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Al-Busafi SA, Alwassief A. Global Perspectives on the Hepatitis B Vaccination: Challenges, Achievements, and the Road to Elimination by 2030. Vaccines (Basel) 2024; 12:288. [PMID: 38543922 PMCID: PMC10975970 DOI: 10.3390/vaccines12030288] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 10/21/2024] Open
Abstract
Annually, more than 1.5 million preventable new hepatitis B (HBV) infections continue to occur, with an estimated global burden of 296 million individuals living with chronic hepatitis B infection. This substantial health challenge results in over 820,000 annual deaths being attributed to complications such as liver cirrhosis and hepatocellular carcinoma (HCC). The HBV vaccination remains the cornerstone of public health policy to prevent chronic hepatitis B and its related complications. It serves as a crucial element in the global effort to eliminate HBV, as established by the World Health Organization (WHO), with an ambitious 90% vaccination target by 2030. However, reports on global birth dose coverage reveal substantial variability, with an overall coverage rate of only 46%. This comprehensive review thoroughly examines global trends in HBV vaccination coverage, investigating the profound impact of vaccination on HBV prevalence and its consequences across diverse populations, including both high-risk and general demographics. Additionally, the review addresses the essential formidable challenges and facilitating factors for achieving WHO's HBV vaccination coverage objectives and elimination strategies in the coming decade and beyond.
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Affiliation(s)
- Said A. Al-Busafi
- Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Ahmed Alwassief
- Division of Gastroenterology and Hepatology, Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman
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Boisson-Walsh A, Thompson P, Fried B, Shea CM, Ngimbi P, Lumande F, Tabala M, Kashamuka MM, Babakazo P, Domino ME, Yotebieng M. Childhood immunization uptake determinants in Kinshasa, Democratic Republic of the Congo: ordered regressions to assess timely infant vaccines administered at birth and 6-weeks. Glob Health Res Policy 2023; 8:50. [PMID: 38057919 PMCID: PMC10698958 DOI: 10.1186/s41256-023-00338-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Despite global efforts to reduce preventable childhood illness by distributing infant vaccines, immunization coverage in sub-Saharan African settings remains low. Further, timely administration of vaccines at birth-tuberculosis (Bacille Calmette-Guérin [BCG]) and polio (OPV0)-remains inconsistent. As countries such as Democratic Republic of the Congo (DRC) prepare to add yet another birth-dose vaccine to their immunization schedule, this study aims to improve current and future birth-dose immunization coverage by understanding the determinants of infants receiving vaccinations within the national timeframe. METHODS The study used two ordered regression models to assess barriers to timely BCG and first round of the hepatitis B (HepB3) immunization series across multiple time points using the Andersen Behavioral Model to conceptualize determinants at various levels. The assessment leveraged survey data collected during a continuous quality improvement study (NCT03048669) conducted in 105 maternity centers throughout Kinshasa Province, DRC. The final sample included 2398 (BCG analysis) and 2268 (HepB3 analysis) women-infant dyads living with HIV. RESULTS Between 2016 and 2020, 1981 infants (82.6%) received the BCG vaccine, and 1551 (68.4%) received the first dose of HepB3 vaccine. Of those who received the BCG vaccine, 26.3%, 43.5%, and 12.8% received BCG within 24 h, between one and seven days, and between one and 14 weeks, respectively. Of infants who received the HepB3 vaccine, 22.4% received it within six weeks, and 46% between six and 14 weeks of life. Many factors were positively associated with BCG uptake, including higher maternal education, household wealth, higher facility general readiness score, and religious-affiliated facility ownership. The factors influencing HepB3 uptake included older maternal age, higher education level, household wealth, transport by taxi to a facility, higher facility general and immunization readiness scores, and religious-affiliated facility ownership. CONCLUSIONS This study demonstrated that the study participants' uptake of vaccines was consistent with the country average, but not in a timely manner. Various factors were associated with timely uptake of BCG and HepB3 vaccines. These findings suggest that investment to strengthen the vaccine delivery system might improve timely vaccine uptake and equity in vaccine coverage.
