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Background International Sustainable Development Goals (SDGs) for elimination of hepatitis B virus (HBV) infection set ambitious targets for 2030. In African populations, infant immunisation has been fundamental to reducing incident infections in children, but overall population prevalence of chronic hepatitis B (CHB) infection remains high. In high-prevalence populations, adult catch-up vaccination has sometimes been deployed, but an alternative Test and Treat (T&T) approach could be used as an intervention to interrupt transmission. Universal T&T has not been previously evaluated as a population intervention for HBV infection, despite high-profile data supporting its success with human immunodeficiency virus (HIV). Methods and findings We set out to investigate the relationship between prevalence of HBV infection and exposure in Africa, undertaking a systematic literature review in November 2019. We identified published seroepidemiology data representing the period 1995–2019 from PubMed and Web of Science, including studies of adults that reported prevalence of both hepatitis B surface antigen (HBsAg; prevalence of HBV infection) and antibody to hepatitis B core antigen (anti-HBc; prevalence of HBV exposure). We identified 96 studies representing 39 African countries, with a median cohort size of 370 participants and a median participant age of 34 years. Using weighted linear regression analysis, we found a strong relationship between the prevalence of infection (HBsAg) and exposure (anti-HBc) (R2 = 0.45, p < 0.001). Region-specific differences were present, with estimated CHB prevalence in Northern Africa typically 30% to 40% lower (p = 0.007) than in Southern Africa for statistically similar exposure rates, demonstrating the need for intervention strategies to be tailored to individual settings. We applied a previously published mathematical model to investigate the effect of interventions in a high-prevalence setting. The most marked and sustained impact was projected with a T&T strategy, with a predicted reduction of 33% prevalence by 20 years (95% CI 30%–37%) and 62% at 50 years (95% CI 57%–68%), followed by routine neonatal vaccination and prevention of mother to child transmission (PMTCT; at 100% coverage). In contrast, the impact of catch-up vaccination in adults had a negligible and transient effect on population prevalence. The study is constrained by gaps in the published data, such that we could not model the impact of antiviral therapy based on stratification by specific clinical criteria and our model framework does not include explicit age-specific or risk-group assumptions regarding force of transmission. Conclusions The unique data set collected in this study highlights how regional epidemiology data for HBV can provide insights into patterns of transmission, and it provides an evidence base for future quantitative research into the most effective local interventions. In combination with robust neonatal immunisation programmes, ongoing PMTCT efforts, and the vaccination of high-risk groups, diagnosing and treating HBV infection is likely to be of most impact in driving advances towards elimination targets at a population level., Anna McNaughton and colleagues study the epidemiology of hepatitis B virus in African countries, and assess strategies to reduce disease burden., Author summary Why was this study done? Hepatitis B virus (HBV) infection is a major global health problem, with an estimated 290 million infections worldwide; international targets set the challenge for this public health threat to be eliminated by 2030. Administering HBV vaccine to babies is a very successful way to prevent new infections, but previous studies have shown that this strategy will take many decades to bring about elimination targets. We set out to investigate other approaches that can be used in combination with the infant vaccination schedule, using data from a meta-analysis and modelling the impact of vaccinating older children and adults, or enhancing testing and treatment (T&T) of existing HBV infections. What did the researchers do and find? We undertook a review and meta-analysis of all the published data describing the frequency of HBV infection, as well as the frequency of exposure to HBV infection in African populations, working with data from 96 studies published between 1995 and 2019. Using these data, we demonstrated a significant relationship between exposure and infection (overall p < 0.001) and identified differences between geographic regions. Using an existing mathematical model, our findings suggest that vaccinating older age groups has negligible sustained effect on HBV rates in a population, but universal T&T of HBV is predicted to have a substantial impact. What do these findings mean? Our results show different patterns of HBV infection and transmission in different regions of Africa, illustrating that interventions may need to be tailored according to the specific setting. We have demonstrated that vaccination campaigns targeting older children and adults are unlikely to be an effective use of resources in most African populations, and that resources are better diverted to improving diagnosis and treatment of existing infections. The study is limited by gaps in existing data, such that many populations in Africa are poorly represented. Our conclusions are drawn from the output of a model and will need to be validated in clinical practice.

Introduction: Institutionalized mentally retarded subjects are well-known to be at-risk for HBV infection. We studied the persistence of vaccine-induced anti-HBs antibodies and the robustness of the HBsAg-specific immune memory in this population, 18-20 years after the first vaccine dose. Materials and methods: Non-immune residents of 4 institutions were immunized in 1984-1986. In 2004, 207 subjects were bled to determine humoral and cellular immune memory. Immune response to a booster dose was evaluated in subjects with anti-HBs level

A patient with agammaglobulinemia developed acute hepatitis that progressed to chronic liver disease with high levels of hepatitis B virus (HBV) DNA in the absence of detectable HBsAg. Sequencing of the a determinant region of HBsAg revealed multiple amino acid substitutions that, unusually, also included a substitution at position 122 that defines subtype specificity. All of these mutations had a profound effect on the antigenicity of this region, which led to the complete failure of variant detection by commercially available routine diagnostic assays or laboratory-based monoclonal antibody assays.

Travellers often present late for the third dose of hepatitis B vaccination and measuring anti-HBs serology is common practice to ensure that these individuals are protected. We assessed the adequacy of immune response in 86 healthy travellers who had their third dose of hepatitis B (HB) vaccine performed more than 1 year (median: 3.4 years; range: 1.1-10.5 years) after the second dose. Eighty-two travellers (95.3%) had evidence of sero-protection (anti-HBs titre >10 UI/L) including 16/17 (94.1%) travellers who had an interval of more than 5 years between second and third vaccine dose. We did not find any risk factor associated with insufficient response.

