Seroprevalence of IgM and IgG Antibodies against SARS-CoV-2 in Asymptomatic People in Wuhan: Data from a General Hospital Near South China Seafood Wholesale Market during March to April in 2020 / 生物医学与环境科学（英文）

The aim of this study was to estimate the seroprevalence of immunoglobulin M (IgM) and G (IgG) antibodies against SARS-CoV-2 in asymptomatic people in Wuhan. This was a cross-sectional study, which enrolled 18,712 asymptomatic participants from 154 work units in Wuhan. Pearson Chi-square test,

Immunoregulation in human malaria: the challenge of understanding asymptomatic infection

Asymptomatic Plasmodium infection carriers represent a major threat to malaria control worldwide as they are silent natural reservoirs and do not seek medical care. There are no standard criteria for asymptomaticPlasmodium infection; therefore, its diagnosis relies on the presence of the parasite during a specific period of symptomless infection. The antiparasitic immune response can result in reducedPlasmodium sp. load with control of disease manifestations, which leads to asymptomatic infection. Both the innate and adaptive immune responses seem to play major roles in asymptomatic Plasmodiuminfection; T regulatory cell activity (through the production of interleukin-10 and transforming growth factor-β) and B-cells (with a broad antibody response) both play prominent roles. Furthermore, molecules involved in the haem detoxification pathway (such as haptoglobin and haeme oxygenase-1) and iron metabolism (ferritin and activated c-Jun N-terminal kinase) have emerged in recent years as potential biomarkers and thus are helping to unravel the immune response underlying asymptomatic Plasmodium infection. The acquisition of large data sets and the use of robust statistical tools, including network analysis, associated with well-designed malaria studies will likely help elucidate the immune mechanisms responsible for asymptomatic infection.

Evaluation of Haemophilus influenzae type b carrier status among children 10 years after the introduction of Hib vaccine in Brazil

The aim of the present study was to assess the prevalence of Haemophilus influenzaetype b (Hib) nasopharyngeal (NP) colonisation among healthy children where Hib vaccination using a 3p+0 dosing schedule has been routinely administered for 10 years with sustained coverage (> 90%). NP swabs were collected from 2,558 children who had received the Hib vaccine, of whom 1,379 were 12-< 24 months (m) old and 1,179 were 48-< 60 m old. Hi strains were identified by molecular methods. Hi carriage prevalence was 45.1% (1,153/2,558) and the prevalence in the 12-< 24 m and 48-< 60 m age groups were 37.5% (517/1,379) and 53.9% (636/1,179), respectively. Hib was identified in 0.6% (16/2,558) of all children in the study, being 0.8% (11/1,379) and 0.4% (5/1,179) among the 12-< 24 m and 48-< 60 m age groups, respectively. The nonencapsulate Hi colonisation was 43% (n = 1,099) and was significantly more frequent at 48-< 60 m of age (51.6%, n = 608) compared with that at 12-< 24 m of age (35.6%, n = 491). The overall resistance rates to ampicillin and chloramphenicol were 16.5% and 3.7%, respectively; the co-resistance was detected in 2.6%. Our findings showed that the Hib carrier rate in healthy children under five years was very low after 10 years of the introduction of the Hib vaccine.

Prevalence of hepatitis B virus infection and carriage after nineteen years of vaccination program in the Western Brazilian Amazon / Prevalência da infecção e de portadores do vírus da hepatite B, após 19 anos do programa de vacinação na Amazônia ocidental Brasileira

INTRODUCTION: Reductions in the prevalence of hepatitis B virus (HBV) infection and carriage, decreases in liver cancer incidence, and changes in patterns of liver dysfunctions are described after hepatitis B vaccination. METHODS: We conducted a population-based seroprevalence study aimed at estimating the HBV prevalence and risk of infection in the rural area of Lábrea following nineteen years of HBV vaccination. RESULTS: Half of the subjects showed total anti-HBc of 52.1 percent (95 percent CI 49.6-54.7). The HBsAg prevalence was 6.2 percent (95 percent CI 5.1-7.6). Multivariate analysis showed an inverse association between HBV infection and vaccination (OR 0.62; 95 percent CI 0.44-0.87). HBsAg remained independently associated with past hepatitis (OR 2.44; 95 percent CI 1.52-3.89) and inversely to vaccination (OR 0.43; 95 percent CI 0.27-0.69). The prevalence of HBeAg among HBsAg-positive individuals was 20.4 percent (95 percent CI 12.8-30.1), with the positive subjects having a median age of 11 years (1-46) p=0.0003. CONCLUSIONS: We demonstrate that HBV infection is still an important public health issue and that HBV vaccination could have had better impact on HBV epidemiology. If we extrapolate these findings to other rural areas in the Brazilian Amazon, we can predict that the sources of chronic infected patients remain a challenge. Future studies are needed regarding clinical aspects, molecular epidemiology, surveillance of acute cases, and risk groups.

