96.0% (386/402), respectively, showing a trend of gradual increases (χtrend values were 718.63 and 589.59, both P values<0.001).

Prevalencia de vacunación completa para la hepatitis B en el personal de salud de tres grandes hospitales generales del Paraguay / Prevalence of complete vaccination for hepatitis B in health personnel of three large general hospitals in Paraguay

Introducción: El personal de salud constituye un grupo de riesgo para la infección por el virus de las hepatitis B. Objetivos: Evaluar la frecuencia de vacunación contra Hepatitis B en profesionales médicos y de enfermería de tres grandes centros hospitalarios del Departamento Central de Paraguay. Materiales y métodos: Estudio cuantitativo, observacional, descriptivo, de corte transversal. Se aplicó un cuestionario al personal médico y de enfermería en estudio, elaborado según trabajos afines. Resultados: Fueron encuestadas 1097 personas, siendo médicos 412 (37.6%) yersonal de enfermería 685 (62.4%). Se encontró un nivel de vacunación completa del 48.2% sobre el total de encuestados, 49.5% de los varones presentaron esquema completo y 47.7% de las mujeres. Según la profesión, el personal de enfermería tiene mejor acatamiento con 51% de vacunación completa contra 47% del personal médico. En el Hospital Central del Instituto de Previsión Social, casi un 62% tenía esquema completo, el Hospital de Clínicas alcanzó 40.9% y solamente 36.6% de los encuestados del Hospital Nacional de Itauguá tenían todas las dosis de vacuna anti-Hepatitis B. Para riesgo biológico bajo, el nivel de vacunación completa fue del 36.0%, alcanzó el 36.8% para riesgo moderado y 57.3% para los de alto riesgo de exposición. Conclusión: Ante la baja prevalencia de vacunación completa contra Hepatitis B en el personal de salud, esta debe mejorarse considerando el riesgo biológico de exposición. El equipo de control de infecciones y el Departamento de salud laboral deben llevar un registro de vacunación del personal y tener un plan de inmunizaciones obligatorio.

Introduction: Health care personnel constitute a risk group for hepatitis B virus infection. Objectives: To evaluate the frequency of vaccination against Hepatitis B in medical and nursing professionals of three large hospital centers in the Central Department of Paraguay. Materials and methods: Quantitative, observational, descriptive, cross-sectional, cross-sectional study. A questionnaire was administered to medical and nursing personnel included in the study, based on related studies. Results: A total of 1097 people were surveyed, 412 (37.6%) were physicians and 685 (62.4%) were nurses. In general, a complete vaccination level of 48.2% of the total respondents was reached, 49.5% of men had a complete vaccination schedule and 47.7% of women. According to profession, the nursing staff had a better compliance with complete vaccination with 51% versus 47% of the medical staff. In the Hospital Central del Instituto de Previsión Social almost 62% had a complete schedule, the Hospital de Clínicas reached 40.9% and only 36.6% of the respondents of the Hospital Nacional de Itauguá had all the doses of anti-Hepatitis B vaccine. For low biological risk, the level of complete vaccination was 36.0%, reaching 36.8% for moderate risk and 57.3% for those at high risk of exposure. Conclusion: The level of complete vaccination against Hepatitis B in health personnel was low and should be improved, taking into account the biological risk of exposure. The infection control team and the occupational health department should keep a record of staff vaccination and have a mandatory immunization plan for it.

Non/hypo-response to hepatitis B vaccination and influencing factors in HIV-infected patients in the context of different immunization schedules / 中华流行病学杂志

Objective: To study the non/hypo-response to hepatitis B vaccination in HIV-infected patients, identify the influencing factors and provide evidence for the development of hepatitis B prevention and control strategies and measures for special population. Methods: On the basis of the randomized controlled trial of 20 µg hepatitis B vaccine immunization at 0-1-6 month, 0-1-2-6 month and 60 µg hepatitis B vaccine immunization at 0-1-2-6 month, the HIV-infected patients who completed one-month follow-up after the full course vaccination were selected as study subjects. Quantification of antibody to hepatitis B surface antigen (anti-HBs) in serum samples was performed by using chemiluminescent microparticle immunoassay (CMIA) and demographic characteristics, disease history, HIV infection and treatment status of the study subjects were collected. Statistical analysis was conducted by χ2 test, t test, unconditional logistic regression and interaction analyses. Results: The non/hypo-response rates to hepatitis B vaccination were 34.65% (35/101), 24.49% (24/98) and 10.99% (10/91) in 20 µg group at 0-1-6 month or 0-1-2-6 month and 60 µg group at 0-1-2-6 month (P<0.001), respectively. Logistic regression analysis showed that after controlling for confounding factors, the risk for non/hypo-response was 0.22 times higher in HIV-infected patients receiving 60 µg hepatitis B vaccine at 0-1-2-6 month than in patients receiving 20 µg hepatitis B vaccine at 0-1-6 month (95%CI: 0.10-0.50), the risk for non/hypo-response was higher in men than in women (OR=3.65, 95%CI: 1.88-7.07), and the risk for non/hypo-response was 2.64 times higher in those without hepatitis B vaccination history than in those with hepatitis B vaccination history (95%CI: 1.10-6.32). Moreover, there were multiplicative interactions between immunization schedule and gender (OR=2.49, 95%CI: 1.24-5.00). Conclusion: The non/hypo-response rate to hepatitis B vaccination was significantly lower in HIV-infected patients receiving 60 µg hepatitis B vaccine at 0-1-2-6 month than in those receiving 20 µg hepatitis B vaccine at 0-1-6 month and 0-1-2-6 month. Gender, vaccination schedule and history of hepatitis B vaccination were the influencing factors of the non/hypo-response to hepatitis B vaccination. There was a multiplicative interaction between vaccination schedule and gender, and men receiving 20 µg hepatitis B vaccines had a higher risk for non/hypo-response to hepatitis B vaccination.