In resource-limited countries, nosocomial transmission of bloodborne pathogens is a major public health concern. After a major outbreak of human immunodeficiency virus (HIV) infection in approximately 400 children in 1998 in Libya, we tested HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) markers in 148 children and collected epidemiological data in a subgroup of 37 children and 46 parents. HIV infection was detected in all children but one, with HCV or HBV coinfection in 47% and 33%, respectively. Vertical transmission was ruled out by analysis of parents' serology. The children visited the same hospital 1-6 times; at each visit, invasive procedures with potential blood transmission of virus were performed. HIV and HCV genotypic analyses identified a HIV monophyletic group, whereas 4 clusters of HCV sequences were identified. To our knowledge, this is the largest documented outbreak of nosocomial HIV transmission.

Cancer chemotherapy in chronic carriers of hepatitis B virus is known to promote viral replication, and, when immunosuppressive treatment is stopped, the return of immune competence can be followed by a fulminant hepatitis. Liver transplantation may be required and has been successfully performed for this condition. However, malignancy recurrence after transplantation has not been reported yet.We here report the case of an asymptomatic hepatitis B surface antigen carrier who developed a malignant lymphoma, which was treated by chemotherapy. After cessation of chemotherapy, he developed a fulminant hepatitis, requiring liver transplantation. Three years later, he developed a recurrent malignant lymphoma, which was treated successfully by autologous bone marrow transplantation. In order to prevent viral replication, lamivudine and intermittent administration of fresh-frozen plasma highly concentrated in anti-HBs immunoglobulin was initiated before the bone marrow transplantation. The patient remains well 12 and 56 months after autologous bone marrow and liver transplantation, respectively.This experience suggests that all hepatitis B surface antigen-positive patients for whom chemotherapy is indicated would benefit from prophylactic antiviral hepatitis B virus therapy. Furthermore, successful autologous bone marrow transplantation is possible after liver transplantation.

Three comparable vaccines against hepatitis B, consisting of recombinant HBsAg, are registered in Switzerland. After intramuscular administration (deltoid, thigh), they induce seroconversion in 95% of subjects following a 0, 1, 6 or 0, 1, 2 and 12 months schedule. The determination of antibody titers is thus not required in healthy subjects in absence of an increased risk of exposure (healthcare workers). Vaccine induced protection is extended beyond the disappearance of specific antibodies, through the persistence of immunological memory, which reactivates immune defense mechanisms upon viral exposure. A booster immunization is thus not necessary after a full immunization course, even if given in the first year of life or in newborns of HBsAg positive mothers. The excellent safety profile of these vaccines (local pain 3-29%, fever 1-6%) allows their universal administration. Two combined vaccines are already available, and new vaccines may yet facilitate prevention of hepatitis B in the future by allowing a reduction in the number of doses required for protection.

To assess the degree of immune system activation associated with addiction or hepatotropic viruses infection, we examined 60 HIV-negative heroin addicts for the presence of hepatitis B virus (HBV) infection markers, hepatitis C virus antibodies (anti-HCV), various auto-antibodies, and serum levels of soluble interleukin-2 receptors (sIL-2R). In addition, 28 anti-HCV positive patients comprising the disease control group, were also examined. Our results demonstrated a high prevalence of anti-HCV antibodies (61.7% and 90% with 1st and 2nd generation ELISA, respectively). Eighty-seven percent (87%) of the addicts positive for anti-HCV by the latter and 92.8% of the disease control patients, were also positive with 2nd generation recombinant immunoblot assay (RIBA-II). In 88.9% of anti-HCV positive addicts, antibody to C22-3 was the predominant (anti-C33c in 81.5%). Antibodies to C33c and C22-3 polypeptides were also more frequent in disease control group (92.8% and 85.7%, respectively). Anti-HCV antibodies were associated with increased transaminases (ALT or AST, P < 0.05), as well as with longer duration of addiction (P < 0.005). HBV infection markers (HBsAg, anti-HBc only and anti-HBs) were also present in the addicts (5%, 28.3% and 26.7%, respectively). Rheumatoid factors (RF) were detected in 36.7%, antinuclear antibodies (ANA) in 11.7%, antibodies (IgG and/or IgM) against cardiolipin (anti-CL) and double stranded DNA (anti-ds DNA) in 20% and 50%, respectively. RF, ANA, anti-CL and anti-dsDNA antibodies were also detected in the disease control group (32.1%, 89.3%, 28.5% and 28.5% respectively).(ABSTRACT TRUNCATED AT 250 WORDS) Eur J Clin Invest

Hepatitis C virus (HCV) seems to be the main causative agent of the parenterally transmitted non-A, non-B hepatitis and the detection of anti-HCV may be a marker of ongoing infection with this virus. This study was undertaken to determine the frequency of anti-HCV in 51 haemodialysis patients of our renal unit. In addition association of these antibodies to sex, history of blood transfusions, and duration on haemodialysis, as well as to serological markers of hepatitis B virus infection, was applied. Enzyme-linked immunosorbent assay (ELISA), were used for the detection of all serological markers. Nine of the 51 (17.6%) haemodialysis patients had anti-HCV. The presence of anti-HCV was related to male sex. Although seropositive patients were transfused more often than seronegatives, this difference is not statistically significant. The presence of anti-HCV was associated with the duration of haemodialysis. The majority of anti-HCV patients had serological markers of previous HBV infection, in contrast to seronegative patients. Nephrol Dial Transplant