INTRODUÇÃO: Reduções nas taxas de prevalência de infecção pelo vírus da hepatite B (VHB) e de portadores, incidência de câncer de fígado e mudança nos padrões de doenças hepáticas são descritos, depois da introdução da vacinação contra hepatite B. MÉTODOS: Foi conduzido um estudo de soro prevalência de base populacional, com o objetivo de estimar a prevalência do VHB e fatores de risco de infecção na área rural de Lábrea, depois de 19 anos de introdução da vacinação contra hepatite B. RESULTADOS: Metade dos indivíduos investigados mostrou reatividade ao anti-HBc total, 52,1 por cento (IC 95 por cento 49,6-54,7). A prevalência do HBsAg foi 6,2 por cento (IC 95 por cento 5,1-7,6). Análises multivariadas mostrou associação inversa da infecção pelo VHB e vacinação (OR 0,62; IC 95 por cento 0<44-0,87). A presença do HBsAg permaneceu independentemente associada com o passado de hepatite (OR 2,44; IC 95 por cento 1,52-3,89) e inversamente associado a história de vacinação (OR 0,43; IC 95 por cento 0,27-0,69). A prevalência do HBeAg, entre os HBsAg positivos foi 20,4 por cento (IC95 por cento 12,8-30,1), tendo em média os indivíduos positivos 11 anos de idade (1-46) p=0,0003. CONCLUSÕES: Foi demonstrado que o VHB é ainda um importante problema de saúde publica, e que a vacinação contra o VHB poderia ter tido um impacto maior na epidemiologia do VHB na região. Se esses achados forem extrapolados para outras regiões rurais da Amazônia brasileira, podemos predizer que a fonte de pacientes crônicos é ainda um desafio a ser vencido. Estudos futuros devem focar os aspectos clínicos, a epidemiologia molecular, vigilância de casos agudos e grupos de risco.

Smooth muscle antibodies and cryoglobulinemia are associated with advanced liver fibrosis in Brazilian hepatitis C virus carriers

Cryoglobulinemia and non-organ-specific-autoantibody are biomarkers of autoimmunity of the chronic infection caused by hepatitis C virus (HCV). In this work, we report the association between the presence of smooth muscle antibodies (SMA) and cryoglobulinemia and chronic liver disease in HCV carriers. Sixty-five untreated HCV patients, 38 women and 27 men were included in this study. Cryoglobulinemia was tested by cryoprecipitation, SMA by indirect fluorescent antibody test, and liver fibrosis and hepatocellular inflammation activity was investigated by histology of liver biopsy using the METAVIR score. The prevalence of SMA in the patients was 33.8 percent and cryoglobulinemia was demonstrated in 36.9 percent patients. Cryoglobulinemia and SMA seropositivity was associated with advanced fibrosis (p < 0.05). The presence of SMA and cryoglobulinemia was not associated with hepatocellular inflammation activity, age, carrier gender or HCV genotype. We concluded that liver biopsy should be recommended for HCV carriers that are seropositive for SMA or cryoglobulinemia.

Nasopharyngeal Pneumococcal Carriage of Children Attending Day Care Centers in Korea: Comparison between Children Immunized with 7-valent Pneumococcal Conjugate Vaccine and Non-immunized