Immunogenicity and influencing factors of hepatitis B vaccination based on different vaccination schedules among chronic kidney disease patients / 中华流行病学杂志

Objective: To explore the immunogenicity and influencing factors of hepatitis B vaccination based on different vaccination schedules among chronic kidney disease (CKD) patients. Methods: CKD patients who participated in randomized controlled trials in four hospitals in Shanxi province and completed three doses of 20 µg vaccination (at months 0, 1 and 6) and four doses of 20 µg or 60 µg vaccination (at months 0, 1, 2, and 6) were surveyed from May 2019 to July 2020.According to the ratio of 1∶1∶1, 273 CKD patients were divided into 3 groups randomly. Quantification of the anti-hepatitis B surface antigen-antibody (anti-HBs) in serum samples was performed using chemiluminescent microparticle immunoassay at months 1 and 6 after the entire course of the vaccinations. The positive rate, high-level positive rate, geometric mean concentration (GMC) of anti-HBs, and the influencing factors were analyzed by χ2 tests, analysis of variance, unconditional logistic regression analysis. Results: A total of 273 CKD patitents were participants.The positive rates in the CKD patients with four doses of 20 µg vaccination (92.96%,66/71) or 60 µg vaccination (93.15%, 68/73) were higher than that in the CKD patients with three doses of 20 µg vaccination (81.69%, 58/71) at month one after the full course of the vaccinations (P<0.05). The GMCs of anti-HBs showed similar results (2 091.11 mIU/ml and 2 441.50 mIU/ml vs. 1 675.21 mIU/ml) (P<0.05). The positive rate was higher in the CKD patients with four doses of 60 µg vaccination (94.83%,55/58) than in those with three doses of 20 µg vaccination (78.79%,52/66) (P<0.05) at month six after the full course of the vaccinations. And the GMC of anti-HBs in the patients with four doses of 60 µg vaccination (824.28 mIU/ml) was significantly higher than those in the patients with 3 or 4 doses of 20 µg vaccination (639.74 mIU/ml and 755.53 mIU/ml) (P<0.05). After controlling the confounding factors, the positive rate in the CKD patients with four doses of 60 µg vaccination were 3.19 (95%CI: 1.02-9.96) and 5.32 (95%CI: 1.27-22.19) times higher than those in the patients with three doses of 20 µg vaccination at months 1 and 6 after the full course of the vaccinations, respectively. The positive rate in CKD patients without immune suppression or hormone therapy was 3.33 (95%CI: 1.26-8.80) and 4.78 (95%CI: 1.47-15.57) times higher than those in the patients with such therapy, respectively. Conclusions: Four doses of 20 µg or 60 µg hepatitis B vaccination could improve the immunogenicity in patients with CKD. And four doses of 60 µg vaccination might play a positive role in maintaining anti-HBs in this population. The immunogenicity in the CKD patients with immune suppression or hormone therapy was poor.

Usos de la levadura Pichia pastoris en la producción de proteínas recombinantes / Uses of Pichia pastoris yeast in the production of recombinant proteins

La levadura metilotrófica Pichia pastoris (clasificada actualmente como Komagataella phaffii) es una de las más importantes para la producción de proteínas heterólogas. En el trabajo se presenta un análisis de las principales características que se ponen de manifiesto en la expresión de proteínas recombinantes expresadas en este microorganismo. Se describen las cepas disponibles para la transformación y producción de proteínas recombinantes expresadas en Pichia pastoris, los principales vectores comerciales para la expresión, los promotores más eficientes, los marcadores seleccionables, la señal de secreción, los métodos usados en las transformaciones genéticas y los patrones de glicosilación que se presentan. Se brindan recomendaciones generales acerca de los parámetros de bioprocesos como la composición del medio, el pH, la temperatura, la velocidad de aireación, la inducción y las estrategias de alimentación para alcanzar altos valores de productividad. Se presentan los resultados de las aplicaciones de Pichia pastoris en la producción de dos vacunas en Cuba, la vacuna contra la hepatitis B y la vacuna para el control de la garrapata(AU)

Pichia pastoris metylotrofic yeast (currently classified as Komagataella phaffii) is one of the most important yeast for the production of heterologous proteins. The work presents an analysis of the main characteristics that are marked in the production of recombinant proteins expressed in Pichia pastoris. It describes the strains available for the transformation and production of recombinant proteins expressed in P. pastoris, the main commercial vectors for expression, the most efficient promoters, selectable markers, the secretion signal, the methods used in genetic transformations and glycosylation patterns that occur. General recommendations are provided on bioprocess parameters such as media composition, pH, temperature, aeration velocity, induction, and feeding strategies to achieve high productivity values. The results of Pichia pastoris applications for the production of two vaccines in Cuba, the hepatitis B vaccine and the tick control vaccine are shown(AU)

Adoption of Euvax-B vaccine in Nineveh

Hepatitis B infection is one of the most important health problems around the world. The high mortality rate of the hepatitis B encouraged research that led to the finding of an effective vaccine against it. The aim of the present study was to find out the use of the Euvax-B vaccine in sectors of Nineveh province. According to the results obtained in this study, in the next five years, the vaccination coverage for the second and third doses needs to improve(AU)

La infección por hepatitis B es uno de los más importantes problemas de salud del mundo. La alta tasa de mortalidad de la hepatitis B impulsó las investigaciones que llevaron a encontrar una vacuna eficaz contra la misma. El objetivo del presente estudio fue conocer el uso de la vacuna Euvax-B en sectores de la provincia de Nínive. De acuerdo con los resultados obtenidos, en los próximos cinco años, se debe incrementar la cobertura de inmunización de la segunda y tercera dosis de la vacuna(AU)

