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Bazrafshani MS, Mehmandoost S, Tavakoli F, Shahesmaeili A, Ghalekhani N, Sharafi H, SeyedAlinaghi S, Haghdoost A, Karamouzian M, Sharifi H. Self-reported lifetime Hepatitis B virus testing, and vaccination uptake among people who inject drugs in Iran: a nationwide study in 2020. BMC Public Health 2024; 24:3156. [PMID: 39538214 PMCID: PMC11562248 DOI: 10.1186/s12889-024-20646-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/06/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is a silent epidemic among people who inject drugs (PWID). HBV testing and vaccination are important for PWID to reduce the risk of infection, prevent chronic complications and contribute to public health efforts in addressing HBV transmission. Our objective was to assess the self-reported lifetime uptake of HBV testing and vaccination among PWID in Iran and their associated factors. METHOD This cross-sectional study was conducted among 2,684 PWID in 11 large cities from July 2019 to March 2020 using a respondent-driven sampling method. Participants were interviewed face-to-face and asked about their lifetime experience of HBV testing and vaccination uptake as the outcome. Logistic regression models were built to identify related factors for reporting HBV testing and vaccination uptake. RESULTS The prevalence of HBV testing and vaccination uptake among PWID was 14.2% (95% confidence intervals [CI]: 12.8-15.6) and 16.4% (95% CI: 14.9-18.1), respectively. Shared needles, syringes, or equipment in the past 12 months decreased the odds of reporting lifetime HBV testing uptake (Adjusted odds ratio [AOR]:0.46, 95% CI: 0.29-0.72). However, having an academic education (AOR: 1.89, 95% CI: 1.09-3.30) and lifetime experience of homelessness (AOR: 1.58, 95% CI: 1.21-2.06) increased the odds of reporting lifetime HBV vaccination uptake. CONCLUSION Our study highlighted the low prevalence of HBV testing and vaccination uptake among PWID in Iran. It is essential to understand and address the obstacles preventing PWID from getting tested and vaccinated for HBV. Addressing these barriers could significantly reduce the burden of HBV among this socio-economically marginalized population.
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Affiliation(s)
- Maliheh Sadat Bazrafshani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Heidar Sharafi
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
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Kusnik A, Najim M, Renjith KM, Vyas C, Renjithlal SLM, Alweis R. The Influence of Urbanization on the Patterns of Hepatocellular Carcinoma Mortality From 1999 to 2020. Gastroenterology Res 2024; 17:116-125. [PMID: 38993549 PMCID: PMC11236338 DOI: 10.14740/gr1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/15/2024] [Indexed: 07/13/2024] Open
Abstract
Background Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related fatalities despite early diagnosis and treatment progress, creating a significant public health issue in the United States. This investigation utilized death certificate data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to investigate HCC mortality patterns and death locations from 1999 to 2020. The objective was to analyze trends in HCC mortality across different population groups, considering the impact of urbanicity. Methods In this study, death certificate data obtained from the CDC WONDER database were utilized to investigate the trends in HCC mortality and location of death between 1999 and 2020. The annual percent change (APC) method was applied to estimate the average annual rate of change during the specified timeframe for the relevant health outcome. Furthermore, including data on the location of death and geographic areas allowed us to gain deeper insights into the patterns and characteristics of HCC and its impact on different regions. Results Between 1999 and 2020, there were 184,073 reported deaths attributed to HCC, and data on the location of death were available for all cases. Most deaths occurred during inpatient admissions (34.93%) or at home (41.19%). The study also found that the highest age-adjusted mortality rate (AAMR) for HCC was observed among male patients, particularly among those identified as Asian or Pacific Islander. Variations in AAMR were determined based on the level of urbanization or rurality of the area, with higher rates observed in more densely populated and urbanized regions. In contrast, less urbanized and populated areas experienced a profound increase in AAMR over the past two decades. Conclusion The HCC-related AAMRs have worsened over time for most ethnic groups, except for Asian or Pacific Islanders, which showed a reduction in APC despite having the worst AAMR. Although rural and less densely populated areas have substantially increased AAMR over the past two decades, more urbanized areas continued to have higher AAMR rates.
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Affiliation(s)
- Alexander Kusnik
- Department of Internal Medicine, Unity Hospital, Rochester, NY, USA
| | - Mostafa Najim
- Department of Internal Medicine, Unity Hospital, Rochester, NY, USA
| | | | - Charmee Vyas
- Division of Palliative Care, University of Kentucky, Lexington, KY, USA
| | | | - Richard Alweis
- Department of Internal Medicine, Unity Hospital, Rochester, NY, USA
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Spradling PR, Bocour A, Kuncio DE, Ly KN, Harris AM, Thompson ND. Hepatitis B Care Continuum Models-Data to Inform Public Health Action. Public Health Rep 2024:333549231218277. [PMID: 38205796 PMCID: PMC11569688 DOI: 10.1177/00333549231218277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
The application of a care continuum model (CCM) can identify gaps in diagnosis, care, and treatment of populations with a common condition, but challenges are inherent in developing a CCM for chronic hepatitis B. In contrast with treatment for HIV or hepatitis C, treatment is not indicated for all people with chronic hepatitis B, clinical endpoints are not clear for those receiving treatment, and those for whom treatment is not indicated remain at risk for complications. This topical review examines the data elements necessary to develop and apply chronic hepatitis B CCMs at the jurisdictional health department level. We conducted a nonsystematic review of US-based publications in Ovid MEDLINE (1946-present), Ovid Embase (1974-present), and Scopus (not date limited) databases, which yielded 724 publications for review. Jurisdictional health departments, if properly supported, could develop locale-specific focused CCMs using person-level chronic hepatitis B registries, updated longitudinally using electronic laboratory reporting data and case reporting data. These CCMs could be applied to identify disparities and improve rates in testing and access to care and treatment, which are necessary to reduce liver disease and chronic hepatitis B mortality. Investments in public health surveillance infrastructure, including substantial enhancements in electronic laboratory reporting and case reporting and the use of supplementary data sources, could enable jurisdictional health departments to develop modified CCMs for chronic hepatitis B that focus, at least initially, on "early" CCM steps, which emphasize optimization of hepatitis B diagnosis, linkage to care, and ongoing clinical follow-up of diagnosed people, all of which can lead to improved outcomes.
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Affiliation(s)
- Philip R. Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angelica Bocour
- Viral Hepatitis Program, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Danica E. Kuncio
- Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Kathleen N. Ly
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aaron M. Harris
- Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicola D. Thompson
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kim SH, Park SH, Lee H. Machine learning for predicting hepatitis B or C virus infection in diabetic patients. Sci Rep 2023; 13:21518. [PMID: 38057379 PMCID: PMC10700585 DOI: 10.1038/s41598-023-49046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Highly prevalent hepatitis B and hepatitis C virus (HBV and HCV) infections have been reported among individuals with diabetes. Given the frequently asymptomatic nature of hepatitis and the challenges associated with screening in some vulnerable populations such as diabetes patients, we conducted an investigation into the performance of various machine learning models for the identification of hepatitis in diabetic patients while also evaluating the significance of features. Analyzing NHANES data from 2013 to 2018, machine learning models were evaluated; random forest (RF), support vector machine (SVM), eXtreme Gradient Boosting (XGBoost), and least absolute shrinkage and selection operator (LASSO) along with stacked ensemble model. We performed hyperparameter tuning to improve the performance of the model, and selected important predictors using the best performance model. LASSO showed the highest predictive performance (AUC-ROC = 0.810) rather than other models. Illicit drug use, poverty, and race were highly ranked as predictive factors for developing hepatitis in diabetes patients. Our study demonstrated that a machine-learning-based model performed optimally in the detection of hepatitis among diabetes patients, achieving high performance. Furthermore, models and predictors evaluated from the current study, we expect, could be supportive information for developing screening or treatment methods for hepatitis care in diabetes patients.
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Affiliation(s)
- Sun-Hwa Kim
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan, Republic of Korea
| | - So-Hyeon Park
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan, Republic of Korea
| | - Heeyoung Lee
- College of Pharmacy, Inje University, Gimhae, Republic of Korea.
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Kwon S, Casleton BG, Rivera GZ, Gella MM, Winkler EL, Kieffer JW, Osuna AB, Casey TM, Yun HC, Marcus JE. Infectious etiologies among post-donation deferrals in a military blood donation center. Transfusion 2023; 63:2265-2272. [PMID: 37850496 DOI: 10.1111/trf.17584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND The burden of transfusion-transmitted infections among blood recipients remains low due to extensive pre- and post-donation screening. However, the military has the unique challenge of providing blood in austere environments with limited testing capabilities. This study evaluates the infectious etiologies of deferred blood donors at a large military blood donation center. METHODS All blood donors at the Armed Service Blood Bank Center, San Antonio, between 2017 and 2022 with positive post-donation screening for hepatitis C (HCV), hepatitis B (HBV), human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV-I/II), Zika (2018-2021), West Nile virus, Trypanosoma cruzi, Treponema pallidum, or Babesia microti (2020-2022) were evaluated. Donors were deferred based on Food and Drug Administration (FDA) guidance. RESULTS Two-hundred and thirteen (213) donors met FDA criteria for deferral. T. pallidum (n = 45, 50.3 per 100,000), HCV (n = 34, 38.0 per 100,000), and HBV (n = 19, 21.2 per 100,000) were the most common pathogens among those with both positive screening and confirmatory testing. The majority of HIV (95%), Chagas (78%), HTLV-I/II (50%) deferrals were due to indeterminate confirmatory tests following initial positive screens. The majority of deferrals for HBV were for a second occurrence of a positive screen despite negative confirmatory testing. CONCLUSION The rates of post-donation deferral for transfusion-transmissible infections were low in this military cohort. Our findings suggest that donor testing in deployed service members should focus on HBV, HCV, and T. pallidum and highlight the need for better diagnostics for HIV, Chagas, and HTLV-I/II.