To confirm the effect of 7-valent pneumococcal conjugate vaccine (PCV7), pneumococcal nasopharyngeal (NP) carriage was compared between vaccinated (3 + 1 doses PCV7) and non-vaccinated children. Vaccinated subjects were recruited from highly vaccinated regions (> or = 60%), Seoul and Incheon whereas control subjects were recruited from Jeju Island where vaccination rates are low (< 15%). NP swabs were obtained from 400 children aged 18-59 months. Serotype and antibiotic susceptibility was analyzed. Pneumococcal carriage rate was 18.0% (36/200) and 31.5% (63/200) for the vaccinated and control group, respectively. Among those vaccinated, 41.7% (15/36) of the serotypes were vaccine-related type (VRT: 6A, 6C, 19A) with the most common serotype 6C. The next common type was non-typable/non-capsule 30.6% (11/36) followed by non-vaccine type 16.7% (6/36) and vaccine type (VT) serotypes were found in only 11.1% (4/36). In contrast, 52.4% (33/63) of the isolates in the control group were VT. Resistance rates for penicillin and erythromycin were lower in the vaccine group (vaccine vs control; penicillin 45.2% vs 71.4%, erythromycin 74.2% vs 90.5%, P < 0.05). Multi-drug resistance was also lower in vaccinated subjects (vaccine vs control; 45.2% vs 69.8%, P < 0.05). PCV7 reduces carriage in VT which leads to replacement of pneumococci by antibiotic susceptible VRT or non-vaccine type strains.

Clinical and immunological features of patients with atopy and concomitant HTLV-1 infection

Human T-cell lymphotropic virus type 1 (HTLV-1) induces an exacerbated type 1 immune response characterized by high spontaneous IFN-γ and TNF-α production. Allergic rhinitis and asthma are associated with the type 2 immune response, with elevated secretion of IL-4 and IL-5. The aim of this study was to characterize the immune response in atopic HTLV-1 carriers. The cytokine profile of atopic HTLV-1 carriers (N = 10; all females) was compared with that of non-atopic HTLV-1 carriers (N = 14; 9 females and 5 males). Mean patient age of atopic and non-atopic groups was 45 ± 8 and 38 ± 11 years, respectively. All atopic HTLV-1 carriers had rhinitis with or without asthma and a skin prick test positive for Dermatophagoides pteronyssinus antigen 1 (Derp-1). There was no difference in cytokine levels between the two groups in unstimulated peripheral blood mononuclear cell cultures. In cultures stimulated with Derp-1, IFN-γ levels tended to be higher (P = 0.06) and IL-5 levels were higher (P = 0.02) in atopic HTLV-1 patients than in non-atopic subjects. In contrast, IL-10 was lower (P = 0.004) in atopic than in non-atopic HTLV-1-infected subjects. This study shows that HTLV-1 infection with an exaggerated type 1 immune response does not prevent atopy. In this case, the exacerbated type 1 and type 2 immune responses were due to a lack of IL-10 production, a cytokine that plays an important role in down-modulating type 1 and type 2 immune responses and in preventing the development of chronic inflammatory diseases.

Ineffectiveness for infants of immunization of mothers with pneumococcal capsular polysaccharide vaccine during pregnancy

Pneumococcal (Pnc) carriage is associated with pneumococcal diseases. Breast feeding and maternal vaccination may be a useful approach to prevent pneumococcal infection in young infants. We examined the risk of Pnc carriage by infants at six months of age after pneumococcal polysaccharide vaccination of pregnant women. We selected 139 pregnant woman. The woman were randomly allocated to receive 23-valent polysaccharide vaccines during pregnancy (Group 1) after pregnancy (Group 2) or not receive any vaccine (Group 3). Nasopharyngeal swabs were collected from the infants at three and six months of age. The infants were evaluated monthly during the first six months. We included 47 mothers in Group 1, 45 mothers in Group 2 and 47 mothers in Group 3. Forty-seven percent of the babies were exclusively breast fed until six months, 26 percent received both breast feeding and artificial feeding and 13 percent received only artificial feeding. Among those patients, 26 percent were colonized by Pnc at six months (12 from Group 1, 13 from Group 2, and 12 from Group 3). There was no significant difference in colonization between the three groups. Thirty percent of the children were colonized by a non-susceptible strain. We concluded that young infants (three months old) are already susceptible to pneumococcal carriage. Vaccination during pregnancy with a polysaccharide vaccine did not decrease Pnc colonization.