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Affiliation(s)
- Alix Boisson-Walsh
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Bruce Fried
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Christopher Michael Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Patrick Ngimbi
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fidéle Lumande
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Martine Tabala
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Pélagie Babakazo
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marisa Elaine Domino
- Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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3
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Ward JW, Wanlapakorn N, Poovorawan Y, Shouval D. Hepatitis B Vaccines. PLOTKIN'S VACCINES 2023:389-432.e21. [DOI: 10.1016/b978-0-323-79058-1.00027-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Neloska M, Isjanovski V, Isjanovski I. Knowledge of hepatitis B among healthy population in community. Arch Public Health 2022. [DOI: 10.3889/aph.2022.6039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Hepatitis B is the world’s most common blood‑borne viral infection, accounting for 2 billion infections, 350 million carriers, and 6 lakh deaths annually. Aim of the paper is to determine the level of knowledge among healthy population in North Macedonia regarding Hepatitis B virus infection. Material and methods: A community‑based cross‑sectional study was undertaken. Questionnaire was administered to 600 healthy individuals, who heard about hepatitis B. Data handled and analyzed by using statistical package SPSS. Results: The profile of those who give the correct answer regarding the cause of hepatitis B that it is a virus are women (65.3%), aged 40 to 49 (42.8%), by nationality are Macedonian, have higher education (52.8%), 92.8% live in urban areas, 74.3% are married, employed (79.2%) and have a moderate monthly income (68.9). About one‑third of the sample said that loss of appetite, diarrhea, nausea/vomiting also associated with hepatitis B. There is a significant difference in knowledge related to early (prodromal) (symptoms such as cold and flu - fever, runny nose, cough) symptoms of hepatitis infection. Only 17.7% give the correct answer that they register, and 81.7% do not. Jaundice is one of the common symptoms of hepatitis, 32.2% give the correct answer, and 25.8% of the symptoms that are present and common are nausea, vomiting and loss of appetite. Conclusions: Important knowledge deficits about the routes of hepatitis B transmission/prevention were identified. Continued efforts should be made to develop and implement hepatitis B educational campaigns/health promotion for these communities.
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Sun M, Li C, Li P, Lu J, Wang Y, Chang F, Li X, Hao M. Impact evaluation of the routine hepatitis B vaccination program of infants in China. J Public Health (Oxf) 2020; 41:158-163. [PMID: 29385505 PMCID: PMC6459360 DOI: 10.1093/pubmed/fdy015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/17/2017] [Accepted: 01/07/2018] [Indexed: 01/29/2023] Open
Abstract
Background To evaluate the impact of the routine hepatitis B vaccination program of infants in China. Methods The incidence of new hepatitis B infection and coverage with three doses of the vaccines by age groups and provinces were derived from the National Network Direct Report System of Infectious Disease during 2004–10. Chi square test and Pearson correlation analysis were used to analyze differences in incidence according to vaccination coverage and the relationship between the coverage with three doses and the incidence in different provinces. Results The incidence of new infection was 8.96/100 000 among children with complete coverage (0–15 years old), which was significantly lower than that with partial or no coverage. Among 0–9-year-old children in 2010, the incidence of new infection was 6.36/100 000, which was significantly lower than 2004. Considering the impact of vaccination on cumulative incidence among 0–5-year-old children, a 2.2-fold greater incidence of new infection was observed in provinces with the lowest to the highest vaccination rate. Conclusion The impact of the routine hepatitis B vaccination program of infants in China has become more apparent over time. Program implementation and regional disequilibrium should be payed attention to as well as the expanded program.