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Affiliation(s)
- Somin Kwon
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Brian G Casleton
- Armed Services Blood Bank Center-San Antonio, Joint Base San Antonio-Lackland, San Antonio, Texas, USA
| | - Glorimar Z Rivera
- Armed Services Blood Bank Center-San Antonio, Joint Base San Antonio-Lackland, San Antonio, Texas, USA
| | - Melita M Gella
- Armed Services Blood Bank Center-San Antonio, Joint Base San Antonio-Lackland, San Antonio, Texas, USA
- Department of Veterans Affairs, Audie Murphy VA Hospital, San Antonio, Texas, USA
| | - Erin L Winkler
- Trainee Health Surveillance, Joint Base San Antonio-Lackland, San Antonio, Texas, USA
| | - John W Kieffer
- Trainee Health Surveillance, Joint Base San Antonio-Lackland, San Antonio, Texas, USA
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Angela B Osuna
- Trainee Health Surveillance, Joint Base San Antonio-Lackland, San Antonio, Texas, USA
| | - Theresa M Casey
- Trainee Health Surveillance, Joint Base San Antonio-Lackland, San Antonio, Texas, USA
| | - Heather C Yun
- Infectious Diseases Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Fort Sam Houston, Texas, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Joseph E Marcus
- Infectious Diseases Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Fort Sam Houston, Texas, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Abu Baker F, Ben Ari Z, Green I, Israel A, Kopelman Y, Abu Mouch S, Davidov Y, Khoury T, Mari A. The impact of ethnicity on chronic hepatitis B infection course and outcome: big data analysis from Israel. ETHNICITY & HEALTH 2023; 28:458-467. [PMID: 35179096 DOI: 10.1080/13557858.2022.2040957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The effect of ethnicity on chronic hepatitis B virus (CHB) infection's course and outcome has attracted little research. We aimed to compare different aspects of ethnic disparities in CHB patients, including prevalence, phenotypes, management, and outcome between two major ethnic groups in Israel. DESIGN We conducted a large retrospective cohort study utilizing the Leumit-Health-Service database. Electronic reports of almost 700,000 members from different ethnicities and districts throughout Israel from 2000 to 2019 were reviewed. Patients' ethnicity was categorized based on the classification of the Israeli Central Bureau of Statistics into two main groups, Arabs and Jews. CHB diagnosis was based on ICD-9-CM codes and supportive serology results. Prevalence, clinical backgrounds, disease course, and patients' outcomes were compared between both groups. RESULTS The prevalence of CHB in the Arab minority group was almost twice and a half-higher when compared to their Jewish counterparts (4.3% vs. 1.8%), but they had a lower rate of referral for HBsAg testing (7% vs. 7.9%). The Arab CHB patients were significantly younger at the time of diagnosis (37.6± 13.5 vs. 45.3± 15; P < 0.001). Male predominance was noted in both groups. The Arab patients had a higher rate of active hepatitis (HBeAg-positive and/or negative hepatitis) phase (36.4% vs. 29.8%; P = 0.01), as well as a significantly higher rate of HBeAg seroconversion (45.2% vs. 35.4%; P = 0.033). Nucleos/tide analogue treatment figures were similar, with most patients in both groups receiving a high barrier to resistance treatment. Patients' outcome was similar in both groups as the rate of hepatocellular carcinoma, cirrhosis, and advanced fibrosis (after stratification analysis) were comparable between both groups. CONCLUSION Marked by a prominently higher prevalence of HBV infection, patients in the Arab ethnic group had a lower rate of referral for HBsAg testing but received comparable management and had a similar outcome compared to their Jewish counterparts.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Ziv Ben Ari
- Liver Diseases Center, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ilan Green
- Research Institute, Leumit Health Services, Tel Aviv, Israel
| | - Areil Israel
- Research Institute, Leumit Health Services, Tel Aviv, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Saif Abu Mouch
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Yana Davidov
- Liver Diseases Center, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital, Shillong, Meghalaya, India
- Faculty of Medicine, Bar-Illan University, Safed, Israel
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Win A, King S, Wu G, Kwon S. Hepatitis B virus screening in Asian immigrants: Community-based campaign to increase screening and linkage to care: A cross-sectional study. Health Sci Rep 2023; 6:e773. [PMID: 36875931 PMCID: PMC9983072 DOI: 10.1002/hsr2.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 03/06/2023] Open
Abstract
Background and Aims Despite established screening guidelines, many Asian immigrants remain unscreened. Furthermore, those with chronic hepatitis B (CHB) are not linked to care citing multiple barriers. The objective of this study was to determine the role of our community-based hepatitis B virus (HBV) campaign on HBV screening and the success of linkage to care (LTC) efforts. Methods Asian immigrants from the New Jersey and New York metropolitan areas were screened for HBV from 2009 to 2019. We started to collect LTC data starting in 2015, and those found to be positive were followed up. In 2017, because of low LTC rates, nurse navigators were hired to aid in the LTC process. Those excluded from the LTC process included those who were already linked to care, declined, and/or had moved or passed away. Results Total of 13,566 participants were screened from 2009 to 2019, of which, the results for 13,466 were available. Of these, 372 (2.7%) were found to have positive HBV status. Approximately 49.3% were female and 50.1% were male, and the rest were of unknown gender. A total of 1191 (10.0%) participants were found to be HBV negative but required vaccination. When we started to track LTC, we found 195 participants that were eligible for LTC between 2015 and 2017 after the exclusion criteria were applied. It was found that only 33.8% were successfully linked to care in that time period. After hiring nurse navigators, we saw LTC rates increase to 85.7% in 2018 and to 89.7% in 2019. Conclusion HBV community screening initiatives are imperative to increase screening rates in the Asian immigrant population. We were also able to demonstrate that nurse navigators can successfully help increase LTC rates. Our HBV community screening model can address issues with barriers to care including lack of access in comparable populations.
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Affiliation(s)
- Aziza Win
- Ross University School of MedicineMiramarFloridaUSA
| | - Scott King
- Department of Computer ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Gregory Wu
- Department of SurgeryHoly Name Medical CenterTeaneckNew JerseyUSA
| | - Steve Kwon
- Department of SurgeryHoly Name Medical CenterTeaneckNew JerseyUSA
- Department of SurgeryColumbia University Medical CenterNew York CityNew YorkUSA
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Efua SDV, Adwoa WD, Armah D. Seroprevalence of Hepatitis B virus infection and associated factors among health care workers in Southern Ghana. IJID REGIONS 2023; 6:84-89. [PMID: 36814439 PMCID: PMC9939711 DOI: 10.1016/j.ijregi.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Introduction The World Health Organization estimates that 37% of Hepatitis B Virus (HBV) infections among Health Care Workers (HCWs) are due to percutaneous occupational exposure to blood and body fluids. In Ghana, occupational exposures are rising; however, the burden of HBV infection in HCWs remains unknown. Our study estimated the prevalence of HBV surface antigens and associated factors among HCWs. Methods We conducted a cross-sectional survey of 340 HCWs using a structured pretested questionnaire and screening for HBV surface antigens. Data were analyzed using SPSS version 20.0 with a level of significance set at <0.05. Results The overall crude prevalence of current HBV infection was 5.9 % (95% CI, 3.0-8.0). Adjusted prevalence by test performance was 5.8%. Prevalence was highest among males 10.2% (95% CI, 4.8-18.5), HCWs other than nurses and doctors 9.2% (95% CI, 4.5-16.2), and those working at lower-level facilities 9.7% (95% CI, 4.8-17.1). Training in the prevention of blood-borne infections was significantly associated with HBV infection (adjusted odds ratio 3.2; 95% CI, 1.1-9.1). Conclusions HBV infection is high in this population. In addition to lifesaving interventions such as vaccination and the use of immunoglobulin, training in blood-borne infections could prevent new HBV infections among Ghanaian HCWs.
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Affiliation(s)
- Senoo-Dogbey Vivian Efua
- Department of Public Health, School of Nursing and Midwifery, University of Ghana, Legon, Accra Ghana, P.O. Box LG 25 Legon Accra, Ghana,Corresponding Author: Senoo-Dogbey Vivian Efua, P.O. Box LG 25, University of Ghana, Accra, Ghana, Phone: +233-244-772-402
| | - Wuaku Delali Adwoa
- Department of Nursing Research, Nursing and Midwifery Training School, Korle-Bu, Accra Ghana, P.O. Box KB 83 Korle-Bu, Accra, Ghana
| | - Deborah Armah
- Department of Maternal and Child Health, School of Nursing and Midwifery, University of Ghana, Legon P.O. Box LG 25 Legon, Accra, Ghana
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Prevalence of Spontaneous Bacterial Peritonitis (SBP) in Hepatitis B (HBV), and Hepatitis C (HCV) Liver Cirrhosis: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:healthcare11020275. [PMID: 36673643 PMCID: PMC9859562 DOI: 10.3390/healthcare11020275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Background and Aim: Spontaneous bacterial peritonitis (SBP) is a common infection in liver cirrhosis. This systematic review and meta-analysis provide detailed information on the prevalence of SBP among hepatitis B virus (HBV) and hepatitis C virus (HCV)-related liver cirrhosis globally. Methods: A systematic search for articles describing the prevalence of SBP in HBV and HCV-related cirrhosis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Our search returned ten (10) eligible articles involving 1713 viral cirrhosis cases representing eight (8) countries. A meta-analysis was performed on our eligible studies using the random effect model. A protocol was registered with PROSPERO (CRD42022321790). Results: The pooled prevalence of SBP in HBV-associated cirrhosis had the highest estimate [8.0% (95% CI, 2.7−21.0%; I2 = 96.13%; p < 0.001)], followed by SBP in HCV-associated liver cirrhosis [4.0% (95% CI, 1.3%−11.5%; I2 = 88.99%; p < 0.001)]. China (61.8%, CI: 57.1−66.3%), the USA (50.0%, CI: 34.6−65.4%), and Holland (31.1%, CI: 21.6−42.5%) had the highest estimate for SBP in HBV associated liver cirrhosis, SBP in HCV associated liver cirrhosis and SBP in HBV + HCV associated liver cirrhosis respectively. There was a significant difference in the prevalence of SBP in viral hepatitis-associated liver cirrhosis with the year of sampling and method of SBP detection at P < 0.001. There was an increase in SBP incidence at the beginning of 2016 across the liver cirrhosis in this study. Conclusion: The findings of this review revealed a rise in the incidence of SBP in viral hepatitis over the last decade. The latter indicates a possible future rise in the global prevalence of SBP among HBV and HCV-related liver cirrhosis.
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Loh K, Badalyan V. Acute Hepatitis. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2023:419-423.e2. [DOI: 10.1016/b978-0-323-75608-2.00059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Kolobova I, Nyaku MK, Karakusevic A, Bridge D, Fotheringham I, O'Brien M. Burden of vaccine-preventable diseases among at-risk adult populations in the US. Hum Vaccin Immunother 2022; 18:2054602. [PMID: 35446725 PMCID: PMC9225203 DOI: 10.1080/21645515.2022.2054602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Life-course immunization holds significant benefit for population health by reducing the burden of vaccine-preventable diseases (VPD) through vaccinating individuals at different stages and circumstances in life. The study aimed to determine the epidemiologic, clinical, economic, and societal burden of VPDs among at-risk adult subpopulations in the United States. A systematic literature review was conducted for articles published between January 2010 and June 2020, which identified 72 publications. There was heterogeneity in available epidemiology data, with the prevalence of VPDs ranging from 1.1% to 68.7%. Where the disease burden was described, outcomes were typically worse among high-risk subpopulations than in the general population. Several VPDs, including herpes zoster, meningococcal, and pneumococcal infections were associated with increased costs. This review suggests that subpopulations may not frequently interact with the healthcare system, or their risk factors may not be recognized by healthcare providers, and therefore individuals may not be appropriately targeted for vaccination.
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Affiliation(s)
- Irina Kolobova
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Mawuli Kwame Nyaku
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | | | | | - Megan O'Brien
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, New Jersey, USA
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Yassin NA, El-Houchi SZ, Abd El-Shafy SF, Soliman NS, Elmonem MA, El-Koofy N. Frequency of Hepatitis A virus as a cause of anicteric hepatitis in children under 5 years: a common yet under-recognized cause. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-022-00134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Hepatitis A is the most common form of acute viral hepatitis in developing countries. In children < 6 years of age, most infections are asymptomatic, and if illness does occur, it is usually anicteric. This study aimed to determine the frequency of HAV in Egyptian children under 5 years presenting with gastroenteritis-like manifestations and to associate the frequency of HAV with social, demographic, and various risk factors.
Results
Among 450 children aged from 6 months to 5 years of both sexes, presenting with gastroenteritis-like manifestations and anicteric hepatitis, 200/450 children had elevated transaminases (ALT, AST) and were recruited in the study. A total number of 24 (12%) out of 200 children were found to have HAV IgM antibodies. Lower maternal and paternal education, poor sanitary and hygienic conditions, crowding, contaminated water, and lack of sanitary facilities were significantly higher in HAV-positive group (p-value < 0.05). ALT and AST were significantly higher in HAV IgM-positive group (p-value < 0.01).
Conclusion
HAV infection is common in Egyptian children with gastroenteritis-like manifestations and anicteric hepatitis. Hepatitis A is a vaccine-preventable disease.
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13
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Jacobson IM, Brown RS, McMahon BJ, Perrillo RP, Gish R. An Evidence-based Practical Guide to Vaccination for Hepatitis B Virus. J Clin Gastroenterol 2022; 56:478-492. [PMID: 35389923 DOI: 10.1097/mcg.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The hepatitis B virus (HBV) is highly infectious, with over 292 million chronically infected people worldwide and up to 2.4 million in the United States. Following infection, clinically silent liver damage can ensue, but symptoms or signs of advanced disease, including cirrhosis and hepatocellular carcinoma, can take decades to emerge. HBV has the heaviest public health burden of all hepatitis viruses and has now surpassed other major communicable diseases (eg, HIV, diarrheal disease, malaria, tuberculosis) as a leading cause of death globally. Preventing transmission is essential, and efforts are in place to reinforce screening, vaccination, and routine follow-up. Three safe and effective vaccines are available in the United States and other countries for HBV prevention, and the benefits of vaccination in preventing infection and its sequelae have been substantiated. For the first time in over 25 years, a new Food and Drug Administration-approved vaccine is available that offers a high degree of immunogenicity after 2, rather than 3, injections. Persistent challenges include the underutilization of vaccination, choice of vaccine, incomplete vaccinations, varying needs in different populations, management of nonresponders or those with undocumented or incompletely documented vaccination courses, and questions about whether and when booster injections may be needed. A panel of US academic hepatologists with expertise and experience in preventing and managing HBV infection have collaborated to write this practical clinical paper intended to guide clinicians in vaccinating for HBV and address questions that regularly arise in the clinic.