Estudo da resposta imune humoral (IgG específica) para antígenos de larvas infectantes (L3) de Wuchereria bancrofti, entre portadores e não portadores de filariose bancroftiana no Município de Olinda-PE / Study of the immune humoral response (IgG specific) for antigens of infective larvae (L3) of Wuchereria bancrofti, between bearers and not bearers of elephantiasis filarial in the city of Olinda-PE

A filariose linfática bancroftiana é uma doença parasitária humana de grande complexidade em sua dinâmica de infecção, necessitando ainda de maiores esclarecimentos, principalmente, em aspectos relacionados à tolerância e imunopatologia. A existência daimunidade protetora em comunidades endêmicas de filariose permanece como objeto de intenso debate e o grupo denominado “endêmicos normais”, tem sido alvo de interesse para elucidar muitas questões referentes à imunologia da doença. O presente trabalho tem como objetivo verificar através de um estudo do tipo caso-controle, as diferenças entre portadorese não portadores de filariose linfática bancroftiana pelo reconhecimento humoral de bandas protéicas de extrato secretório-excretório de larvas infectantes de Wuchereria bancrofti. Osquatro setores censitários de Olinda-PE, com maior prevalência de filariose, foram escolhidos como área de estudo. Consideramos “grupo controle” portadores da filariose bancroftiana e “grupo de casos” os de endêmicos normais. O extrato antigênico foi obtidopor incubação de larvas infectantes em meio Hanks por 72h em 5% de CO2. As bandas protéicas foram separadas por eletroforese (SDS-PAGE) e por western-blot, transferidas e incubadas com os soros humanos. Foram considerados portadores da doença os positivospela técnica da gota espessa ou filtração e endêmicos normais os residentes de área endêmica negativos pelo teste de detecção parasitária e captura de antígenos (Og4C3). Participaram do estudo 325 indivíduos, 130 considerados endêmicos normais e 195portadores de filariose bancroftiana. As bandas protéicas da composição do extrato de L3 foram as de 200, 175, 138, 105, 100, 76, 55, 49, 42, 39, 38, 32, 28, 14 kDa. Na comparaçãodo reconhecimento das proteínas entre os grupos estudados, apenas as proteínas 175 e 105 kDa não diferiram significativamente, os portadores de filariose bancroftiana não reconheceram a proteína 175 e no grupo...

Natural History of HBeAg Negative Chronic Hepatitis B Virus Infection: A Cohort Study / 대한간학회지

BACKGROUND/AIMS: The long-term virologic and biochemical changes in patients with HBeAg negative HBV infection, especially in Asia, remain unclear. To address this issue, we conducted a 3 year- retrospective, cohort study. METHODS: A total of 157 patients with HBeAg negative HBV infection who were monitored without treatment were reviewed between January 1999 and March 2004. Those patients were followed up every 3 months with liver function tests and serologic tests. All patients were stratified into 3 groups; inactive carrier (IC), viremic carrier (VC) and chronic hepatitis (CH). Serum HBV DNA was measured by a hybridization assay (sensitivity: 1.4 x 10(5) genomes/mL, Digene Diagnostics, Silver Spring, USA). RESULTS: The median age of enrolled patients was 42.7 years (M:F=2.3:1). By single time-point observations, the 3 year-cohort prevalence of HBeAg negative CH varied from 12.7 to 35.8% (median 20.7%) HBeAg negative CH was accumulated over time (P=0.002) and transition rates among three groups after 3 years of follow-up are as follows: IC to CH, 6.0%; IC to VC, 4.1%; VC to CH, 23.2%. VC seems to be a disease state in the middle of transition from IC to CH. CONCLUSIONS: We demonstrated the dynamic changing patterns of HBeAg negative CH with time, of which the change from IC or VC to CH was dominant.

Estatus inmunológico de las madres infectadas por T. cruzi / Immunological status of mothers infected with Trypanosoma cruzi

The mechanisms of congenital transmission of Chagas disease remain largely unknown. To better understand the role of maternal immunology during pregnancy in congenital Chagas transmission, we studied the cytokine production and the parasitic load in three groups of mothers: infected mothers who transmitted the disease to their babies (M+B+-), infected mothers who did not transmit the disease to their babies (M+B-) and not infected mothers as a control group (M-B-). M+B+ mothers produced less IFNgamma and more IL-10 than the M+B- mothers, and they are not able to produce IL-2. M+B+ mothers showed a higher parasitic load. These results, indicated that the congenital Chagas transmission is associated with an immunological imbalance and a high parasitic load in the M+B+ mothers.

Chronic hepatitis B virus carriers have low lymphoproliferative responses to HBsAg and reduced interleukin-2 synthesis.