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Affiliation(s)
- Mei Sun
- Research Institute of Health Development Strategies, Fudan University, 177 box, 130 Dong'an Road, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Chengyue Li
- Research Institute of Health Development Strategies, Fudan University, 177 box, 130 Dong'an Road, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Pingping Li
- Research Institute of Health Development Strategies, Fudan University, 177 box, 130 Dong'an Road, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.,Current address: Shanghai Children's Medical Center, Shanghai, China
| | - Jun Lu
- Research Institute of Health Development Strategies, Fudan University, 177 box, 130 Dong'an Road, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Ying Wang
- Research Institute of Health Development Strategies, Fudan University, 177 box, 130 Dong'an Road, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Fengshui Chang
- Research Institute of Health Development Strategies, Fudan University, 177 box, 130 Dong'an Road, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Xiaohong Li
- Research Institute of Health Development Strategies, Fudan University, 177 box, 130 Dong'an Road, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Mo Hao
- Research Institute of Health Development Strategies, Fudan University, 177 box, 130 Dong'an Road, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
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Grazzini M, Arcangeli G, Mucci N, Bonanni P, Bini C, Bechini A, Boccalini S, Tiscione E, Paolini D. High chance to overcome the non-responder status to hepatitis B vaccine after a further full vaccination course: results from the extended study on healthcare students and workers in Florence, Italy. Hum Vaccin Immunother 2019; 16:949-954. [PMID: 31634048 PMCID: PMC7227660 DOI: 10.1080/21645515.2019.1680082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Healthcare workers (HCWs) are considered high-risk subjects for Hepatitis B Virus (HBV) infection due to occupational exposure to blood and body fluids. Vaccination represents the core strategy for HBV infection prevention. Following our previous publication on this topic, we aimed to assess the effectiveness of booster vaccine doses in eliciting the immunological response in seronegative (<10 mIU/mL) HCWs and students of Careggi Teaching Hospital, Florence (Italy). All subjects received primary vaccination course, and they were tested for serum anti-HBs antibodies. In seronegative subjects, a challenge dose of vaccine was administered and the test was repeated 1 month later. Six hundred and ninety-eight (87.8%) of 795 HCWs and students tested responded to the challenge dose. After this challenge dose, males more often had negative anti-HBs titer compared with females (15.9% vs 10.2%; p < .05). The completion of the second vaccination course was offered to subjects with persistently negative anti-HBs titer. 76.2% (32) of those who accepted the fifth dose, and 3 of the 5 who accepted the sixth dose seroconverted. This report shows the importance to convey a strong message to negative subjects at the initial anti-HBs dosage: accepting all the three additional vaccine doses allows the vast majority of them to obtain protection.
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Affiliation(s)
| | - Giulio Arcangeli
- Department of Experimental and Clinical Medicine University of Florence, Florence, Italy
| | - Nicola Mucci
- Department of Experimental and Clinical Medicine University of Florence, Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Costanza Bini
- Department of Experimental and Clinical Medicine University of Florence, Florence, Italy
| | - Angela Bechini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Emilia Tiscione
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Diana Paolini
- Department of Health Sciences, University of Florence, Florence, Italy
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Posuwan N, Vuthitanachot V, Chinchai T, Wasitthankasem R, Wanlapakorn N, Poovorawan Y. Serological evidence of hepatitis A, B, and C virus infection in older adults in Khon Kaen, Thailand and the estimated rates of chronic hepatitis B and C virus infection in Thais, 2017. PeerJ 2019; 7:e7492. [PMID: 31489265 PMCID: PMC6705384 DOI: 10.7717/peerj.7492] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/16/2019] [Indexed: 01/02/2023] Open
Abstract
Hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV) viruses are hepatotropic viruses responsible for acute/chronic hepatitis associated with liver failure, cirrhosis, and hepatocellular carcinoma. Due to the limited data on the prevalence of hepatitis in the older population in Thailand, this study aimed to evaluate the seroprevalence of these viruses in elderly Thais. Using an automated immunoassay, serum samples from individuals older than 60 years of age in Chum Phae district of Khon Kaen province in northeast Thailand were analyzed for anti-HAV (n = 93), HBV markers (n = 460, HBsAg, anti-HBs, and anti-HBc), and anti-HCV (n = 460). Samples were classified into five age groups (61-65, 66-70, 71-75, 76-80, and >80 years). The overall seroprevalence of anti-HAV, HBsAg, anti-HBc, anti-HBs, and anti-HCV was 98.9%, 4.6%, 51.5%, 32.4%, and 1.3%, respectively. When samples were stratified into three groups representing three generations (children/young adults aged 6 months-30 years and middle-aged adults between 31-60 years old from a previous survey, and older adults aged >60 years from the current study), the highest levels of anti-HAV and anti-HBc were found in older adults. Children/young adults had the lowest levels of HBsAg and anti-HCV, and the highest level of anti-HBs. These findings are consistent with the integration of HBV vaccination into the Expanded Program on Immunization (EPI) in 1992 and coincide with increased awareness of blood-borne viral transmission in Thailand. Extrapolating from our data, the estimated numbers of cases of chronic HBV and HCV infection in Thailand in 2017 were 2.2 and 0.79 million, respectively. Thus, effective treatments for viral hepatitis B and C for middle-aged and elderly Thais are needed. This seroprevalence survey could be used to help formulate policies and possible guidelines for treatment and prevention in specific age groups, which is recommended to facilitate the elimination of viral hepatitis by 2030.