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Affiliation(s)
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
| | - Brian J McMahon
- University of Washington, Seattle, WA
- University of Alaska
- Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Robert P Perrillo
- Hepatology Division, Baylor Scott and White Medical Center, University of Texas Southwestern, Dallas, TX
| | - Robert Gish
- Loma Linda University, Loma Linda
- UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA
- University of Nevada Las Vegas and Reno Schools of Medicine, Las Vegas, NV
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14
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Stahl HJ, Wu AK, Li H, Hu D, Liu W, Lam SK. Elucidating a Silent Illness: Hepatitis B Knowledge Among Asian Individuals in an Urban Center. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:417-424. [PMID: 35389958 DOI: 10.1097/phh.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite comprising less than 6% of the US population, Asian individuals make up more than half of the approximately 1.6 million chronic hepatitis B virus (HBV) infections in the United States. The purpose of this investigation was to identify characteristics associated with HBV knowledge in this disproportionately affected population. METHODS A cross-sectional, multilingual survey study using convenience sampling was conducted in a Midwestern urban city to collect information on respondents' demographics, health care access, and HBV knowledge. Hepatitis B virus knowledge was categorized into epidemiology, natural history, transmission, and vaccination. Data were analyzed using Kruskal-Wallis and Spearman correlation tests. RESULTS Of the 174 individuals who completed surveys, 139 (79.9%) were Asian. Characteristics of univariate analyses associated with higher knowledge scores included younger age (18-49 years), proficiency in reading English, college education, current employment status, physician using preferred language, last physician's visit in 2018 or prior, perceived lack of time to see a physician, use of emergency department, prior HBV vaccination, prior HBV testing, higher level of self-reported knowledge about HBV, and acquiring health information from the Internet, messaging applications, friends, and family (P < .05). In the multivariable analysis, shorter residency in the United States (0-10 years), current employment status, having heard of HBV, and confidence in their HBV knowledge were associated with higher knowledge scores. CONCLUSION Knowledge deficits existed in our study population regarding HBV transmission, vaccination, and epidemiology, while knowledge was higher regarding HBV natural history. Education efforts should be designed to improve knowledge deficits about HBV for individuals with risk factors using culturally sensitive Internet and social media platforms.
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Affiliation(s)
- Heidi J Stahl
- Case Western Reserve University School of Medicine, Cleveland, Ohio (Mss Stahl and Wu, Messrs Li and Hu, and Dr Lam); Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (Ms Liu); Cleveland Clinic Children's, Department of Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, Ohio (Dr Lam); and Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Lam)
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15
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Low Rates of Hepatitis B Virus Treatment Among Treatment-Eligible Patients in Safety-Net Health Systems. J Clin Gastroenterol 2022; 56:360-368. [PMID: 33780210 DOI: 10.1097/mcg.0000000000001530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/10/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Timely initiation of antiviral therapy in chronic hepatitis B virus (CHB) reduces risk of disease progression. We evaluate overall treatment rates and predictors of treatment among treatment-eligible safety-net CHB patients. METHODS We retrospectively evaluated adults with CHB from 2010 to 2018 across 4 large safety-net health systems in the United States. CHB was identified with ICD-9/10 diagnosis coding and confirmed with laboratory data. Treatment eligibility was determined using American Association for the Study of Liver Diseases (AASLD) guidelines. Comparison of CHB treatment rates among treatment-eligible patients were performed using χ2 testing, Kaplan Meier methods and log-rank testing. Adjusted multivariate Cox proportional hazards models evaluated independent predictors of receiving treatment among eligible patients. RESULTS Among 5157 CHB patients (54.7% male, 34.6% African American, 22.3% Asian), 46.8% were treatment-eligible during the study period. CHB treatment rates were 48.4% overall and 37.3% among CHB patients without human immunodeficiency virus. Significantly lower odds of treatment were observed in females versus males (odds ratio: 0.40, 95% confidence interval: 0.33-0.49, P<0.001) and patients age 65 years or above versus age below 45 years (odds ratio: 0.68, 95% confidence interval: 0.51-0.92, P=0.012). Conversely, significantly greater odds of treatment were observed in African American and Asians versus non-Hispanic whites, CHB patients with indigent care versus commercially insured patients, and non-English speaking versus English speaking patients. CONCLUSION Among a large multicentered, safety-net cohort of CHB patients, 46.8% of treatment-eligible CHB patients overall and 37.3% of treatment-eligible CHB patients without human immunodeficiency virus received antiviral therapy. Improving CHB treatment rates among treatment-eligible patients represents "low hanging fruit," given the clear benefits of antiviral therapy in mitigating disease progression.
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16
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Nolt D, O’Leary ST, Aucott SW. Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices. Pediatrics 2022; 149:184545. [PMID: 35104357 PMCID: PMC9645715 DOI: 10.1542/peds.2021-055554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The purpose of this report is to educate providers about the risk of infectious diseases associated with emerging alternative peripartum and neonatal practices. This report will provide information pediatricians may use to counsel families before birth and to appropriately evaluate and treat neonates who have been exposed to these practices.
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Affiliation(s)
- Dawn Nolt
- Division of Infectious Diseases, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon,Address correspondence to Dawn Nolt, MD, MPH.
| | - Sean T. O’Leary
- Divisions of Infectious Diseases and General Academic Pediatrics, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus/Children’s Hospital Colorado, Aurora, Colorado
| | - Susan W. Aucott
- Division of Neonatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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17
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Le D, Ciceron AC, Pan J, Juon HS, Berg CJ, Nguyen TA, Le HC, Yang YT. Linkage-to-Care Following Community-Based HBV and HCV Screening Among Immigrants from the Washington–Baltimore Metropolitan Area, 2016–2019. J Immigr Minor Health 2022; 24:1137-1144. [PMID: 35064900 PMCID: PMC8783186 DOI: 10.1007/s10903-022-01327-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
Understanding characteristics that impact linkage-to-care (LTC) among individuals living with HBV and/or HCV can enhance public health efforts to provide tailored care services to prevent and treat viral hepatitis among immigrants. Using HBV/HCV screening and LTC data from immigrants (2016–2019), descriptive and logistic regression analyses were conducted to assess (1) the relationship between LTC and sociodemographic factors and (2) factors associated with HBV/HCV LTC. About 87% of those positive HBsAg had LTC and 52% had LTC among those with HCVAB and confirmed PCR. Access to care was an important LTC predictor for HBV–LTC: those who had neither health insurance nor primary care provider (PCP) were more likely to have HBV–LTC than those who had either health insurance or PCP (aOR = 2.95, 95% CI = 1.32–6.59). It is essential to equally provide HBV/HCV LTC support to all immigrants from countries with high prevalence regardless of access to care.
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Affiliation(s)
- Daisy Le
- School of Nursing, The George Washington University, 1919 Pennsylvania NW, Suite 500, Washington, DC, 20006, USA.
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
| | - Annie Coriolan Ciceron
- School of Nursing, The George Washington University, 1919 Pennsylvania NW, Suite 500, Washington, DC, 20006, USA
| | - Jane Pan
- Hepatitis B Initiative of Washington DC (HBI-DC), Washington, DC, USA
| | - Hee-Soon Juon
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carla J Berg
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - T Angeline Nguyen
- Hepatitis B Initiative of Washington DC (HBI-DC), Washington, DC, USA
| | - Hai Chi Le
- Hepatitis B Initiative of Washington DC (HBI-DC), Washington, DC, USA
| | - Y Tony Yang
- School of Nursing, The George Washington University, 1919 Pennsylvania NW, Suite 500, Washington, DC, 20006, USA
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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18
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Cross-Sectional Association of Urinary Bisphenol A and Vaccine-Induced Immunity against Hepatitis B Virus: Data from the 2003–2014 National Health and Nutrition Examination Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031103. [PMID: 35162124 PMCID: PMC8834708 DOI: 10.3390/ijerph19031103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/01/2022] [Accepted: 01/15/2022] [Indexed: 11/17/2022]
Abstract
Hepatitis B virus (HBV) infection poses a serious health burden; bisphenol A (BPA), a commonly used plasticizer for consumer products, is a potential immune disruptor. However, epidemiologic studies revealing the association between BPA exposure and immunity are limited. This study investigates the association between environmental BPA exposure and immune response following HBV vaccination in a nationally representative sample population. Using National Health and Nutrition Examination Survey data from six cycles, we analyzed the data of 6134 participants, classified as susceptible to HBV infection (n = 3086) or as having vaccine-induced immunity (n = 3048). Associations between BPA level and HBV susceptibility were assessed using multivariable logistic regression and expressed as odds ratios (ORs) of the pooled data and data for each cycle. There was a significant association in the pooled data after adjusting for potential confounders (adjusted OR (aOR): 1.14, 95% confidence interval (CI): 1.05–1.23). However, the associations between BPA concentration and HBV susceptibility were inconsistent across the survey cycles and tended to decrease in more recent cycles. Although this study preliminarily suggests that BPA attenuates the immune response to hepatitis B vaccination, further prospective studies are warranted to elucidate the discrepancies observed.
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19
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Brodzinski A, Neumeyer-Gromen A, Dudareva S, Zimmermann R, Latza U, Bremer V, Poethko-Müller C. [Hepatitis B virus infection and vaccine-induced immunity: the role of sociodemographic determinants : Results of the study "German Health Interview and Examination Survey for Adults" (DEGS1, 2008-2011)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:159-169. [PMID: 34958395 PMCID: PMC8813829 DOI: 10.1007/s00103-021-03473-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund und Ziel Trotz niedriger Prävalenz der Hepatitis-B-Virus-(HBV-)Infektion in Deutschland ist es wichtig, vulnerable Gruppen und Ansatzpunkte für die Prävention zu identifizieren. In ersten Analysen der „Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1, 2008–2011) waren HBV-Infektion und -Impfung mit sozidemografischen Determinanten assoziiert. In dieser Arbeit werden die Ergebnisse im Detail untersucht. Material und Methoden In DEGS1 lag für 7046 Teilnehmende (Alter: 18–79 Jahre) eine HBV-Serologie vor. Die stattgehabte HBV-Infektion war durch Antikörper gegen das Hepatitis-B-Core-Antigen (Anti-HBc) definiert, die impfinduzierte Immunität durch alleinigen Nachweis von Antikörpern gegen das Hepatitis-B-Surface-Antigen (Anti-HBs). Seroprävalenzen von HBV-Infektions- und -Impfstatus wurden geschlechtsstratifiziert geschätzt und Assoziationen mit Alter, Gemeindegröße, Einkommen, formaler Bildung, Krankenversicherung und Migrationsgeneration in logistischen Regressionen analysiert. Ergebnisse Die HBV-Infektion war bei Männern und Frauen unabhängig mit den Altersgruppen 34–64 und ≥ 65 Jahre, erster Migrationsgeneration und Leben in größeren Gemeinden assoziiert, zudem bei Männern mit niedrigem Einkommen und bei Frauen mit niedriger Bildung. Die impfinduzierte Immunität war bei Männern und Frauen unabhängig mit den Altersgruppen 18–33 und 34–64 Jahre, mittlerer und hoher Bildung und hohem Einkommen assoziiert, darüber hinaus bei Männern mit mittlerem Einkommen und privater Krankenversicherung und bei Frauen mit fehlendem Migrationshintergrund. Diskussion Die Berücksichtigung von Migrationsstatus, Einkommen und Bildung könnte zur zielgenauen Ausrichtung der HBV-Prävention beitragen. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03473-z) enthalten.
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Affiliation(s)
- Annika Brodzinski
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | | | - Sandra Dudareva
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Ruth Zimmermann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Ute Latza
- Fachbereich Arbeit und Gesundheit, Bundesanstalt für Arbeitsschutz und Arbeitsmedizin BAuA, Berlin, Deutschland
| | - Viviane Bremer
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Christina Poethko-Müller
- Abteilung für Epidemiologie und Gesundheitsmonitoring, FG 25 Körperliche Gesundheit, Robert Koch-Institut, General-Pape-Straße 62-66, 12101, Berlin, Deutschland.
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20
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Health care resources utilization and costs associated with different clinical stages of chronic hepatitis B in Egypt. EGYPTIAN LIVER JOURNAL 2021. [DOI: 10.1186/s43066-021-00162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Chronic hepatitis B (CHB) is associated with many serious clinical and social consequences. Despite Egypt being classified as a country of low endemicity, the infection is associated with a 15–25% risk of premature death from liver cancer or end-stage liver disease. The national committee of treatment and control of viral hepatitis has already offered a high-quality service for the diagnosis and treatment of CHB on a free basis. The current study aims to estimate the health care resources utilization and the annual direct medical cost associated with different clinical stages of CHB-related disease in Egypt.