BACKGROUND: Chronic carriers of hepatitis B virus (HBV) have impairment of lymphoproliferative responses. Recently HBV infection of peripheral blood mononuclear cells (PBMC) has been reported. The defect in the proliferative capacity of carrier PBMC has not been correlated to the presence of HBV in these cells. METHODS: PBMC of fourteen HBV carriers and 14 healthy individuals were stimulated with phytohemagglutinin (PHA), pokeweed mitogen (PWM) or anti-CD3 for 3 days and with HBsAg and purified protein derivative (PPD) for 6 days. The supernatants of unstimulated and PHA-stimulated PBMC cultures were bioassayed for interleukin-2 (IL-2); the supernatants of unstimulated and lipopolysaccharide (LPS)-stimulated cultures were bioassayed for IL-1. DNA extracted from PBMC was hybridized with a 32P-labeled HBV probe to look for HBV DNA. RESULTS: HBV carriers' PBMC showed impaired responses to PHA, PWM and anti-CD3. No carrier demonstrated lymphoproliferative response to hepatitis B surface antigen (HBsAg). Seven of eight carriers with impaired HBsAg-specific proliferative responses who were tested for their response to an unrelated antigen showed a positive response to PPD. PBMC from HBV carriers produced similar amounts of IL-1 as normal PBMC on LPS stimulation; however, they produced significantly lower amounts of IL-2 as compared to normal PBMC under both spontaneous and PHA-stimulated conditions. HBV DNA was demonstrable in the PBMC of all fourteen carriers. CONCLUSIONS: The abnormal immune function found in chronic HBV carriers may be a consequence of replicative viral infection of the mononuclear cells.

Evidências sorológicas da circulação do arbovírus Rocio (Flaviviridae) na Bahia / Serological evidence of the circulation of the Rocio arbovirus (Flaviviridae) in Bahia

Oito casos com anticorpos anti-Rocio são descritos, de quatro cidades do Estado da Bahia, sendo seis portadores de anticorpos IgG (IH e TN) e dois IgM (ELISA e TN). Os autores comentam sobre a circulação deste arbovírus no Estado, e as possibilidades de reações cruzadas com outros vírus antigenicamente relacionados.

Eight antibody anti-Rocio cases, from four distinct cities in the state of Bahia, are described; six of them being carriers of the antibody IgG (HI and NT) and two IgM (ELISA and NT). The authors comment on the circulation of these arboviruses in the state of Bahia and on the possibility of cross reactions with other antigenically related viruses.

Inquérito soro-epidemiológico antilistéria em Uberaba, MG / A seroepidemiological investigation of listerosis in Uberaba, MG

From a total of 445 individuals, 17.1 per cent had antibodies against L. monocytogenes detected by the agglutination tube test. They were separated in seven groups: bloods donnors (n = 50), Hospital visitors (n = 40), frigorific workers (n = 28), aviculture workers (n = 87), herdsman (n = 31), agriculture students (n = 60) and street-sweepers (n = 51). L1/2a serotype was predominant. Individuals from urban areas (19.5 per cent) and those who had less contact with animals (21.7 per cent) had significantly positive serology when compared with individuals from rural areas (9.4 per cent) and those who had close contact with animals (13.2 per cent). The overall picture is individuals of more specialized occupations had more frequently (25.9 per cent) anti listeria antibodies similar to the results observed in developed countries where listeriosis is a public health problem in urban areas.

Estafilococos resistentes à Oxacilina säo encontrados entre portadores da comunidade? / Are there oxacilin resistent staphilococci among carriers in the communitty?

O objetivo deste trabalho é investigar a existência de estafilococos resistentes à oxacilina entre portadores da comunicade. Para tanto, estudamos amostras obtidas de 93 estudantes de medicina näo expostos ao ambiente hospitalar. Dois testes laboratoriais foram empregados para detecçäo de resistência à oxacilina: teste de difusäo em ágar e teste de triagem com meio salino. Isolou-se Staphylococcus aureus em 21 (22,6 por cento) dos estudantes, näo tendo sido observada resistência a oxacilina. Em três estudantes encontramos estafilococos coagulares negativos apresentando resistência a oxacilina. Os dois testes laboratoriais usados na detecçäo de resistência apresentaram boa correlaçäo. Os dados obtidos apoiam o uso de oxacilina para tratamento de estafilococcias adquiridas na comunidade

Toxoplasma infection in healthy persons and in patients with HIV or ocular disease.