Transmisión vertical de hepatitis B: importancia de incorporar el cribado en el control prenatal en Chile / Vertical transmission of hepatitis B: the importance of incorporating screening during pregnancy in Chile

Resumen La transmisión vertical de hepatitis B es responsable de 50% de las infecciones en el mundo e implica 90% de riesgo de evolucionar a hepatitis crónica y sus complicaciones. La inmunoprofilaxis postparto (inmunoglobulina más vacuna) es la medida de prevención más efectiva. Sin embargo, puede existir fracaso a pesar de dicha intervención, debido a factores como alta carga viral o la presencia de HBeAg en la madre, los que sólo pueden evitarse si se hace el diagnóstico y tratamiento durante la gestación. En Chile, en el año 2019 se incorporó la vacunación en los recién nacidos, pero no existe aún cribado durante el embarazo, a diferencia de los países desarrollados. En los últimos años se ha experimentado un aumento acelerado de inmigración proveniente principalmente de América latina y el Caribe, con prevalencias altas en algunos de ellos. Chile debiese avanzar prontamente hacia el cribado de hepatitis B en embarazo.

Abstract Half of cases of hepatitis B around the world are produced from vertical transmission; and 90% of them can evolve to chronic hepatitis and their long term complications. Postpartum immunoprophylaxis (immunoglobulin and vaccine) is the most effective preventive measure. However, despite this prophylaxis, vertical transmission is possible if the mother presents a high viral load or e-antigen. This risk can be reduced only if screening during pregnancy and treatment if needed, are incorporated. In 2019, vaccination for hepatitis B in newborn was incorporated in Chile, but not yet prenatal screening, unlike developed countries. Chile has experienced a growth in immigration from Latin America and Caribbean, some countries with high endemicity included. Prenatal screening in Chile should be promptly incorporated.

Análisis económico de las vacunas del primer año de vida con componente pertussis en el contexto de la ini-ciativa mundial de erradicación de la poliomielitis en Argentina / Vaccination in children under 1 year with pertussis component in the context of the global initiative for the eradication of poliomyelitis in Argentina: economic analysis

INTRODUCCIÓN: La Iniciativa Mundial de Erradicación de la Polio promueve la introducción de vacuna de polio inactivada (IPV) en sus programas, con la posterior retirada de Sabin (bOPV). OBJETIVO: Construir un modelo de económico que compare diferentes esquemas de vacunación para la prevención de polio y tosferina en el primer año de vida. Material y MÉTODOS: Análisis de cuatro escenarios de vacunación del esquema primario para Argentina, en base a los precios de las vacunas, costos del programa y reactogenicidad de vacuna celular o acelular para Bordetella pertussis: - Escenario 1 (caso base): dos dosis de IPV, una dosis de bOPV y tres dosis de vacuna pentavalente (DTwP-HB-Hib); - Escenario 2: tres dosis IPV y de pentavalente; - Escenario 3: tres dosis de hexavalente (DTaP-HepB-IPV-Hib); - Escenario 4: dos dosis de hexavalente más una dosis de pentavalente más IPV. RESULTADOS: El costo incremental en base al escenario 1 fue de USD 3.716.671; 19.696.668 y 14.383.341 para los escenarios 2, 3 y 4, respectivamente. Para la reactogenicidad, la diferencia fue de USD -14.178.240 comparado el caso base con el escenario 3. DISCUSIÓN: La inversión de incorporación de full IPV y costos asociados se modifica según tipo de vacuna y reactogenicidad asociada al componente B. pertussis.

BACKGROUND: Global Polio Eradication Initiative promotes the introduction of inactivated polio vaccine (IPV) in its programs, with withdrawal of Sabin (bOPV). There is no an economic analysis of the investment related to the incorporation of IPV vaccines together with a whole cell Bordetella pertussis vaccine or combined with acellular hexavalent. AIM: An economic model that compares different vaccination schemes for the prevention of polio and pertussis in the first year of life was carried out. METHODS: Four vaccination scenarios for the primary scheme based on Argentina demographic and costs data were developed: - Scenario 1 (base case): two doses of IPV, one dose of bOPV and three doses of pentavalent (DTwP-HepB-Hib) vaccine; - Scenario 2: three doses of IPV plus three doses of pentavalent; - Scenario 3: three doses of hexavalent; - Scenario 4: two doses of hexavalent plus one dose of pentavalent plus IPV. RESULTS: The incremental cost based on scenario 1 was USD 3.716.671; 19.696.668 and 14.383.341 for scenarios 2, 3 and 4 respectively. In terms of reactogenicity savings was -14.178.240 compared base case with scenario 3. DISCUSSION: Full IPV introduction investment and costs associated were modified according to the type of vaccine and reactogenicity related with the B. pertussis component.

Vertical transmission of hepatitis B virus: propositions and future directions / 中华医学杂志(英文版)

Chronic hepatitis B virus (HBV) infection due to vertical transmission remains a critical concern with regards to eliminating HBV infection. Implementation of hepatitis B vaccine, the foundation to prevent perinatal and horizontal transmission, has reduced the prevalence of HBV by >80%. In countries where the hepatitis B immune globulin (HBIG) is available, such as China and the United States, the administration of HBIG and hepatitis B vaccine to the infants of mothers who are positive for hepatitis B surface antigen has become a standard practice and is effective in preventing vertical transmission. Accumulating evidence on the efficacy and safety of antiviral prophylaxis during pregnancy indicates the probability of attaining the goal of the World Health Organization to eliminate hepatitis by 2030. In this review, we discuss the transmission routes, diagnostic criteria, and preventive strategies for vertical transmission. A preventive program that includes screening before pregnancy, antiviral prophylaxis during pregnancy, and postpartum immunoprophylaxis provides "perfect strategies" to eliminate vertical transmission. However, there is still a notable gap between "perfect strategies" and real-world application, including insufficient coverage of timely birth dose vaccine and the efficacy and necessity of HBIG, especially in mothers who are negative for hepatitis B envelope antigen. In particular, there is a clear need for a comprehensive long-term safety profile of antiviral prophylaxis. Therefore, feasible and cost-effective preventive strategies need to be determined across regions. Access also needs to be scaled up to meet the demands for prophylaxis and prevalence targets.