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Affiliation(s)
- Nawarat Posuwan
- Center of Excellence in Clinical Virology Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
| | | | - Teeraporn Chinchai
- Department of Microbiology, Faculty of Medicine, Srinakharinwirot University, Watthana, Bangkok, Thailand
| | - Rujipat Wasitthankasem
- Center of Excellence in Clinical Virology Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand.,National Biobank of Thailand, National Science and Technology Development Agency, Thailand Science Park, PathumThani, Thailand
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand.,Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, Thailand
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Short-term immunogenicity of standard and accelerated hepatitis B virus vaccination schedules in healthy adults: a comparative field study in China. Biosci Rep 2018; 38:BSR20180846. [PMID: 30201691 PMCID: PMC6435458 DOI: 10.1042/bsr20180846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/15/2018] [Accepted: 08/29/2018] [Indexed: 02/05/2023] Open
Abstract
World Health Organization recommends hepatitis B virus (HBV) immunization at 0, 1, and 6 months. However, studies have suggested that shortening the interval between the first and last HBV immunization can improve completion rates. Less clear is whether accelerated immunization is as immunogenic as standard immunization. Thus, the present study aimed to compare the short-term immunogenicity of yeast-derived hepatitis B vaccine in healthy adults immunized on an accelerated or standard schedule. Between June 2013 and March 2014, individuals from Jinfeng and Longmen, China were randomly assigned to receive the vaccine on an accelerated schedule (at 0, 1, and 2 months; n=201) or a standard schedule (at 0, 1, and 6 months; n=206). Subjects filled out a questionnaire asking about demographic and other health data, and they underwent physical examination. Blood was assayed for HBV surface antigen and HBV surface antibody (HBsAb) at 1–2 months after the three-dose schedule. Multivariate binary logistic regression was used to determine whether the rate of anti-HBs seroconversion differed with immunization schedule. Covariance analysis was used to compare geometric mean HBsAb concentration between the two schedules. The anti-HBs seroconversion rate was 84.6% in the accelerated group and 90.3% in the standard group. After controlling for several potential confounders, the accelerated schedule was associated with significantly lower anti-HBs seroconversion rate (OR: 0.560, 95% CI: 0.318–0.988). Similarly, the accelerated schedule was associated with significantly lower geometric mean HBsAb concentration. These results suggest that the standard schedule is more likely to lead to anti-HBs seroconversion and higher HBsAb levels in adults.
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Zhao X, Pang X, Wang F, Cui F, Wang L, Zhang W. Maternal folic acid supplementation and antibody persistence 5 years after hepatitis B vaccination among infants. Hum Vaccin Immunother 2018; 14:2478-2484. [PMID: 29923793 PMCID: PMC6284482 DOI: 10.1080/21645515.2018.1482168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/08/2018] [Accepted: 05/18/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Maternal exposure to dietary factors during pregnancy may modulate the immunity of offspring by epigenetic programming. But the relationship between intrauterine environment and persistence of protective antibody after hepatitis B vaccination has not been reported. This study was to investigate the 5-year persistence of protective antibody response after primary hepatitis B vaccination, and its relationship with maternal folic acid supplementation. MATERIALS AND METHODS A total of 1461 children who completed a 3-dose 10 μg recombinant hepatitis B vaccine at birth and did not infect hepatitis B virus were followed up. Logistic regression and mediation analysis was used to explore the relationship between 5-year persistence of protective antibody and maternal nutrition. RESULTS Of 1403 children who did not revaccinated during the follow-up, 76.1% had protective hepatitis B surface antibody (anti-HBs) levels. Twenty percent of mothers did not take folate during pregnancy. Mediation analysis showed a total effect of folic acid supplementation on good persistence (odds ratio: 1.10, 95% CI: 1.03-1.17, p = 0.0010), a direct effect was 1.07 (95% CI: 1.01-1.13, p = 0.0128) and an indirect effect was 1.03 (95% CI: 1.00-1.06, p = 0.0672); the proportion of good persistence mediated by primary response was 30.3%. CONCLUSION This study indicated a good protective anti-HBs persistence at year 5 after 10 μg recombination hepatitis B vaccination in infants. Maternal folic acid supplementation may improve the persistence of protective antibodies through other pathways. Multi-center cohort studies should be conducted to verify this conclusion.