Methodology
The data was retrieved through record review for three months in the General Administration of Hepatitis Viruses Control, Egypt. Then, the data was extrapolated to the population level by multiplying the prevalence in Egypt with a focus on the productive age groups (25–59 years).
Results
The cost and utilization of different health care resources increase with disease progression. The total annual direct medical costs due to CHB in Egypt is 21.3 L.E. Billion (4.7 Int$ billion/year) for the management of estimated 1,420,700 CHB patients. The direct medical costs among the productive age group (25–59 years) constitute more than half of the total cost (57%). The highest disease burden is encountered among (25–29 years) age group; 2.695 L.E. billion (0.59 Int$ billion/year). Despite liver transplantation phase being associated with the highest annual cost/patient, the number of patients in this stage is the lowest. Then, it only constitutes 0.04% of the disease direct medical cost in the country. The chronic hepatitis clinical stage constitutes 57.26% of the disease direct medical cost in Egypt’s working age group.
Conclusion
Strengthening the preventive and control measures is mandatory to alleviate the disease’s direct medical costs. Close monitoring of the chronic hepatitis stage is mandatory to prevent disease progression. Enhancement of vaccination efforts will lower the disease prevalence and its cost. The universal health insurance system which is gradually implemented in Egypt nowadays will be a cornerstone in relieving the economic stresses by allowing more access to high-quality health care services.
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21
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Jones PD, Gmunder K, Batrony S, Martin P, Kobetz E, Carrasquillo O. Acceptability and Feasibility of Home-Based Hepatitis B Screening Among Haitian Immigrants. J Immigr Minor Health 2021; 23:1170-1178. [PMID: 33686574 PMCID: PMC9166933 DOI: 10.1007/s10903-021-01165-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
Hepatitis B (HBV) is endemic in Haiti, therefore Haitian immigrants should be screened to identify and link affected individuals to care. Current screening approaches are ineffective. We assessed the acceptability and feasibility of home-based screening among Haitian immigrants using community health workers (CHWs). We recruited participants exiting a pragmatic trial evaluating strategies to improve care delivery (NCT02970136). Participants completed an acceptability questionnaire. Blood drawn by CHWs at participants' homes or community sites was tested for hepatitis B surface antigen, hepatitis B surface antibody and hepatitis B core antibody. Of 60 participants, 59 found screening acceptable; 53 had blood drawn. Of those, 45.3% had HBV previously, 49.1% remained susceptible and 5.7% were vaccinated. Respondents cited various reasons community members might find screening unacceptable. The high prior HBV rate highlights the need for effective outreach programs. Home-based HBV screening was both acceptable and feasible among Haitian immigrants.
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Affiliation(s)
- Patricia D Jones
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
- Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1112, Miami, FL, 33136, USA.
| | - Kristin Gmunder
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Saradjine Batrony
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paul Martin
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1112, Miami, FL, 33136, USA
| | - Erin Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, Division of Computational Medicine and Population Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Olveen Carrasquillo
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Roberts H, Ly KN, Yin S, Hughes E, Teshale E, Jiles R. Prevalence of HBV Infection, Vaccine-Induced Immunity, and Susceptibility Among At-Risk Populations: US Households, 2013-2018. Hepatology 2021; 74:2353-2365. [PMID: 34097776 DOI: 10.1002/hep.31991] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS In the USA, HBV is one of the leading causes of chronic liver disease and cirrhosis and is a major cause of liver cancer. We aimed to estimate the prevalence of past and present HBV infection, susceptibility to HBV infection, and vaccine-induced immunity to hepatitis B among the US population during 2013-2018. APPROACH AND RESULTS Prevalence estimates and 95% CIs were analyzed using 2013-2018 data from the National Health and Nutrition Examination Survey. Serologic testing among noninstitutionalized persons aged ≥ 6 years was used for classifying persons as total hepatitis B core antibody (anti-HBc), indicative of current or previous (ever having had) HBV infection; HBsAg, indicative of current HBV infection; and antibody to ABsAg (anti-HBs), indicative of immunity attributable to hepatitis B vaccination. Persons who tested negative for anti-HBc, HBsAg, and anti-HBs were considered susceptible to HBV infection. Non-US-born residents accounted for 69.1% of the population with chronic HBV infection and were 9.1 times more likely to be living with chronic hepatitis B, compared with US-born persons. Among adults aged ≥ 25 years who resided in US households, an estimated 155.8 million persons (or 73.4%) were susceptible to HBV infection, and an estimated 45.4 million had vaccine-induced immunity to hepatitis B. Men who have sex with men (MSM) were 3.6 times more likely to have ever been infected with HBV; however, MSM were just as likely to have vaccine-induced immunity to hepatitis B as non-MSM. CONCLUSION Despite increasing immune protection among young persons vaccinated after birth, the estimated prevalence of persons living with chronic hepatitis B in the USA has remained unchanged at 0.3% since 1999.
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Affiliation(s)
- Henry Roberts
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Kathleen N Ly
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Shaoman Yin
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Elizabeth Hughes
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Ruth Jiles
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
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Su SY, Lee LT, Lee WC. Mortality trends in chronic liver disease and cirrhosis from 1981 to 2015 in Taiwan. Popul Health Metr 2021; 19:36. [PMID: 34600536 PMCID: PMC8487474 DOI: 10.1186/s12963-021-00269-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 09/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background Globally, the morbidity and mortality rates for chronic liver disease and cirrhosis are increasing. The National Viral Hepatitis Therapy Program in Taiwan was implemented in 2003, but evidence regarding the program’s effect on the trends of mortality for chronic liver disease and cirrhosis is limited. Methods We analyzed mortality rates for chronic liver disease and cirrhosis in Taiwan for the period from 1981 to 2015. An autoregressive age–period–cohort model was used to estimate age, period, and cohort effects. Results Age-adjusted mortality rates for chronic liver disease and cirrhosis all displayed a flat but variable trend from 1981 to 2004 and a decreasing trend thereafter for both sexes. The age–period–cohort model revealed differential age gradients between the two sexes; mortality rates in the oldest age group (90–94 years) were 12 and 66 times higher than those in the youngest age group (30–34 years) for men and women, respectively. The period effects indicated that mortality rates declined after 2004 in both sexes. Mortality rates decreased in men but increased in women in the 1891–1940 birth cohorts and increased in both sexes in the birth cohorts from 1950 onward. Conclusions The National Viral Hepatitis Therapy Program in Taiwan may have contributed to the decrease in mortality rates for chronic liver disease and cirrhosis in adulthood. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00269-w.
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Affiliation(s)
- Shih-Yung Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Xuzhou Rd., Rm. 536, No. 17, Taipei, 100, Taiwan.,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Long-Teng Lee
- Department of Family Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.,Taipei Jen-Chi Hospital, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Xuzhou Rd., Rm. 536, No. 17, Taipei, 100, Taiwan. .,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
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24
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Ly KN, Xing J, Spradling PR. Trends in Prevalence and Characteristics of Resolved and Current Hepatitis B Among US-Born Persons: National Health and Nutrition Examination Survey, 2001-2018. J Infect Dis 2021; 224:804-812. [PMID: 33903902 PMCID: PMC10977924 DOI: 10.1093/infdis/jiab224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/21/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND After decades of decline, US acute hepatitis B incidence flattened since 2011. In persons aged ≥40 years and in jurisdictions affected by the opioid crisis, there is an increase in new cases. Data suggest new infections are occurring among US-born persons. METHODS We used National Health and Nutrition Examination Survey data during 2001-2018 to examine changes in total antibody to hepatitis B virus core antigen (anti-HBc) prevalence in US-born persons. During 2013-2018, the distribution of characteristics was examined. RESULTS During 2001-2006, 2007-2012, and 2013-2018, anti-HBc prevalence was 3.5%, 2.5%, and 2.6% among US-born persons, respectively. This corresponded to 5.7 (range, 4.8-6.6) million US-born persons with resolved or current HBV infection during 2013-2018, including 344 600 persons aged 6-29 years. The largest increase and highest prevalence was among persons who reported injection drug use (IDU), which increased from 35.3% during 2001-2006 to 58.4% during 2013-2018 (P = .07). CONCLUSIONS Anti-HBc prevalence among US-born persons remained flat during the most recent period, coinciding with a doubling of prevalence among persons reporting IDU. These data are consistent with acute hepatitis B surveillance trends, showing increasing incidence in subpopulations where prevention could be strengthened.Anti-HBc prevalence among US-born persons decreased from 2001-2006 to 2007-2012 and remained flat during 2013-2018, coinciding with a near doubling of prevalence among US-born persons reporting a history of injection drug use.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jian Xing
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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25
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Wong RJ, Brosgart CL, Welch S, Block T, Chen M, Cohen C, Kim WR, Kowdley KV, Lok AS, Tsai N, Ward J, Wong SS, Gish RG. An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign-Born Persons Living in the United States. Hepatology 2021; 74:607-626. [PMID: 33655536 PMCID: PMC8453838 DOI: 10.1002/hep.31782] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study. APPROACH AND RESULTS We performed systematic searches for articles published in 2009-2019 reporting HBsAg seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in-country rates. CONCLUSIONS Including FB and U.S.-born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA.,Division of Gastroenterology and HepatologyVeterans Affairs Palo Alto Healthcare SystemPalo AltoCA
| | - Carol L Brosgart
- Department of Medicine, Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCA
| | | | - Tim Block
- Hepatitis B FoundationDoylestownPA.,Baruch S Blumberg InstituteDoylestownPA
| | | | - Chari Cohen
- Hepatitis B FoundationDoylestownPA.,Baruch S Blumberg InstituteDoylestownPA
| | - W Ray Kim
- Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA
| | | | - Anna S Lok
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMI
| | | | - John Ward
- Coalition for Global Hepatitis EliminationTask Force for Global HealthDecaturGA
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26
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Walti CS, Krantz EM, Maalouf J, Boonyaratanakornkit J, Keane-Candib J, Joncas-Schronce L, Stevens-Ayers T, Dasgupta S, Taylor JJ, Hirayama AV, Bar M, Gardner RA, Cowan AJ, Green DJ, Boeckh MJ, Maloney DG, Turtle CJ, Hill JA. Antibodies against vaccine-preventable infections after CAR-T cell therapy for B cell malignancies. JCI Insight 2021; 6:146743. [PMID: 33914708 PMCID: PMC8262349 DOI: 10.1172/jci.insight.146743] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/28/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Little is known about pathogen-specific humoral immunity after chimeric antigen receptor–modified T (CAR-T) cell therapy for B cell malignancies. METHODS We conducted a prospective cross-sectional study of CD19-targeted or B cell maturation antigen–targeted (BCMA-targeted) CAR-T cell therapy recipients at least 6 months posttreatment and in remission. We measured pathogen-specific IgG against 12 vaccine-preventable infections and the number of viral and bacterial epitopes to which IgG was detected (“epitope hits”) using a serological profiling assay. The primary outcome was the proportion of participants with IgG levels above a threshold correlated with seroprotection for vaccine-preventable infections. RESULTS We enrolled 65 children and adults a median of 20 months after CD19- (n = 54) or BCMA- (n = 11) CAR-T cell therapy. Among 30 adults without IgG replacement therapy (IGRT) in the prior 16 weeks, 27 (90%) had hypogammaglobulinemia. These individuals had seroprotection to a median of 67% (IQR, 59%–73%) of tested infections. Proportions of participants with seroprotection per pathogen were comparable to population-based studies, but most individuals lacked seroprotection to specific pathogens. Compared with CD19-CAR-T cell recipients, BCMA-CAR-T cell recipients were half as likely to have seroprotection (prevalence ratio, 0.47; 95% CI, 0.18–1.25) and had fewer pathogen-specific epitope hits (mean difference, –90 epitope hits; 95% CI, –157 to –22). CONCLUSION Seroprotection for vaccine-preventable infections in adult CD19-CAR-T cell recipients was comparable to the general population. BCMA-CAR-T cell recipients had fewer pathogen-specific antibodies. Deficits in both groups support the need for vaccine and immunoglobulin replacement therapy studies. FUNDING Swiss National Science Foundation (Early Postdoc Mobility grant P2BSP3_188162), NIH/National Cancer Institute (NIH/NCI) (U01CA247548 and P01CA018029), NIH/NCI Cancer Center Support Grants (P30CA0087-48 and P30CA015704-44), American Society for Transplantation and Cellular Therapy, and Juno Therapeutics/BMS. In this prospective study, we investigated antibodies against vaccine-preventable infections and other pathogen-specific antibodies in individuals with remission after CAR-T cell therapy for B lineage malignancies.