Hepatitis B Vaccination and Factors Related with Unresponsiveness in Healthy Children

ABSTRACT Background: The aim of this study was to assess the effectiveness of hepatitis B vaccination and factors associated with vaccine unresponsiveness in healthy children. Methods: A total of 141 healthy children aged between two and five years were included in the study. All of the cases had received 20 μg of recombinant DNA vaccine for hepatitis B (0, 1 and 6 months). Demographic features and factors such as duration of breastfeeding, exposure to HBsAg-positive family members, administration of concomitant vaccines and exposure to smoke were determined. Hepatitis B vaccination serological markers were evaluated. Post-vaccination serologic evaluation was performed one month after the last dose of primary vaccination, one month after the booster dose. Human leukocyte antigens typing was performed in non-responders. Results: Only 87.9% of the children achieved seroprotection antibodies to hepatitis B surface antigen (anti-HBsAG titers ≥ 10 mIU/ml) one month after primary vaccination. No difference was observed between vaccine responsiveness and age, gender, birthweight, maturity, duration of breastfeeding, exposure to HBsAg-positive family members, and mid-upper arm circumference (p > 0.05). HLA types, DRB 111 (64.7%), B5 (52.9%), DRB 104 (52.9%) and DRB 11001 (47%) were detected at increased frequency in non-responders. The antibody titers were significantly higher in children who breastfed for the first six months and longer and who were vaccinated concomitantly with other common vaccines. Conclusion: The seroprotection antibodies to hepatitis B surface antigen correlated with breast feeding and hepatitis B vaccination concomitant with other common vaccines. HLA types DRB 111, B5, DRB 104 and DRB 11001 had increased frequency in non-responders.

Reducción en la infección por VHB y VHD en dos poblaciones indígenas de la Amazonia peruana después de la vacunación contra la hepatitis B / Reduction of HBV and HDV infection in two indigenous peoples of Peruvian Amazon after the vaccination against hepatitis B

Resumen: Objetivo: Conocer el resultado de la vacunación contra la hepatitis B en las comunidades hiperendémicas Kandozi y Chapra de la Amazonia Peruana a partir de la prevalencia de infecciones por los virus de la hepatitis B (VHB) y Delta (VHD), ocho años después de iniciada la vacunación. Material y métodos: Se realizó un estudio transversal en 2 944 pobladores de 67 comunidades indígenas Kandozi y Chapra en abril de 2010. El tamizaje serológico para el antígeno de superficie del VHB (HBsAg), anticuerpos anti-HBc IgM e IgG, anticuerpos anti-HBs y anti-VHD se determinaron mediante pruebas de ELISA. Resultados: Las tasas de prevalencia del HBsAg, anti-HBc IgG, anti-HBs ≥10 mlUI/ml y anti-VHD fueron 2.3, 39.13, 50.95 y 2.11%, respectivamente. La prevalencia del HBsAg en niños <11 años fue cero. Entre los portadores del HBsAg, las tasas de prevalencia de sobreinfeccion por el VHD e infección aguda por el VHB fueron 2.11% (todos fueron >14 años) y 11.94%, respectivamente. Conclusiones: Estos hallazgos muestran la eliminación de portadores de VHB en niños <11 años, ocho años después de iniciada la vacunación contra el VHB.

Abstract: Objective: To determine the outcome of the vaccination against hepatitis, we determined the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections, eight years after introduction of the vaccination. Materials and methods: A cross-sectional study was performed in 2 944 participants of 67 Kandozi and Chapra indigenous peoples in April 2010. Serological screening for hepatitis B surface antigen (HBsAg), antibody anti-HBc IgM and IgG, antibody anti-HBs and anti-HDV were determined by ELISA tests. Results: The prevalence rates of HBsAg, anti-HBc total, anti-HBs ≥10 mlUI/ml and anti-HDV were 2.3, 39.13, 50.95 and 2.11%, respectively. The prevalence rate of HBsAg in children <11 years was 0%. Among carriers of HBsAg, the prevalence rates of HDV and acute HBV infections were 2.11% (all were >14 years) and 11.94%, respectively. HBsAg and anti-HBc total were associated with individuals ≥10 years (p<0.001). Conclusions: These findings show the elimination of HBV carriers in children <11 years, eight years following introduction of the vaccination against HBV.

Seroprotección para virus de hepatitis B en estudiantes universitarios de atención prehospitalaria en Cali, Colombia / Seroprotection for hepatitis B virus in university students of prehospital care in Cali, Colombia