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Affiliation(s)
- Xinyu Zhao
- Dept of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Xinghuo Pang
- Beijing Center for Disease Control and Prevention, Beijing, China
| | - Fuzhen Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fuqiang Cui
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Wang
- Dept of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Wei Zhang
- Beijing Center for Disease Control and Prevention, Beijing, China
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Salama II, Sami SM, Said ZN, Salama SI, Rabah TM, Abdel-Latif GA, Elmosalami DM, Saleh RM, Abdel Mohsin AM, Metwally AM, Hassanin AI, Emam HM, Hemida SA, Elserougy SM, Shaaban FA, Fouad WA, Mohsen A, El-Sayed MH. Early and long term anamnestic response to HBV booster dose among fully vaccinated Egyptian children during infancy. Vaccine 2018. [PMID: 29530634 DOI: 10.1016/j.vaccine.2018.02.103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate early and long term anamnestic response to a booster dose of HBV vaccine among non-seroprotected children. SUBJECTS AND METHOD A national community based project was carried out on 3600 children aged 9 months to 16 years, fully vaccinated during infancy. They were recruited from 6 governorates representing Egypt. It revealed that 1535 children (42.8%) had non sero-protective anti-HBs (<10 IU/L) and were HBsAg or anti-HBc negative. A challenging dose of 10 μg of mono-valent Euvax HBV vaccine was given to 1121/1535 children. Quantitative assessment of anti-HBs was performed to detect early (2-4 weeks) and long term (one year) anamnestic responses. RESULTS Early anamnestic response developed among 967/1070 children (90.3%).Children having detectable anti-HBs (1-9 IU/L) significantly developed early anamnestic response (90%) compared to 85% with undetectable anti-HBs (<1 IU/L), P < 0.001. Multiple logistic analysis revealed that undetectable anti-HBs, living in rural residence and children aged 15-16 years were the most significant predicting risk factors for the absence of early anamnestic response (<10 IU/L), with AOR 2.7, 2.7 & 4.7 respectively. After one year, long term anamnestic response was absent among 15% of children who previously showed early response. Poor early anamnestic response and undetectable pre-booster anti-HBs were the significant predicting risk factors for absent long term anamnestic response, with AOR 18.7 & 2.7 respectively. CONCLUSION Immunological memory for HBV vaccine outlasts the presence of anti- HBs and HBV vaccination program provides effective long term protection even in children showing waning or undetectable concentrations of anti-HBs. This signifies no need for a booster dose especially to healthy children.
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Affiliation(s)
- Iman I Salama
- Community Medicine Research Department, National Research Centre, Egypt.
| | - Samia M Sami
- Child Health Department, National Research Centre, Egypt
| | - Zeinab N Said
- Microbiology and Immunology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Somaia I Salama
- Community Medicine Research Department, National Research Centre, Egypt
| | - Thanaa M Rabah
- Community Medicine Research Department, National Research Centre, Egypt
| | | | | | - Rehan M Saleh
- Community Medicine Research Department, National Research Centre, Egypt
| | | | - Ammal M Metwally
- Community Medicine Research Department, National Research Centre, Egypt
| | | | - Hanaa M Emam
- Dermatology and Venereology Department, National Research Centre, Egypt
| | - Samia A Hemida
- Community Medicine Research Department, National Research Centre, Egypt
| | - Safaa M Elserougy
- Environmental and Occupational Medicine Department, National Research Centre, Egypt
| | | | - Walaa A Fouad
- Community Medicine Research Department, National Research Centre, Egypt
| | - Amira Mohsen
- Community Medicine Research Department, National Research Centre, Egypt
| | - Manal H El-Sayed
- Pediatrics Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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12
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Yasobant S, Trivedi P, Saxena D, Puwar T, Vora K, Patel M. Knowledge of hepatitis B among healthy population: A community-based survey from two districts of Gujarat, India. J Family Med Prim Care 2017; 6:589-594. [PMID: 29417014 PMCID: PMC5787961 DOI: 10.4103/2249-4863.222009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Hepatitis B is the world's most common blood-borne viral infection, accounting for 2 billion infections, 350 million carriers, and 6 lakh deaths annually. Country like India still harbors approximately 30–60 million hepatitis B virus (HBV) carriers. A modest estimate would put the number of deaths occurring due to HBV infection per year in India to around 100,000. To prevent transmission and progression of the disease, proper community awareness including prevention is necessary. Therefore, this study aims to study the knowledge awareness among the healthy population about hepatitis B including knowledge regarding vaccine. Methodology: A community-based cross-sectional study was undertaken in two districts of Gujarat. Cluster sampling (30 clusters) was used, and pretested questionnaire was administered to 600 (with a prevalence rate of 5% in Gujarat having design effect of 2 within 95% confidence interval and 10% nonrespondent) healthy individuals, who heard about hepatitis B. Data handled and analyzed in EpiData Analysis V2.2.2.183. Results: Majority of the participants knew about symptoms whereas only 41% knew about prevention methods and few 34% knew about the mode of transmission. Although 40% sample has knowledge about the availability of vaccination, only 20% were self-vaccinated. The common reason for nonvaccination was lack of awareness. Conclusions: Only one-third of the populations in study districts are aware about hepatitis B and its vaccine. Less than one-fifth of the populations are vaccinated for hepatitis B. Important knowledge deficits about the routes of hepatitis B transmission/prevention were identified. Continued efforts should be made to develop and implement hepatitis B educational campaigns/health promotion for these communities.