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Affiliation(s)
- Carla S Walti
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Elizabeth M Krantz
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joyce Maalouf
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jim Boonyaratanakornkit
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jacob Keane-Candib
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laurel Joncas-Schronce
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Terry Stevens-Ayers
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Sayan Dasgupta
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Justin J Taylor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Alexandre V Hirayama
- Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Merav Bar
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rebecca A Gardner
- Clinical Research Division, and.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Damian J Green
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Michael J Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - David G Maloney
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Cameron J Turtle
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, and.,Immunotherapy Integrated Research Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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27
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Asemota J, Oladunjoye O, Babalola A, Nwosu U, Liu PHS, Oladunjoye AO, Castro-Webb N, Miksad RA. Comparison of Hepatocellular Carcinoma in Hispanic and Non-Hispanic Patients. Cureus 2021; 13:e14884. [PMID: 34104609 PMCID: PMC8180179 DOI: 10.7759/cureus.14884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fastest growing cancer in the United States. Studies have shown that compared to Blacks and non-Hispanic Whites, Hispanics have a higher HCC incidence and mortality rate. Most studies investigating HCC in Hispanics have been conducted utilizing data largely from the Western and Southern United States. These findings may, however, not be highly representative of Hispanics in the Northeast, given the nonhomogenous distribution and diversity of Hispanics across the United States. METHODS Some 148 HCC patients diagnosed between 1996 and 2012 were identified from a tertiary center in the northeastern United States. Hispanic patients were randomly matched to non-Hispanic White patients by year of diagnosis. Patient characteristics, HCC risk factors, treatment, and outcome were recorded. A Kaplan-Meier (KM) plot with log-rank tests was used for survival analysis. RESULTS Compared to non-Hispanic White patients (n=89), Hispanic HCC patients (n=59) were more likely to have chronic hepatitis C infection (69.5% vs. 38.2%, p < 0.01), alcoholic liver disease (37.3% vs. 21.4%, p = 0.04) and were less likely to have chronic hepatitis B infection (6.8% vs. 24.7%, p = 0.01), and private insurance (37.3% vs. 57.3%, p = 0.02). Hispanics were more likely to be diagnosed with an earlier stage disease (Barcelona Clinic Liver Cancer, BCLC stages A and B) compared to non-Hispanic patients (71.7% vs. 36.8%, p < 0.01) and were more likely to receive locoregional treatment. Although Hispanics trended towards improved overall survival, this finding did not hold when stratified by the BCLC stage. CONCLUSION Risk factors for HCC in the northeastern Hispanic population are like those found among Hispanics in other US regions. Other research suggests Hispanics are at increased risk for hepatic injury and HCC. However, HCC in this northeastern Hispanic population appears to be less aggressive (earlier stage and trend towards better overall survival) than non-Hispanics. Further research may be needed to identify potential differences by ethnic group for HCC risk factors, presentation, and outcomes.
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Affiliation(s)
- Joseph Asemota
- Internal Medicine, Howard University Hospital, Washington DC, USA
- Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
- Clinical Anatomy, St. George's University School of Medicine, True Blue, GRD
| | - Olubunmi Oladunjoye
- Internal Medicine, Tower Health-Reading Hospital, West Reading, USA
- Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Atinuke Babalola
- Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Ugonna Nwosu
- Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Po-Hong S Liu
- Internal Medicine, UT Southwestern Medical Center, Dallas, USA
- Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Nelsy Castro-Webb
- Epidemiology and Public Health, Boston University School of Medicine, Boston, USA
- Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Rebecca A Miksad
- Medicine, Boston University School of Medicine, Boston, USA
- Oncology, Flatiron Health, New York, USA
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28
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Deerin JF, Clifton R, Elmi A, Lewis PE, Kuo I. Hepatitis B birth dose vaccination patterns in the military health System, 2014-2018. Vaccine 2021; 39:2094-2102. [PMID: 33741189 DOI: 10.1016/j.vaccine.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Since 2005, the universal hepatitis B (HepB) birth dose has been recommended for all medically stable infants weighing ≥2,000 g at birth. The timing of the birth dose provides a critical safeguard and prevents infection among infants born to HBsAg-positive mothers not identified prenatally. We assess infant HepB vaccination in the U.S. Department of Defense's Military Health System (MHS) to identify trends in vaccination coverage and sociodemographic factors associated with non-receipt of the birth dose, receiving the first HepB vaccine >3 days of life, and not receiving any HepB vaccine in the first 18 months of life utilizing parental refusal codes. To our knowledge, this is one of the first studies assessing trends in parental refusal of the HepB birth dose utilizing administrative claims parental refusal codes. METHODS We conducted a retrospective cohort analysis of MHS live births from January 1, 2014 through December 31, 2018 utilizing administrative claims data. Data were included from 44 hospitals in 24 unique states, territories, or countries. We analyzed diagnosis codes for vaccine refusal and vaccination and current procedural terminology (CPT) codes to identify vaccination patterns. Generalized linear mixed effects models with a logit link were used to assess factors associated with vaccination patterns. RESULTS HepB birth dose vaccination coverage increased from 79.6% in 2014 to 88.1% in 2018 (p < .0001). Refusal rates also increased from 3.7% in 2014 to 4.5% in 2018 (p < .0001). The percentage of patients with missing diagnosis codes for vaccine refusal or vaccination decreased from 16.7% in 2014 to 7.4% in 2018. Factors associated with non-receipt of the birth dose included earlier year of birth, white maternal race, higher maternal age, higher birth order, and longer infant length of stay in hospital. CONCLUSION Vaccination coverage for HepB birth dose is high in the MHS and increased over time; concurrently, refusal rates also increased over time. Utilizing administrative claims data has the benefit of differentiating reasons for non-receipt of the birth dose over time.
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Affiliation(s)
- Jessica Fung Deerin
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology, United States.
| | - Rebecca Clifton
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology, United States
| | - Angelo Elmi
- The George Washington University, Milken Institute School of Public Health, Department of Biostatistics and Bioinformatics, United States
| | - Paul E Lewis
- Defense Health Agency, Armed Forces Health Surveillance Branch, United States
| | - Irene Kuo
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology, United States
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29
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Ajayi F, Jan J, Singal AG, Rich NE. Racial and Sex Disparities in Hepatocellular Carcinoma in the USA. CURRENT HEPATOLOGY REPORTS 2020; 19:462-469. [PMID: 33828937 PMCID: PMC8020839 DOI: 10.1007/s11901-020-00554-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW In this review, we aim to provide a summary of the current literature on race and gender disparities in hepatocellular carcinoma (HCC) incidence, stage at diagnosis, treatment and prognosis in the United States. RECENT FINDINGS HCC incidence rates are rising in the U.S. in all racial/ethnic groups except for Asian/Pacific Islanders, with disproportionate rises and the highest rates among Hispanics compared to Blacks and non-Hispanic whites. There are striking sex disparities in HCC incidence and mortality; however, with the shifting epidemiology of HCC risk factors in the U.S, there is recent evidence that HCC is trending towards less male predominance, particularly among younger birth cohorts. Despite significant advances in HCC treatment over the past decade, disparities in HCC surveillance and treatment receipt persist among racial and ethnic minorities and the socioeconomically disadvantaged. Black patients continue to experience worse survival outcomes than non-Black patients with HCC. SUMMARY There are significant racial and gender disparities in HCC incidence, treatment, and mortality in the U.S. Though these disparities are well-documented, data are still limited on the specific determinants driving disparities in HCC. To achieve health equity for all patients with HCC, we must advance beyond simply reporting on disparities and begin implementing targeted interventions to eliminate disparities.
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Affiliation(s)
- Faith Ajayi
- Division of Digestive and Liver Diseases, Department of Internal Medicine
| | - Jenny Jan
- Division of Digestive and Liver Diseases, Department of Internal Medicine
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine
- Harold C. Simmons Comprehensive Cancer Center
- Department of Population and Data Sciences, UT Southwestern Medical Center
| | - Nicole E. Rich
- Division of Digestive and Liver Diseases, Department of Internal Medicine
- Harold C. Simmons Comprehensive Cancer Center
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30
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Ziogas DC, Kostantinou F, Cholongitas E, Anastasopoulou A, Diamantopoulos P, Haanen J, Gogas H. Reconsidering the management of patients with cancer with viral hepatitis in the era of immunotherapy. J Immunother Cancer 2020; 8:jitc-2020-000943. [PMID: 33067316 PMCID: PMC7570225 DOI: 10.1136/jitc-2020-000943] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
In the evolving immune-oncology landscape, numerous patients with cancer are constantly treated with immune checkpoint inhibitors (ICPIs) but among them, only sporadic cases with pre-existing hepatitis B virus (HBV) and hepatitis C virus (HCV) are recorded. Despite the global dissemination of HBV and HCV infections, viral hepatitis-infected patients with cancer were traditionally excluded from ICPIs containing trials and current evidence is particularly limited in case reports, retrospective cohort studies and in few clinical trials on advanced hepatocellular carcinoma. Thus, many concerns still remain about the overall oncological management of this special subpopulation, including questions about the efficacy, toxicity and reactivation risks induced by ICPIs. Here, we examine the natural course of both HBV and HCV in cancer environment, review the latest antiviral guidelines for patients undergoing systematic cancer therapies, estimating treatment-related immunosuppression and relocate immunotherapy in this therapeutic panel. Among the ICPIs-treated cases with prior viral hepatitis, we focus further on those experienced HBV or HCV reactivation and discuss their host, tumor and serological risk factors, their antiviral and immunological management as well as their hepatitis and tumor outcome. Based on a low level of evidence, immunotherapy in these specific cancer cases seems to be associated with no inferior efficacy and with a relevantly low reactivation rate. However, hepatitis reactivation and subsequent irreversible complications appeared to have poor response to deferred antiviral treatment. While, the prophylactic use of modern antiviral drugs could eliminate or diminish up front the viral load in most cases, leading to cure or long-term hepatitis control. Taking together the clinical significance of preventive therapy, the low but existing reactivation risk and the potential immune-related hepatotoxicity, a comprehensive baseline assessment of liver status, including viral hepatitis screening, before the onset of immunotherapy should be suggested as a reasonable and maybe cost-effective strategy but the decision to administer ICPIs and the necessity of prophylaxis should always be weighed at a multidisciplinary level and be individualized in each case, up to be established by future clinical trials.
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Affiliation(s)
- Dimitrios C Ziogas
- First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Frosso Kostantinou
- First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Evangelos Cholongitas
- First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Amalia Anastasopoulou
- First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Panagiotis Diamantopoulos
- First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - John Haanen
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Helen Gogas
- First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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31
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Arciuolo RJ, Lazaroff JE, Rosen JB, Lim S, Zucker JR. Trends in Hepatitis B Surveillance Among Pregnant Women in New York City, 1998-2015. Public Health Rep 2020; 135:676-684. [PMID: 32795209 PMCID: PMC7485044 DOI: 10.1177/0033354920946793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Infants born to women with hepatitis B virus (HBV) infection are at high risk for chronic HBV infection and premature death. We examined epidemiologic trends among women with HBV infection who gave birth in New York City (NYC) to inform public health prevention activities. METHODS We obtained data on HBV-infected women residing and giving birth in NYC during 1998-2015 from the NYC Perinatal HBV Prevention Program. We obtained citywide birth data from the NYC Office of Vital Statistics. We calculated the incidence of births to HBV-infected women per 100 000 live births and stratified by maternal race, birthplace, and age. We calculated annual percentage change (APC) in incidence of births to HBV-infected women by using joinpoint regression. RESULTS Of 29 896 HBV-infected women included in the study, 28 195 (94.3%) were non-US-born, of whom 16 600 (58.9%) were born in China. Overall incidence of births to HBV-infected women per 100 000 live births increased from 1156 in 1998 to 1573 in 2006 (APC = 3.1%; P < .001) but declined to 1329 in 2015 (APC = -1.4%; P = .02). Incidence among US-born women declined from 1998 to 2015 (330 to 84; APC = -7.3%; P < .001) and among non-US-born women increased from 1998 to 2007 (1877 to 2864; APC = 3.6%; P < .001) but not thereafter. Incidence among women born in China increased from 1998 to 2006 (13 275 to 16 480; APC = 1.8%; P = .02) but decreased to 12 631 through 2015 (APC = -3.3%; P < .001). CONCLUSIONS The incidence of births to HBV-infected women in NYC declined significantly among US-born women but not among non-US-born women, highlighting the need for successful vaccination programs worldwide.