Introducción: El personal de salud se encuentra expuesto a contraer enfermedades infecto contagiosas en el ejercicio de su labor, una de ellas es la hepatitis B. Los estudiantes de atención prehospitalaria no se encuentran exentos de sufrir esta enfermedad, sobre todo por el contexto de las emergencias y desastres donde se desenvuelven. Objetivo: Determinar la prevalencia de seroprotección para el virus de hepatitis B en estudiantes de atención prehospitalaria en una universidad en Colombia. Métodos: Estudio descriptivo de corte transversal realizado a estudiantes de atención prehospitalaria en el periodo febrero-junio de 2017. No se utilizó ninguna técnica de muestreo porque se incluyó la totalidad de los estudiantes en práctica. Se aplicó un cuestionario con preguntas de datos sociodemográficos, registro del esquema de vacunación para hepatitis B y el resultado de los anticuerpos (Anti-HBs). Para el análisis estadístico se utilizó Microsoft Excel 2010, se construyeron estadísticas descriptivas. Las variables numéricas se describieron con base en medidas de tendencia central y variabilidad, las variables categóricas se describieron con base en prevalencias y distribuciones porcentuales. Resultados: En la caracterización de los 103 estudiantes evaluados se encontró que el 98 por ciento obtuvo títulos de anticuerpos (Anti-HBs) mayores a 10 UI/ml, considerándose como reactivos a las dosis de las vacunas, alcanzando títulos protectores. Sin embargo, el 93 por ciento no cumplió con el esquema de vacunación establecido. Conclusiones: Los resultados obtenidos evidencian la efectividad de las dosis aplicadas de vacuna para el virus de hepatitis B para obtener los títulos de anticuerpos a estudiantes de atención prehospitalaria en una universidad en Colombia. Pero existen incumplimientos en los tiempos recomendados para la aplicación de cada una de las dosis y en el tiempo de toma de los títulos(AU)

Introduction: Health personnel are at risk of infectious diseases when doing their job. One of them is hepatitis B. Prehospital care students are not free from suffering this disease, especially due to the emergencies and disasters context in which they work. Objective: To determine the prevalence of seroprotection for the hepatitis B virus in prehospital care students at a university in Colombia. Methods: Descriptive cross-sectional study carried out on prehospital care students during the period February-June 2017. No sampling technique was used because all the students in practice were included. A questionnaire was applied with questions of social-demographic data, registration of the vaccination schedule for hepatitis B and result of (Anti-HBs) antibodies. For statistical analysis, Microsoft Excel 2010 was used and descriptive statistics were designed. Numerical variables were described based on measures of central tendency and variability, categorical variables were described based on prevalence and percentage distributions. Results: In the depiction of the 103 students who were evaluated, it was found that 98 percent obtained antibody titers (Anti-HBs) bigger than 10 IU / ml, being considered as reactive to the doses of the vaccines and getting protective titles. However, 93 percent did not fill the established vaccination schedule. Conclusions: It can be concluded that the results obtained show the effectiveness of the applied doses of vaccine for the hepatitis B virus to obtain antibody titers to prehospital care students at a university in Colombia. But there are breaches in the recommended times for the application of each of the doses and in the time of taking the antibody titers(AU)

Análise da soroconversão após esquema habitual de vacinação contra hepatite B em pacientes com doenças inflamatórias intestinais / Seroconversion analysis after habitual hepatitis b vaccination scheme in patients with inflammatory bowel diseases

ABSTRACT BACKGROUND: Patients with inflammatory bowel disease (IBD) vaccinated for hepatitis B have a low success rate in achieving protective antibody levels. The main factors suggested for this are IBD itself and the use of immunosuppressive drugs. OBJECTIVE: To evaluate the concentration of anti-HBs antibodies and to verify factors associated with the effectiveness of hepatitis B vaccination in patients with IBD. METHODS: This is a prospective, consecutive, observational, descriptive and analytical, non-randomized, qualitative study that evaluated the levels of anti-HBs antibodies in IBD patients at the Interdisciplinary Inflammatory Bowel Disease Clinic of the Family and Community Health Unit of UNIVALI - Itajaí, Santa Catarina. RESULTS: Thirty-six patients were vaccinated against hepatitis B virus (HBV), of which 29 were female. The average age was 46.2 years. Regarding the type of IBD, twenty-four patients had Crohn's disease and the duration of inflammatory bowel disease was 74 months. Fifteen patients were on concomitant immunosuppressive therapy. The effective response rate to HBV vaccine was 72.2%, verified by anti-HBs titration ≥10 UI/L. Statistical analysis revealed a negative response to vaccination in patients with Crohn's disease and immunosuppressive drugs. CONCLUSION: The success rate of HBV immunization in IBD patients is low compared to the general population. Type of disease and use of immunosuppressive drugs appear to influence the vaccine response.

RESUMO CONTEXTO: Os pacientes com doenças inflamatórias intestinais (DII) vacinados para hepatite B possuem baixa taxa de sucesso em alcançar níveis protetores de anticorpos. Os principais fatores sugeridos para isso são a própria DII e o uso de medicamentos imunossupressores. OBJETIVO: Avaliar a titulação de anticorpos anti-HBs e verificar fatores associados a efetividade da vacinação contra hepatite B em pacientes com DII. MÉTODOS: Trata-se de um estudo prospectivo e consecutivo, de caráter observacional, descritivo e analítico, não-randomizado, qualiquantitativo, que avaliou a titulação de anticorpos anti-HBs em pacientes portadores de DII no Ambulatório Interdisciplinar de Doença Inflamatória Intestinal da Unidade de Saúde da Família e Comunitária da UNIVALI - Itajaí, Santa Catarina. RESULTADOS: Trinta e seis pacientes foram vacinados contra o vírus da hepatite B (VHB), destes, 29 eram do sexo feminino. A média de idade foi de 46,2 anos. Em relação ao tipo de DII, 24 pacientes eram portadores de doença de Crohn e o tempo médio de doença inflamatória intestinal encontrado foi de 74 meses. Quinze pacientes estavam em uso de terapia imunossupressora concomitante à vacinação. A taxa de resposta à vacina contra o VHB foi de 72,2%, verificada através de titulação de anti-HBs ≥10 UI/L. A análise estatística revelou uma resposta negativa à vacinação em pacientes em uso de medicamentos imunossupressores e portadores de doença de Crohn. CONCLUSÃO: A taxa de sucesso na imunização contra o VHB em pacientes com DII é baixo quando comparado à população em geral. Tipo de doença e uso de medicamentos imunossupressores parecem desempenhar influência na resposta vacinal.