Toxoplasma infection is associated with acquired immune deficiency syndrome (AIDS), pregnancy, chorioretinitis, etc. Since the number of AIDS patients is increasing rapidly in Thailand and there are few reports about T. gondii immune status in this country. Toxoplasma-specific IgG and IgM antibodies (Ab) were determined in healthy persons and patients with different symptoms who were suspected of toxoplasmosis. Specific IgG Ab were detected in 3.2% of healthy persons, 12.5% of patients with ocular disease and in 42.5% in HIV positive patients. Only 3.1% of patients with ocular disease were positive for specific IgM Ab. No specific IgM Ab were found in the other samples studied.

Historia natural de la infección amibiana durante el primer año de vida: estudio comparativo de cohortes / Natural history of amebic infection in infants: a cohort comparative study

Introducción. El mecanismo de transmisión intrafamiliar es uno de los más importantes en la infección amibiana; sin embargo el papel de la madre portadora no ha sido demostrado con objetividad y existe escasa información sobre la historia natural de la respuesta inmune humoral en los portadores asintomáticos. Fue objetivo de este estudio identificar el papel de la infección materna por Entamoeba hystolytica en la transmisión del parásito a sus hijos y su relación con la respuesta inmune humoral así como con la caracterización del tipo de zimodemo. Material y métodos. Se efectuó un estudio comparativo y prolectivo de cohortes madre-recién nacido caracterizado por la presencia (n= 21) o ausencia (n= 29) de madres portadoras del parásito, a las cuales se visitó cada 2 semanas durante un año, a partir del nacimiento de los hijos. En cada ocasión se obtuvieron muestras de heces del binomio para la identificación de E. histolytica por estudios coproparasitoscópicos y cultivo de Robinson. Cada 4 meses se colectó sangre venosa del binomio para hemaglutinación indirecta y Western-blot. Resultados. El 51 por ciento de las muestras fecales de las madres portadoras mantuvieron esta característica a lo largo del seguimiento, mientras que sólo en el 1.5 por ciento de las muestras de las madres no portadoras se idenificó al parásito P < 0.0001). La incidencia de infección amibiana durante el primer año de vida de los hijos índice fue de 10 por ciento (5/50), cuatro pertenecientes a la cohorte de madres portadoras y uno a la de no portadoras (P = 0.1). En los cinco niños infectados los títulos de anticuerpos antiamibianos fueron más altos que el resto de los hijos (P < 0.02) y el Western blot mostró que hay fracciones antigénicas que inducen anticuerpos séricos de clase IgG, IgA e IgM contra este parásito desde fases muy tempranas. Conclusiones. ninguno de los portadores, incluidos los cinco niños infectados, presento manifestaciones de enfermedad amibiana. El patrón de excreción de quistes de E. histolytica entre las madres fue diferente, a pesar de compartir las mismas características del medio ambiente. La respuesta inmunológica observada en los niños infectados, sugiere mecanismos de inducción de anticuerpos diferentes a los descritos para la amibiasis intestinal invasora

Prevalencia de la infección por el virus de la hepatitis B (VHB) en mujeres embarazadas / Prevalence of the hepatitis B virus infection in pregnant women

De los diferentes virus de la hepatitis, el tipo B (VHB) es el que presenta una mayor transmisión perinatal. Una característica importante de la infección vertical por el VHB es el alto riesgo de progresar hasta una infección crónica. Se estudiaron los sueros de mujeres embarazadas que acudieron para realizarse estudios básicos de laboratorio de control prenatal, en búsqueda de marcadores serológicos de infección por el VHB. Se analizaron 1,443 sueros, identificándose cuatro positivos para el AgsHB y 28 con anticuerpos IgG contra el Ag core, lo que proporcionó una prevalencia de madres portadoras de la AgsHB del 0.27 por ciento y de pacientes con antiHBc de 1.95 por ciento. No se detectó ninguna mujer con Ige ni con anticuerpos IgM contra el Ag core. La importancia del escrutinio de embarazadas en búsqueda del AgsHB es identificar a las pacientes cuyos recién nacidos deben ser inmunizados contra el VHB y así reducir la posibilidad de transmisión