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Affiliation(s)
- Robert J. Arciuolo
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Atlanta, GA, USA
| | - Julie E. Lazaroff
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Jennifer B. Rosen
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Sungwoo Lim
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Jane R. Zucker
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, Queens, NY, USA
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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32
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Goding Sauer A, Siegel RL, Jemal A, Fedewa SA. Current Prevalence of Major Cancer Risk Factors and Screening Test Use in the United States: Disparities by Education and Race/Ethnicity. Cancer Epidemiol Biomarkers Prev 2020; 28:629-642. [PMID: 30944145 DOI: 10.1158/1055-9965.epi-18-1169] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/11/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022] Open
Abstract
Overall cancer death rates in the United States have declined since 1990. The decline could be accelerated by eliminating socioeconomic and racial disparities in major risk factors and screening utilization. We provide an updated review of the prevalence of modifiable cancer risk factors, screening, and vaccination for U.S. adults, focusing on differences by educational attainment and race/ethnicity. Individuals with lower educational attainment have higher prevalence of modifiable cancer risk factors and lower prevalence of screening versus their more educated counterparts. Smoking prevalence is 6-fold higher among males without a high school (HS) education than female college graduates. Nearly half of women without a college degree are obese versus about one third of college graduates. Over 50% of black and Hispanic women are obese compared with 38% of whites and 15% of Asians. Breast, cervical, and colorectal cancer screening utilization is 20% to 30% lower among those with <HS education compared with college graduates. Screening for breast, cervical, and colorectal cancers is also lower among Hispanics, Asians, and American Indians/Alaska Natives relative to whites and blacks. Enhanced, multilevel efforts are needed to further reduce the prevalence of modifiable risk factors and improve screening and vaccination, particularly among those with lower socioeconomic status and racial/ethnic minorities.
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Affiliation(s)
- Ann Goding Sauer
- Intramural Research Department, American Cancer Society, Atlanta, Georgia.
| | - Rebecca L Siegel
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
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33
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Bhuiyan AR, Kabir N, Mitra AK, Ogungbe O, Payton M. Disparities in Hepatitis B Vaccine Coverage by Race/Ethnicity: The National Health and Nutrition Examination Survey (NHANES) 2015-2016. Diseases 2020; 8:E10. [PMID: 32316174 PMCID: PMC7348843 DOI: 10.3390/diseases8020010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022] Open
Abstract
Hepatitis B virus (HBV) infection is the most common form of viral hepatitis and remains a global public health problem, even though the HBV vaccine is available. HBV leads to chronic liver disease, including cirrhosis, liver cancer, and death. This study aimed to identify disparities in HBV vaccine coverage with the serological test by race/ethnicity, adjusting for gender and age. In this study, 5735 adult participants were included, obtaining data from the National Health and Nutrition Examination Survey (NHANES), 2015-2016. Proc survey frequency, bivariate- and multivariate logistic regression in the weighted sample were performed due to the complex survey design of NHANES. Data were analyzed using SAS, version 9.2.4. The overall prevalence of HBV vaccine coverage was only 23.3% (95% CI: 20.7%, 25.9%). In a multivariate logistic regression model, data showed that Mexican Americans (OR 0.57, 95% CI: 0.38, 0.86) and African Americans (OR 0.70, 95% CI 0.56, 0.84) had lower vaccine coverage compared to Whites. Females had (OR 1.55, 95% CI: 1.30, 1.85) higher vaccine coverage compared to men. Older age groups (30-49 years) (OR 0.41, 95% CI: 0.32, 0.52) and age group ≥ 50 years (OR 0.18, 95% CI 0.14, 0.23) had lower vaccine coverage compared to younger adults aged 18-29 years.
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Affiliation(s)
- Azad R. Bhuiyan
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, MS 39213, USA; (N.K.); (A.K.M.); (M.P.)
| | - Nusrat Kabir
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, MS 39213, USA; (N.K.); (A.K.M.); (M.P.)
| | - Amal K. Mitra
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, MS 39213, USA; (N.K.); (A.K.M.); (M.P.)
| | - Oluwabunmi Ogungbe
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205, USA;
| | - Marinelle Payton
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, MS 39213, USA; (N.K.); (A.K.M.); (M.P.)
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Liu Z, Suo C, Mao X, Jiang Y, Jin L, Zhang T, Chen X. Global incidence trends in primary liver cancer by age at diagnosis, sex, region, and etiology, 1990-2017. Cancer 2020; 126:2267-2278. [PMID: 32201944 DOI: 10.1002/cncr.32789] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 01/15/2020] [Accepted: 01/31/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The incidence of primary liver cancer (PLC) continues to increase worldwide. The incidence trends and patterns of PLC associated with different age at diagnosis remain unknown. METHODS We collected detailed information on PLC between 1990 and 2017 from Global Burden of Disease Study 2017. Estimated annual percentage changes in the PLC age-standardized incidence rate (ASR) diagnosed by age, sex, region, and etiology were calculated to quantify the temporal trends in PLC ASR. RESULTS Globally, the number of PLC cases for which the age at diagnosis was <30 years decreased from 17,381 in 1990 to 14,661 in 2017, whereas the number of PLC cases diagnosed at age 30 to 59 and ≥60 years old increased from 216,561 and 241,189 in 1990 to 359,770 and 578,344 in 2017, respectively. The ASR of PLC cases with age at diagnosis <30 years and between 30 and 59 years decreased in both sexes, whereas the ASR of PLC with age at diagnosis ≥60 years increased in males and remained stable in females at the global level. Males had a more dramatic increase in PLC diagnosed at age ≥60 years but a milder decrease in PLC diagnosed between 30 and 59 years of age. This decrease was attributed largely to the reduction in PLC caused by hepatitis B and hepatitis C and was consistent in most regions except for developed countries, in which the ASR of PLC increased irrespective of sex and age. The ASR of PLC due to nonalcoholic steatohepatitis (NASH) increased by the greatest magnitude in most regions. CONCLUSION PLC in highly endemic regions has been partly alleviated due to the potent control of hepatitis, especially among young and middle-aged people. However, an unfavorable trend was observed in most developed countries and in elderly populations. As such, PLC prevention schedules should give more attention to NASH and elderly patients.
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Affiliation(s)
- Zhenqiu Liu
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, Fudan University, Shanghai, China.,School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Chen Suo
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Xianhua Mao
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, Fudan University, Shanghai, China.,School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Yanfeng Jiang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, Fudan University, Shanghai, China.,School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, Fudan University, Shanghai, China.,School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Xingdong Chen
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, Fudan University, Shanghai, China.,School of Life Sciences, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
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Liu KSH, Seto WK, Lau EHY, Wong DKH, Lam YF, Cheung KS, Mak LY, Ko KL, To WP, Law MWK, Wu JT, Lai CL, Yuen MF. A Territorywide Prevalence Study on Blood-Borne and Enteric Viral Hepatitis in Hong Kong. J Infect Dis 2020; 219:1924-1933. [PMID: 30668746 DOI: 10.1093/infdis/jiz038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/18/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Viral hepatitis epidemiological data are important for the World Health Organization plan of eliminating viral hepatitis. We aimed to document the prevalence of viral hepatitis A to E in Hong Kong. METHODS This community-based study was open to all Hong Kong Chinese citizens aged ≥18 years. Baseline data and risk factors were collected. Hepatitis A-E serology was measured, including hepatitis B e antigen, antibodies to hepatitis B e antigen, antibodies to hepatitis D, hepatitis B virus (HBV) DNA for hepatitis B surface antigen (HBsAg)-positive participants, and antibodies to hepatitis B surface antigen and antibodies to hepatitis B core antigen (anti-HBc) in HBsAg-negative participants. Hepatitis C virus (HCV) RNA and genotypes were determined in anti-HCV-positive participants. RESULTS A total of 10 256 participants were recruited from February 2015 to July 2016. Overall HBsAg seroprevalence was 7.8% (95% confidence interval [CI], 7.3%-8.3%), which was reduced significantly with HBV vaccination (odds ratio, 0.15 [95% CI, .11-.21]). Among HBsAg-negative participants, anti-HBc seroprevalence increased from 5.4% (<26 years) to 60.1% (>65 years). No hepatitis D virus (HDV) cases were detected. Anti-HCV positivity was 0.5% (95% CI, .3%-.6%). Prevalence of antibodies to hepatitis A virus (anti-HAV) and hepatitis E virus (anti-HEV) was 65.2% (95% CI, 64.2%-66.1%) and 33.3% (95% CI, 32.4%-34.2%), respectively, and were influenced by age, family income, and being born in mainland China. CONCLUSIONS HBV seroprevalence remained high despite universal vaccination. High anti-HBc seroprevalence underlines the potential issue of HBV reactivation during profound immunosuppression. HCV and HDV remained uncommon. Anti-HAV seroprevalence had decreased whereas anti-HEV seroprevalence had risen.
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Affiliation(s)
- Kevin S H Liu
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital.,Department of State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital
| | - Eric H Y Lau
- School of Public Health, University of Hong Kong
| | - Danny Ka-Ho Wong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital.,Department of State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital
| | - Yuk-Fai Lam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Ka-Shing Cheung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Lung-Yi Mak
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Kwan-Lung Ko
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | - Wai-Pan To
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital
| | | | - Joseph T Wu
- School of Public Health, University of Hong Kong
| | - Ching-Lung Lai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital.,Department of State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital
| | - Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital.,Department of State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital
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Jacobson RM. Routine Childhood Vaccines Given in the First 11 Months of Life. Mayo Clin Proc 2020; 95:395-405. [PMID: 31879133 DOI: 10.1016/j.mayocp.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/06/2019] [Accepted: 06/26/2019] [Indexed: 01/02/2023]
Abstract
The US Advisory Committee on Immunization Practices recommends that infants beginning at birth receive several vaccines directed against a variety of infectious diseases that currently pose threats of morbidity and mortality to infants and those around them, including the 3-dose hepatitis B (HepB) series. The first dose is due at birth. This series protects against maternal-infant transmission of the HepB virus and against exposure the rest of the infant's life. At age 2 months infants are to receive not only their second dose of HepB vaccine but also a series of vaccines directed against diphtheria, tetanus, pertussis, pneumococcus, rotavirus, poliovirus, and Haemophilus influenzae type b. At 4 months, infants are to repeat those vaccines except for the HepB vaccine. At age 6 months infants are to finish the HepB series and receive the third doses of the other vaccines received at 2 and 4 months except for the rotavirus vaccine, depending on the brand used. Also, starting at 6 months, depending on the time of year, infants are to begin a 2-dose series against influenza separated by 28 days. Each of these vaccines is due at a time when the vaccine works to protect against an immediate risk and to provide long-term protection. These vaccine-preventable diseases vary in terms of the nature of exposure, the form of the morbidity, the risk of mortality, and the ability of routine vaccination to prevent or ameliorate harm.