Mapeamento da imunização contra o vírus da hepatite B e a estigmatização de doenças virais no contexto odontológico / Mapping immunization against hepatitis B virus and the stigmatization of viral diseases within odontology

Introdução: A AIDS e a Hepatite B são doenças virais de grande impacto epidemiológico e social, que repercutem de maneira negativa em todas as conjunturas, instâncias e práxis da saúde pública mundial. Na perspectiva odontológica, a alta infectividade, a patogenicidade e a estigmatização do vírus da imunodeficiência humana (HIV) e da hepatite B (VHB), além de deixarem os profissionais mais expostos às suas vulnerabilidades laborais, podem fomentar práticas e presunções discriminatórias. Objetivo: A presente tese foi dividida em dois capítulos, com objetivos diferentes. Capítulo 1 - mapear o perfil de imunização dos cirurgiões-dentistas da rede pública de saúde por meio do teste imunocromatográfico Anti-HBsAg e identificar seus fatores associativos. Capítulo 2 - comparar o conhecimento, a presença e a manifestação de atos discriminatórios e estigmatizantes de cirurgiões-dentistas, auxiliares e acadêmicos de Odontologia a respeito das representações sociais do HIV/AIDS e da hepatite B. Metodologia: Tratam-se de dois estudos epidemiológicos transversais quantitativos. Para a condução metodológica do primeiro capítulo, fizeram parte do universo amostral cirurgiões-dentistas da Atenção Primária à Saúde (APS) de 40 municípios pertencentes ao Departamento Regional de Saúde ­ II (DRS-II), do estado de São Paulo. A coleta dos dados foi feita em três etapas: aplicação do inquérito semiestruturado; investigação do protocolo vacinal contra o VHB; e análise da imunização pelo teste rápido imunocromatográfico AntHbsAg. Para o processamento estatístico, foi utilizada a análise bivariada em subsequência à análise de regressão logística binomial. No segundo capítulo, fizeram parte do universo amostral cirurgiões-dentistas e auxiliares em saúde bucal da APS dos 40 municípios da DRS-II e acadêmicos de Odontologia de uma universidade pública. Para a condução do estudo foi construído um instrumento de pesquisa que tinha como objetivo identificar de maneira ampla e objetiva as atitudes e os comportamentos potencialmente profusos de ações discriminantes. Para análise dos dados utilizou-se o Teste Z de proporção para comparação entre os grupos. Resultados: No capítulo 1, do total da amostra (219), 74,9% afirmou ter tomado as três doses da vacina e 35,6% não estava imune contra o VHB. Foram verificadas associações entre a variável dependente e o tempo de trabalho no serviço público; o conhecimento da temática em estudo; o desconhecimento do número de doses da vacina que foram administradas; e ter tomado menos de três doses da vacina. No capítulo 2, participaram da pesquisa 550 sujeitos. Foram verificadas associações significativas no conhecimento dos participantes do estudo sobre o HIV/AIDS e hepatite B, com maior representatividade de cirurgiões-dentistas. Dentre as doenças infecciosas analisadas, foi observado, de modo geral, um maior receio perante o HIV/AIDS. Por outro lado, quando inqueridos sobre o risco de infectividade, houve maior representatividade da hepatite B. Além disso, 30,7% e 42,2% dos indivíduos aceitariam ser atendidos por um profissional com HIV/AIDS e hepatite B, respectivamente, com maiores proporções de recusas pelos auxiliares e acadêmicos. Sobre a existência de distinções nas condutas clínicas de atendimento ao paciente com AIDS e hepatite B, o grupo de auxiliares teve as maiores proporções. Conclusão: No primeiro capítulo, parte dos cirurgiões-dentistas da APS não eram imunes contra o VHB. Já sobre os fatores de risco analisados, foi verificado que o conhecimento, o tempo de trabalho e a completude do esquema vacinal foram influentes para a não imunização. No segundo capítulo, foi possível concluir que o conhecimento sobre a temática ainda é obstáculo a ser enfrentada pelos auxiliares e acadêmicos. Em relação à presença e à manifestação de atitudes discriminatórias e estigmatizantes, foi constatado que elas existem de maneira velada e oculta pelos grupos dos acadêmicos e auxiliares, principalmente em relação ao HIV/AIDS(AU)