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Affiliation(s)
- Robert M Jacobson
- Department of Pediatric and Adolescent Medicine and Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
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Wu D. Correlation of viral load of Hepatitis B with the gestation period and the development of diabetes mellitus. Saudi J Biol Sci 2019; 26:2022-2025. [PMID: 31889788 PMCID: PMC6923489 DOI: 10.1016/j.sjbs.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To elaborate how the viral load of HBV affects the gestational diabetes mellitus (GDM). METHODS We enrolled 196 chronic HBV-infected pregnant patients in this hospital between January 2012 and December 2017 for delivery in this study. According to the viral load of HBV-DNA, these patients were divided into the HBV-DNA negative group (n = 107, <1 × 103 copies/mL) and HBV-DNA positive group (n = 89, ≥1 × 103 copies/mL). Simultaneously, 100 HBV-free pregnant women who were admitted to the hospital for delivery were included in the control group. Before delivery, fasting venous blood was drawn from the pregnant women to perform the HBV-DNA quantification through qRT-PCR; from the 24th to 28th gestation week, all pregnant women underwent OGTT, with the third-trimester-of-pregnancy as the endpoint. Besides, we also measured the FBG, 2hPG and hemoglobin A1c (HbAIc). RESULTS Among 168 pregnant patients carrying chronic HBV, viral load of 107 patients was less than 1 × 103 copies/mL (54.6%), and 89 not less than 1 × 103 copies/mL (45.4%). The incidence rates of GDM in the HBV-DNA negative group and HBV-DNA positive group were 18.7% and 19.1%, respectively, significantly higher than that in the control group (p < 0.05), while the difference of the incidence rates of GDM between two HBV-DNA groups were not significant (p > 0.05). In HBV-DNA negative group and HBV-DNA positive group, FBGs, 2hPGs and HbAIcs were respectively (6.96 ± 0.36) mmol/L and (7.04 ± 0.37) mmol/L, (10.26 ± 1.29) mmol/L and (10.16 ± 1.12) mmol/L, and (8.66 ± 0.97) % and (8.91 ± 0.90) %, significantly higher than (4.57 ± 0.34) mmol/L, (6.16 ± 0.86) mmol/L and (5.13 ± 0.57) % (p < 0.05); however, between two HBV-DNA groups, comparisons of the FBG, 2hPG and HbAIc suggested no significant differences (p > 0.05). In 196 patients carrying chronic HBV, positive correlations were identified between the viral load of HBV-DNA, and FBG, 2hPG and HbAIc (p < 0.01). CONCLUSION HBV infection can increase the incidence rate of GDM, and the viral load of HBV-DNA is correlated with the glucose level of pregnant patients.
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Sangaramoorthy M, Yang J, DeRouen MC, Ho C, Somsouk M, Tana MM, Thompson CA, Gibbons J, Gomez SL, Shariff-Marco S. Disparities in Hepatocellular Carcinoma Incidence in California: An Update. Cancer Epidemiol Biomarkers Prev 2019; 29:79-87. [PMID: 31719066 DOI: 10.1158/1055-9965.epi-19-0560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/01/2019] [Accepted: 11/04/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Given changes in hepatocellular carcinoma (HCC) incidence and the ethnodemographic landscape, we analyzed recent HCC incidence patterns and trends in California. METHODS Using 47,992 primary, invasive HCC cases diagnosed from 1988 to 2014 from the California Cancer Registry, we calculated age-adjusted incidence rates (IR), annual percent change (APC), and 95% confidence intervals (CI) by sex, race/ethnicity, and nativity among Hispanics and Asian ethnic groups. RESULTS Compared with non-Hispanic Whites (NHW), all other racial/ethnic groups had higher HCC incidence. Vietnamese had the highest IRs (males: 47.4, 95% CI, 45.3-49.5; females: 14.1, 95% CI, 13.0-15.3). Foreign-born Chinese, Japanese, Korean, and Vietnamese had higher incidence than U.S.-born. The reverse was observed for Hispanic males, whereas no differences by nativity were seen for Hispanic females. IRs increased most for NHWs. Among Asians, male and female Filipinos and Japanese males experienced rate increases, whereas male and female Koreans and Chinese males experienced rate decreases. U.S.-born male and female Hispanics and Japanese had higher APCs than foreign-born, as did Filipino males, whereas Chinese males had a reverse pattern. Annual increases in HCC incidence slowed down in recent years for U.S.-born Hispanic males and females and stabilized among male NHWs and non-Hispanic Blacks. For some Asian groups, early time periods exhibited increasing/stable APCs, whereas later time periods showed decreasing APCs. CONCLUSIONS We found significant racial/ethnic and nativity differences in HCC IRs and trends. IMPACT With changing trends, closer surveillance of HCC incidence by disaggregated race/ethnicity and nativity is warranted among Hispanics and Asians.
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Affiliation(s)
- Meera Sangaramoorthy
- Greater Bay Area Cancer Registry, San Francisco, California.,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California
| | - Juan Yang
- Greater Bay Area Cancer Registry, San Francisco, California.,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California
| | - Mindy C DeRouen
- Greater Bay Area Cancer Registry, San Francisco, California.,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California.,UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Chanda Ho
- Department of Transplantation, California Pacific Medical Center, San Francisco, California
| | - Ma Somsouk
- UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California.,UCSF, Division of Gastroenterology at Zuckerberg San Francisco General, San Francisco, California
| | - Michele M Tana
- UCSF, Division of Gastroenterology at Zuckerberg San Francisco General, San Francisco, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, San Diego, California.,Department of Family Medicine and Public Health, University of California San Diego, San Diego, California
| | - Joseph Gibbons
- Department of Sociology, College of Arts & Letters, San Diego State University, San Diego, California
| | - Scarlett Lin Gomez
- Greater Bay Area Cancer Registry, San Francisco, California.,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California.,UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Salma Shariff-Marco
- Greater Bay Area Cancer Registry, San Francisco, California. .,University of California, San Francisco (UCSF), School of Medicine, Department of Epidemiology & Biostatistics, San Francisco, California.,UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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Moore MS, Bocour A, Winters A. Surveillance-Based Estimate of the Prevalence of Chronic Hepatitis B Virus Infection, New York City, 2016. Public Health Rep 2019; 134:695-702. [PMID: 31647883 DOI: 10.1177/0033354919882962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Chronic hepatitis B virus (HBV) infection is a lifelong infection that can cause serious liver damage and liver cancer. The last surveillance-based prevalence estimate of chronic HBV infection in New York City was 1.2% in 2008; however, it did not account for persons with undiagnosed infection. The objective of this study was to calculate the prevalence of chronic HBV infection, including undiagnosed infection, for 2016 by using surveillance data and literature-based information. METHODS We calculated the number of persons with diagnosed chronic HBV infection (2000-2016) who were alive and living in New York City in 2016 by using routine surveillance data. We estimated the percentage of persons with undiagnosed chronic HBV infection by using birth region-specific percentages from the literature, weighted by the proportion of the New York City population with diagnosed chronic HBV infection from the same birth region. We identified minimum, maximum, and most likely values for the percentage with undiagnosed chronic HBV infection to generate 95% certainty limits (CLs) of the prevalence estimate. RESULTS The prevalence of chronic HBV infection in 2016, including undiagnosed infection, in New York City was 2.7% (95% CL, 2.2%-3.6%), representing approximately 230 000 persons. The prevalence of diagnosed chronic HBV infection was 1.5%. The estimated prevalence among non-US-born residents was 6.9% (95% CL, 5.4%-8.9%). CONCLUSIONS The current burden of chronic HBV infection in New York City, especially for non-US-born residents, is substantial. A renewed focus and dedication of resources is required to increase the number of new diagnoses and improve provider capacity to care for the large number of persons with chronic HBV infection.
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Affiliation(s)
- Miranda S Moore
- Viral Hepatitis Program, Bureau of Communicable Disease, Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Angelica Bocour
- Viral Hepatitis Program, Bureau of Communicable Disease, Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Ann Winters
- Viral Hepatitis Program, Bureau of Communicable Disease, Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
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Nazari M, Rosenblum JS, Trumbo S. Hepatitis B-associated hepatocellular carcinoma in a young Haitian man: a review of screening guidelines. BMJ Case Rep 2019; 12:12/10/e230530. [PMID: 31604717 DOI: 10.1136/bcr-2019-230530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a terminal, yet preventable, outcome of untreated infection with hepatitis B virus (HBV). HBV is endemic in many areas of Latin America and the Caribbean, including Haiti. Haitians have the highest incidence of liver cancer among Caribbean immigrants. Unfortunately, many of these patients are not screened, despite current guidelines. As HBV is treatable, screening of high-risk populations is crucial to early intervention and prevention of poor outcomes. We highlight the case of a young Haitian male immigrant who presented with unintentional weight loss and epigastric pain and found to have HCC associated with HBV. Despite chemotherapy, the patient died 15 months after diagnosis. Increased awareness of HBV among patients from high-incidence countries may result in early recognition of this disease and reduced morbidity and mortality from devastating complications.
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Affiliation(s)
- Matthew Nazari
- Department of Internal Medicine and Pediatrics, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Jared Spencer Rosenblum
- National Cancer Institute, Neuro-Oncology Branch, National Institutes of Health, Bethesda, MD, USA
| | - Silas Trumbo
- Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Carrier P, Debette-Gratien M, Jacques J, Loustaud-Ratti V. Cirrhotic patients and older people. World J Hepatol 2019; 11:663-677. [PMID: 31598192 PMCID: PMC6783402 DOI: 10.4254/wjh.v11.i9.663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023] Open
Abstract
The global population is aging, and so the number of older cirrhotic patients is increasing. Older patients are characterised by a risk of frailty and comorbidities, and age is a risk factor for mortality in cirrhotic patients. The incidence of non-alcoholic fatty liver disease as an aetiology of cirrhosis is increasing, while that of chronic viral hepatitis is decreasing. Also, cirrhosis is frequently idiopathic. The management of portal hypertension in older cirrhotic patients is similar to that in younger patients, despite the greater risk of treatment-related adverse events of the former. The prevalence of hepatocellular carcinoma increases with age, but its treatment is unaffected. Liver transplantation is generally recommended for patients < 70 years of age. Despite the increasing prevalence of cirrhosis in older people, little data are available and few recommendations have been proposed. This review suggests that comorbidities have a considerable impact on older cirrhotic patients.
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Affiliation(s)
- Paul Carrier
- Fédération d’Hépatologie, Centre Hospitalier Universitaire Dupuytren de Limoges, Limoges 87042, France
- Faculté de Médecine et de Pharmacie de Limoges, Rue Docteur Marcland, Limoges 87042, France
| | - Marilyne Debette-Gratien
- Fédération d’Hépatologie, Centre Hospitalier Universitaire Dupuytren de Limoges, Limoges 87042, France
- Faculté de Médecine et de Pharmacie de Limoges, Rue Docteur Marcland, Limoges 87042, France
| | - Jérémie Jacques
- Service de Gastroentérologie, Centre Hospitalier Universitaire Dupuytren de Limoges, Limoges 87042, France
| | - Véronique Loustaud-Ratti
- Fédération d’Hépatologie, Centre Hospitalier Universitaire Dupuytren de Limoges, Limoges 87042, France
- Faculté de Médecine et de Pharmacie de Limoges, Rue Docteur Marcland, Limoges 87042, France.
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Bentouhami MR, Chakib A, El Fane M. Hepatitis B knowledge, attitudes and practices among Moroccan college students. Rev Epidemiol Sante Publique 2019; 67:397-402. [PMID: 31561941 DOI: 10.1016/j.respe.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 06/16/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Viral Hepatitis B (HBV) prevalence in Morocco is estimated at 1.81%. University students are an exposed population due to their risky behaviors. Their knowledge about HBV is still unknown. The aim of our study was to assess the knowledge, attitudes and practices of college students in Casablanca about HBV. METHODS A cross-sectional study was carried out in January 2015 among the students of the eight schools of Hassan II University in Casablanca using a self-administered questionnaire. A knowledge score was calculated to compare the groups with sufficient and insufficient knowledge. A logistic regression adjusted on gender was performed to explore the factors associated with a sufficient knowledge about HBV (P<0.05). RESULTS The response rate was 90.2% (n=652). The median age was 21 years old. From our sample, 97.5% knew the existence of "hepatitis". The main means of information were media and relatives. The most known way of infection was blood transmission (50.3%) while 11.5% believed in the effectiveness of the traditional methods of treatment. Eating with an HBV infected person was thought to be a risky behavior for 38% of the students. A knowledge level that was deemed to be sufficient was scored by 31.1% of the students. The sufficient knowledge was correlated to being a health care student, being vaccinated and being married. CONCLUSION Casablanca's student knowledge about HBV remains limited. We believe that improvements in awareness and access to immunization are needed. These measures would likely help decreasing HBV incidence in students and ensure a better social integration of patients.