Introduction: AIDS and hepatitis B are viral diseases of great epidemiological and social impact. They negatively affect all conjunctures, instances, and praxis of global public health. From the dental perspective, the high infectivity, pathogenicity, and stigmatization of the human immunodeficiency virus (HIV) and hepatitis B virus (HBV) expose professionals to their work vulnerability and may foster discriminatory practices and presumptions. Objective: the main objective was addressed in two chapters, with different purposes. In chapter 1, we aimed to map the immunization profile of dental surgeons in the public health system and to identify its associative factors. To this end, we employed the anti-HBsAg immunochromatographic test. In chapter 2, we aimed to compare the knowledge, presence, and manifestation of discriminatory and stigmatizing acts of dental surgeons, dental assistants, and dental students concerning the social representations of HIV/AIDS and hepatitis B. Methodology: Two quantitative cross-sectional epidemiological studies were conducted. In the first chapter, the sample comprised dental surgeons working at the Primary Health Care (PHC) of 40 municipalities belonging to the Regional Health Department II (DRS-II) of the state of São Paulo. Data collection was performed in three stages: a semistructured interview; an investigation into the vaccine protocol against HBV; and an immunization analysis through the anti-HBsAg immunochromatographic rapid test. A binomial logistic regression analysis and a bivariate analysis provided the statistical data. In the second chapter, the sample comprised dental surgeons and dental assistants working at the PHC of 40 municipalities belonging to the DRS-II and dental students of a pubic university. We built a research instrument to broadly and objectively identify the potentially profuse attitudes and behaviors of discriminating actions. For data analysis, we performed the proportion Z-test to compare groups. Results: In chapter 1, 74.9% of the sample (219) claimed to have taken the three doses of the vaccine, while 35.6% were not immune against HBV. We verified associations between the dependent variable and the working time in the public service, the knowledge about the subject under study, the unawareness of the number of vaccine doses taken, and the fact of having taken less than three doses. In chapter 2, 550 subjects participated in the study. We found significant associations regarding participants' knowledge of HIV/AIDS and hepatitis B, with a greater representation of dental surgeons. Among the diseases investigated, HIV/AIDS raised the greatest concern. On the other hand, concerning the risk of infectivity, hepatitis B had a greater representativeness. In general, 30.7% and 42.2% of participants would accept receiving care from professionals with HIV/AIDS and hepatitis B, respectively; assistants and students had a higher proportion of refusal of care. Dental assistants had greater representativeness regarding distinctions in the clinical conduct of care for patients with AIDS or hepatitis B. Conclusion: In the first chapter, some of the dental surgeons were not immune to HBV. Regarding the risk factors, we verified that the knowledge, the working time, and the completeness of the vaccination schedule affected non-immunization. In the second chapter, we concluded that knowledge about the subject is still an impediment to be faced by dental assistants and students. Regarding the presence and manifestation of discriminatory and stigmatizing behaviors, we verified that they are veiled and hidden by groups of dental students and assistants, especially concerning HIV/AIDS(AU)

Post-vaccination anti-HBs testing among healthcare workers: More economical than post-exposure management for Hepatitis B / Teste anti-HBs pós-vacinação entre trabalhadores da saúde: mais econômico que manejo pós-exposição para Hepatite B / Pruebas anti-HBs post-vacunación entre los trabajadores de la salud: más económico que el manejo post-exposición para la Hepatitis B

Objective: to compare the direct cost, from the perspective of the Unified Health System, of assessing the post-vaccination serological status with post-exposure management for hepatitis B among health care workers exposed to biological material. Method: cross-sectional study and cost-related, based on accident data recorded in the System of Information on Disease Notification between 2006 and 2016, where three post-exposure and one pre-exposure management scenarios were evaluated: A) accidents among vaccinated workers with positive and negative serological status tests for hepatitis B, exposed to known and unknown source-person; B) handling unvaccinated workers exposed to a known and unknown source-person; C) managing vaccinated workers and unknown serological status for hepatitis B and D) cost of the pre-exposure post-vaccination test. Accidents were assessed and the direct cost was calculated using the decision tree model. Results: scenarios where workers did not have protective titles after vaccination or were unaware of the serological status and were exposed to a positive or unknown source-person for hepatitis B. Conclusion: the direct cost of hepatitis B prophylaxis, including confirmation of serological status after vaccination would be more economical for the health system.

Objetivo: comparar o custo direto, sob a perspectiva do Sistema Único de Saúde, da avaliação do status sorológico pós-vacinação com o manejo pós-exposição para hepatite B entre trabalhadores da área da saúde expostos ao material biológico. Método: estudo transversal e de custo, realizado a partir dos dados de acidentes registrados no Sistema de Informação de Agravos de Notificação entre 2006 e 2016, em que foram avaliados três cenários de manejo pós-exposição e um de pré-exposição: A) acidentes entre trabalhadores vacinados com status sorológico positivo e negativo para hepatite B, expostos à pessoa-fonte conhecida e desconhecida; B) manejo dos trabalhadores não vacinados expostos à pessoa-fonte conhecida e desconhecida; C) manejo dos trabalhadores vacinados e status sorológico desconhecido para hepatite B e D) custo do teste pós vacinação pré-exposição. Os acidentes foram avaliados e o custo direto foi calculado utilizando o modelo árvore de decisão. Resultados: apresentaram maior custo os cenários em que os trabalhadores não possuíam títulos protetores após a vacinação ou desconheciam o status sorológico e foram expostos à pessoa-fonte positivo ou desconhecida para hepatite B. Conclusão: o custo direto da profilaxia para hepatite B, incluindo a confirmação do status sorológico após vacinação seria mais econômico para o sistema de saúde.

Objetivo: comparar el costo directo, desde la perspectiva del Sistema Único de Salud, de la evaluación del status serológico post-vacunación con el manejo post-exposición para la hepatitis B entre los trabajadores de la salud expuestos a material biológico. Método: estudio transversal y de costos, basado en datos de accidentes registrados en el Sistema de Información de Enfermedades Notificables entre 2006 y 2016, en el que se evaluaron tres escenarios de gestión posteriores a la exposición y uno previo a la exposición: A) accidentes entre trabajadores vacunados con status serológico positivo y negativo para hepatitis B, expuestos a una fuente de origen conocida y desconocida; B) manejo de trabajadores no vacunados expuestos a una fuente conocida y desconocida; C) manejo de trabajadores vacunados y estado serológico desconocido para hepatitis B y D) costo de la prueba de pre-exposición post-vacunación. Se evaluaron los accidentes y se calculó el costo directo utilizando el modelo de árbol de decisión. Resultados: los escenarios en los que los trabajadores no tenían títulos de protección después de la vacunación o desconocían el status serológico y estaban expuestos a una persona fuente positiva o desconocida para la hepatitis B reflejaron un costo más alto. Conclusión: el costo directo de la profilaxis para la hepatitis B, incluida la confirmación del status serológico después de la vacunación sería más económico para el sistema de salud.