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Affiliation(s)
- M R Bentouhami
- Department of infectious diseases, Ibn Rochd Hospital, Casablanca, Morocco.
| | - A Chakib
- Department of infectious diseases, Ibn Rochd Hospital, Casablanca, Morocco
| | - M El Fane
- Department of infectious diseases, Ibn Rochd Hospital, Casablanca, Morocco
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Tang AS, Lyu J, Wang S, He Q, Pong P, Harris AM. Disparities in Hepatitis B Virus Infection and Immunity Among New York City Asian American Patients, 1997 to 2017. Am J Public Health 2019; 108:S327-S335. [PMID: 30383421 DOI: 10.2105/ajph.2018.304504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To measure disparities in hepatitis B virus (HBV) infection and immunity among a high-risk patient population at a community health center in New York City. METHODS We performed a retrospective chart review of 25 565 adults with HBV surface antigen, surface antibody, and total core antibody tests from 1997 to 2017. We categorized HBV test results by infection and immunity status and analyzed by demographic characteristics with χ2 and logistic regression analysis. RESULTS Of 25 565 adults, 13.4% were currently infected, 52.1% were ever infected, 33.4% were immune from vaccination, and 14.5% were susceptible. Significant factors associated with ever infection were age, male sex, being China-born, limited English proficiency, having Medicaid or no insurance, and family history of HBV (P < .01). CONCLUSIONS Our study demonstrated a high burden of HBV infection among foreign-born Asian Americans seeking care at a community health center. Public Health Implications. It is important to test patients at high risk for HBV infection with all 3 tests to identify those with current infection, risk for reactivation, or need for vaccination, and to assess the effectiveness of public health interventions.
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Affiliation(s)
- Amy S Tang
- Amy S. Tang, Janice Lyu, Qingqing He, and Perry Pong are with the Charles B. Wang Community Health Center, New York, NY. Su Wang is with the Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ. Aaron M. Harris is with the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Janice Lyu
- Amy S. Tang, Janice Lyu, Qingqing He, and Perry Pong are with the Charles B. Wang Community Health Center, New York, NY. Su Wang is with the Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ. Aaron M. Harris is with the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Su Wang
- Amy S. Tang, Janice Lyu, Qingqing He, and Perry Pong are with the Charles B. Wang Community Health Center, New York, NY. Su Wang is with the Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ. Aaron M. Harris is with the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Qingqing He
- Amy S. Tang, Janice Lyu, Qingqing He, and Perry Pong are with the Charles B. Wang Community Health Center, New York, NY. Su Wang is with the Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ. Aaron M. Harris is with the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Perry Pong
- Amy S. Tang, Janice Lyu, Qingqing He, and Perry Pong are with the Charles B. Wang Community Health Center, New York, NY. Su Wang is with the Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ. Aaron M. Harris is with the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Aaron M Harris
- Amy S. Tang, Janice Lyu, Qingqing He, and Perry Pong are with the Charles B. Wang Community Health Center, New York, NY. Su Wang is with the Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ. Aaron M. Harris is with the Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
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Tafesh ZH, Brown RS. Management of Virologic Failure in Patients with Chronic Hepatitis B Treated with Nucleos(t)ide Analogues. CURRENT HEPATOLOGY REPORTS 2019; 18:363-369. [DOI: 10.1007/s11901-019-00483-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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45
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Leng J, Peruluswami P, Bari S, Gaur S, Radparvar F, Parvez F, Chen Y, Flores C, Gany F. South Asian Health: Inflammation, Infection, Exposure, and the Human Microbiome. J Immigr Minor Health 2019; 21:26-36. [PMID: 28952002 PMCID: PMC5871532 DOI: 10.1007/s10903-017-0652-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper presents the results of the literature review conducted for the working group topic on inflammation, infection, exposure, and the human microbiome. Infection and chronic inflammation can elevate risk for cardiovascular disease and cancer. Environmental exposures common among South Asian (SA) subgroups, such as arsenic exposure among Bangladeshis and particulate matter air pollution among taxi drivers, also pose risks. This review explores the effects of exposure to arsenic and particulate matter, as well as other infections common among SAs, including human papillomavirus (HPV) and hepatitis B/C infection. Emerging research on the human microbiome, and the effect of microbiome changes on obesity and diabetes risk among SAs are also explored.
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Affiliation(s)
- Jennifer Leng
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Ponni Peruluswami
- Department of Medicine, Icahn School of Medicine at the Mount Sinai Medical Center, 1468 Madison Avenue, New York, NY, USA
| | - Sehrish Bari
- The Earth Institute, Columbia University, 2910 Broadway, New York, NY, USA
| | - Sunanda Gaur
- Robert Wood Johnson Medical School, South Asian Total Health Initiative, Rutgers School of Public Health, Rutgers, The State University of New Jersey, 1 Robert Wood Johnson Place, New Brunswick, NJ, USA
| | - Farshid Radparvar
- Cardiology Department, Queens Hospital Center, 82-68 164th Street, Jamaica, New York, NY, USA
| | - Faruque Parvez
- Department of Environmental Health Sciences, Columbia University, 722 W 168th Street, New York, NY, USA
| | - Yu Chen
- Department of Population Health, Department of Environmental Medicine, New York University School of Medicine, 550 1st Avenue, New York, NY, USA
| | - Cristina Flores
- The Warren Alpert Medical School, The Brown Human Rights Asylum Clinic (BHRAC), Brown University, 222 Richmond Street, Providence, RI, USA
| | - Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.
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46
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Gomes C, Wong RJ, Gish RG. Global Perspective on Hepatitis B Virus Infections in the Era of Effective Vaccines. Clin Liver Dis 2019; 23:383-399. [PMID: 31266615 DOI: 10.1016/j.cld.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatitis B virus (HBV) infection is a global health burden. The chronicity of this infection leads to complication such as cirrhosis and hepatocellular carcinoma, making it a leading cause of morbidity and mortality worldwide. Chronic infection commonly develops among those who acquire infection during childhood, hence the importance of effective implementation of HBV vaccination policies designed to eradicate chronic HBV. This article provides updated estimates of worldwide HBV disease prevalence and discusses how implementation of vaccination policies has affected HBV epidemiology.
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Affiliation(s)
- Chantal Gomes
- Department of Medicine, Division of Gastroenterology and Hepatology, Endoscopy Unit, Alameda Health System, Highland Hospital, Highland Hospital Campus, Highland Care Pavilion 5th Floor, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Robert J Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, Endoscopy Unit, Alameda Health System, Highland Hospital, Highland Hospital Campus, Highland Care Pavilion 5th Floor, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Stanford Health Care, 300 Pasteur Drive, Palo Alto, CA 94304, USA
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Toy M, Hutton DW, So S. Population Health And Economic Impacts Of Reaching Chronic Hepatitis B Diagnosis And Treatment Targets In The US. Health Aff (Millwood) 2019; 37:1033-1040. [PMID: 29985701 DOI: 10.1377/hlthaff.2018.0035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The National Academies of Sciences, Engineering, and Medicine have concluded that eliminating the public health problem of chronic hepatitis B is feasible. We examined the economic and public health impact of reaching the World Health Organization targets of having 90 percent of chronic hepatitis B cases diagnosed and 80 percent being treated by 2030 in the United States with an annual incremental increase in screening and treatment rates. To reach the targets by 2030 would require screening approximately 14.5 million adults in at-risk populations to diagnose an estimated 870,000 undiagnosed cases and would result in substantial health gains: an increase of 16.5 million quality-adjusted life-years (QALYs), and reductions in liver-related deaths of 37 percent and in cases of compensated cirrhosis of 24 percent, decompensated liver cirrhosis of 51 percent, and liver cancer of 35 percent. Achieving the targets by 2030 would be highly cost-effective at $103 per QALY and would be cost-saving if the antiviral drug price were no more than $114 per month. Achieving them by 2025 would be cost-saving and would reduce liver-related deaths by 47 percent.
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Affiliation(s)
- Mehlika Toy
- Mehlika Toy ( ) is a research scientist at the Stanford University School of Medicine, in California
| | - David W Hutton
- David W. Hutton is an associate professor of health management and policy at the University of Michigan, in Ann Arbor
| | - Samuel So
- Samuel So is a professor of surgery at the Stanford University School of Medicine
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48
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Da BL, Surana P, Schueler SA, Jalaly NY, Kamal N, Taneja S, Vittal A, Gilman CL, Heller T, Koh C. Twitter As a Noninvasive Bio-Marker for Trends in Liver Disease. Hepatol Commun 2019; 3:1271-1280. [PMID: 31497747 PMCID: PMC6719740 DOI: 10.1002/hep4.1394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022] Open
Abstract
With the success of hepatitis C virus (HCV) direct-acting antiviral therapies, there has been a shift in research focus to the other major chronic liver diseases (CLDs). The use of social media, specifically Twitter, has become a popular platform for understanding public health trends and for performing health care research. To evaluate this, we studied the areas of public interest and social media trends of the following three major CLDs: hepatitis B virus (HBV), HCV, and nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH). Twitter activity data from January 1, 2013, through January 1, 2019, for HBV, HCV, and NAFLD/NASH were collected using the social media analytic tool Symplur Signals (Symplur LLC) software. Content and regression analyses were performed to understand and predict Twitter activity for each of the CLDs. Over the study period, there were 810,980 tweets generating 4,452,939,516 impressions. HCV tweet activity peaked in 2015 at 243,261 tweets, followed by a decline of 52.4% from 2015 to 2016 with a subsequent plateau through 2018. Meanwhile, NAFLD/NASH and HBV tweet activity has continued to increase, with projections that these two CLDs will surpass HCV by the second half of 2023 and 2024, respectively. Treatment and Management was the most popular content category for HCV and NAFLD/NASH, while Prevention was the most popular content category for HBV. Conclusion: Twitter is a useful social media tool to gauge public interest in liver disease over time. The information provided by Twitter can be used to identify gaps in public knowledge or highlight areas of interest that may need further research. Future studies on the use of Twitter in liver disease are warranted.
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Affiliation(s)
- Ben L Da
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Pallavi Surana
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Samuel A Schueler
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Niloofar Y Jalaly
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Natasha Kamal
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Sonia Taneja
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Anusha Vittal
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Christy L Gilman
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health Bethesda MD
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Hyun S, Lee S, Ventura WR, McMenamin J. Knowledge, Awareness, and Prevention of Hepatitis B Virus Infection Among Korean American Parents. J Immigr Minor Health 2019. [PMID: 28639095 PMCID: PMC6061079 DOI: 10.1007/s10903-017-0609-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatitis B (HB) affects 240 million people around the world, and children and young adults make up a large proportion of the infected population. Approximately 1 million people die from HB each year. Despite the seriousness of HB and its complications, many are poorly linked to clinical care. A lack of health literacy may be a critical barrier hindering access to HB care for adults as well as children in these populations. We, therefore, performed a survey to assess the level of knowledge of HB among Korean American parents. The survey was conducted on 521 Korean American adults who attended community-based HB awareness campaigns held at various locations throughout the metropolitan New York area between January 2015 and November 2016. Of these, 296 parents, who had children between ages 1 and 30, were identified. All participants were asked a series of questions regarding various aspects of HB and were evaluated on the basis of their awareness on each subject. A separate questionnaire was also employed to obtain demographic characteristics of the participants. The study revealed a significant deficit of knowledge of HB in most aspects the survey evaluated. Although the majority of the participants knew that HB is a liver disease, and many of them had been screened for HB, they had a poor understanding of vaccination, screening, their own HB status, modes of HBV transmission, and the consequences and treatment of HB. The participants also had a low level of awareness of their own children’s HB status. This study demonstrates a low level of knowledge of HB among Korean American parents electing to attend a hepatitis education program. In addition, many parents are not aware of their children’s screening and immune (or non-immune) status. The lack of health literacy may contribute to poor health access in HB care, not only in adults but also in children. This suggests an urgent need for education on HB in Korean American parents as well as in young children.
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Affiliation(s)
| | - Seulgi Lee
- Holy Name Medical Center, Teaneck, NJ USA
| | | | - Joseph McMenamin
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
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50
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Abnormal Liver Enzymes. Gastroenterol Nurs 2019; 41:497-507. [PMID: 30418344 DOI: 10.1097/sga.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Abnormal liver enzymes are frequently encountered in primary care offices and hospitals and may be caused by a wide variety of conditions, from mild and nonspecific to well-defined and life-threatening. Terms such as "abnormal liver chemistries" or "abnormal liver enzymes," also referred to as transaminitis, should be reserved to describe inflammatory processes characterized by elevated alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. Although interchangeably used with abnormal liver enzymes, abnormal liver function tests specifically denote a loss of synthetic functions usually evaluated by serum albumin and prothrombin time. We discuss the entities that most commonly cause abnormal liver enzymes, specific patterns of enzyme abnormalities, diagnostic modalities, and the clinical scenarios that warrant referral to a hepatologist.
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