The effectiveness of the national hepatitis B vaccination program 25 years after its introduction in Iran: a historical cohort study

ABSTRACT Introduction: Hepatitis B virus (HBV) is responsible for one of the most common human viral infections. An estimated 257 million people are living with chronic HBV infection worldwide, and mortality has reached 900,000 deaths in recent years. In 2001, the World Health Organization reported a prevalence of chronic hepatitis B infection in Iran between 2-7%. Objective: To assess the effect of the national HBV mass vaccination program after 25 years. Methods: A retrospective cohort study was conducted in vaccinated and unvaccinated people according to the year of birth. Blood samples were obtained from each enrolled person and data about demographic variables, and medical and vaccination history were collected using a standardized questionnaire. Persons were considered uninfected if they were negative for both HBsAg and anti-HBc. Also, Vaccine effectiveness was measured by calculating the risk of disease among vaccinated and unvaccinated persons and defining the percentage risk reduction of infection in the vaccinated group. Results: A total of 2720 persons were interviewed. The rate of HBV breakthrough infection among the vaccinated group was significantly lower than in unvaccinated group. One hundred ninety-four cases with positive HBV markers of infection were identified. The risk ratio of HBV infection was 0.71, 95% CI: 0.54-0.94 (vaccinated/unvaccinated). The estimated vaccination effectiveness against Hepatitis B infection was 29% (95% CI: 6%-46%). Conclusions: Iran has successfully combined hepatitis B vaccination into regular immunization programs. The WHO goal of reducing HBsAg prevalence to an equivalent of 1% by 2020 has been reached. With respect to vaccination effectiveness and low prevalence of the disease in the country, catch-up hepatitis B vaccination programs for adolescents can guarantee the immunity of the population.

Eficácia de um novo esquema vacinal contra hepatite B em pacientes submetidos a transplante de fígado / New immunization schedule effectiveness against hepatitis b in liver transplantation patients

ABSTRACT BACKGROUND: Although liver transplantation is considered to be a high-risk procedure, it is well-established as a treatment option for the cure and quality of life enhancement for individuals who suffer from diseases. Preventing an infection by hepatitis B virus through immunization schedules has been the most effective way to reduce complications, since it decreases the number of people who suffer from chronic hepatitis caused by the hepatitis B virus and eradicates its transmission. OBJECTIVE: 1. Analyzing evidence in the literature on various schedules employed for immunization against hepatitis B in patients who have received a liver transplantation. 2. Suggesting potential immunization schedules against hepatitis B in patients who suffer from liver cirrhosis, without previous verifying documentation, using the Child-Turcotte Pugh score, according to evidences found in the literature. METHODS: Systematic review of the literature, conducted on the data bases MedLine, PubMed, and Lilacs, between September, 2017 and January, 2018, by using the following keywords: "Liver Transplantation, "Immunization Schedule", "Hepatitis B Vaccines". In order to analyze the articles, a summary figure was especially designed and both the results and discussion were presented in a descriptive way. RESULTS: We included 24 studies; among them, eight had accelerated immunization schedules, 13 followed the conventional schedules, and three had super accelerated schedules. Regarding immunization, 21 studies were conducted with patients in the pre-transplant period, one with a transplanted patient, one with a pre-transplant group, and one with a post-transplant group. Found articles suggest that, disregarding the chosen immunization schedule, seroconversion rates tended to be lower as the liver disease advanced, compared to the healthy population. CONCLUSION: The studies did not find seroconversion superiority between the different immunization schedules (conventional and unconventional). However, since candidates to liver transplantation are usually very vulnerable, results show that super accelerated immunization schedules are possibly recommended for such group of patients; serologic test results will be higher when the immunization schedule is completed in the pre-transplant period.

RESUMO CONTEXTO: O transplante de fígado, apesar de ser um procedimento de elevado risco, está consolidado como recurso terapêutico para cura e melhoria da qualidade de vida de indivíduos acometidos por doenças. A prevenção da infecção pelo vírus da hepatite B através da vacinação tem sido a medida mais efetiva para reduzir complicações, diminuindo o número de pessoas com hepatite crônica pelo vírus da hepatite B e eliminando a transmissão. OBJETIVO: 1. Analisar as evidências na literatura sobre os diferentes esquemas utilizados para a vacina contra a hepatite B em pacientes submetidos a transplante de fígado. 2. Sugerir possíveis esquemas de vacinação contra hepatite B para pacientes com cirrose hepática, sem documentação comprovatória anterior, em relação à classificação de Child-Turcotte Pugh, segundo evidências encontradas na literatura. MÉTODOS: Revisão sistemática da literatura, realizada nas bases de dados MedLine, PubMed e Lilacs, no período de setembro/2017 a janeiro/2018, com as seguintes palavras chaves: "Liver Transplantation, "Immunization Schedule", "Hepatitis B Vaccines". Para análise dos artigos foi utilizado um quadro sinóptico especialmente construído para esse fim e a apresentação dos resultados e discussão foi feita de forma descritiva. RESULTADOS: Foram incluídos 24 estudos, sendo oito com esquemas vacinais acelerados, 13 com esquemas convencionais e três com esquemas super acelerado. Quanto ao período da vacinação, 21 estudos foram realizados com pacientes no período pré-transplante, um em pacientes transplantados e um com um grupo pré e um grupo pós transplante. Os artigos encontrados sugerem que independente do esquema vacinal escolhido, as taxas de soroconversão tendem a ser menores conforme o avançar da doença hepática, em relação à população saudável. CONCLUSÃO: Os estudos não encontraram superioridade de soroconversão entre os diferentes esquemas de vacinação (convencional e não convencional). Entretanto, sabendo da vulnerabilidade que os candidatos a transplante de fígado estão expostos, os resultados demonstram que o esquema de vacinação superacelerado pode ser indicado para este grupo de pacientes, e que os resultados sorológicos são mais elevados quando o esquema de vacinação é completado no período pré-transplante.