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Affiliation(s)
- Sandul Yasobant
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Poonam Trivedi
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Tapasvi Puwar
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Kranti Vora
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Mayur Patel
- All India Institute of Diabetes and Research, Ahmedabad, Gujarat, India
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Takamoto T, Sugawara Y, Hashimoto T, Makuuchi M. Evaluating the current surgical strategies for hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2016; 10:341-57. [PMID: 26558422 DOI: 10.1586/17474124.2016.1116381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. Despite careful surveillance programs and the development of antiviral therapy for hepatitis virus infection, the occurrence rate of HCC remains high. Liver resection and liver transplantation are mainstay curative treatments. Most patients with HCC have impaired liver function, and surgical treatment is always accompanied by the risk of decompensation of the remnant liver, especially when the volume of the remnant liver is too small and the liver function too low to meet metabolic demands. The mortality of liver resection has dramatically decreased over the last three decades from 20% to less than 5% due to the accumulation of knowledge of liver anatomy, perioperative management and preoperative assessment of liver function. Here we provide an overview of the multidisciplinary treatments and current standard treatment strategies for HCC, to explore the possibility of expanding surgical treatments beyond the current standards.
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Affiliation(s)
- Takeshi Takamoto
- a Divisions of Hepato-Biliary-Pancreatic and Liver Transplantation Surgery , Japanese Red Cross Medical Center , Tokyo , Japan
| | - Yasuhiko Sugawara
- a Divisions of Hepato-Biliary-Pancreatic and Liver Transplantation Surgery , Japanese Red Cross Medical Center , Tokyo , Japan
| | - Takuya Hashimoto
- a Divisions of Hepato-Biliary-Pancreatic and Liver Transplantation Surgery , Japanese Red Cross Medical Center , Tokyo , Japan
| | - Masatoshi Makuuchi
- a Divisions of Hepato-Biliary-Pancreatic and Liver Transplantation Surgery , Japanese Red Cross Medical Center , Tokyo , Japan
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14
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Poovorawan K, Soonthornworasiri N, Sa-angchai P, Mansanguan C, Piyaphanee W. Hepatitis B vaccination for international travelers to Asia. Trop Dis Travel Med Vaccines 2016; 2:14. [PMID: 28883958 PMCID: PMC5530950 DOI: 10.1186/s40794-016-0031-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/13/2016] [Indexed: 12/18/2022] Open
Abstract
There is a wide range in prevalence of hepatitis B virus (HBV) infection and HBV immunization programs between different regions. Hepatitis B is a vaccine preventable disease yet is still endemic in the majority of countries in Asia. Despite the decreasing global prevalence of chronic HBV infection, there is still considerable risk of HBV infection among international travelers to high endemic areas. Numbers of international travelers are expected to increase year by year; thus immunization among this cohort is a crucial preventive measure. Among international travelers to Asia, HBV immunization should be recommended for those without previous HBV vaccination who plan to travel to countries with intermediate to high prevalence of HBV, and especially for those individuals at greater risk of HBV infection; including travelers engaging in casual sex, getting a tattoo or piercing, and those having dental surgery or other medical procedures. Longer duration of travel is also associated with a greater risk of HBV infection. Travelers from low HBV prevalence countries, especially those born before implementation of universal HBV vaccination, might benefit from HBV vaccination during long-term traveling to HBV intermediate to high endemic country.
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Affiliation(s)
- Kittiyod Poovorawan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Patiwat Sa-angchai
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chayasin Mansanguan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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15
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Sreedhar S, Antony A, Poulose N. Study on the effectiveness and impact of pentavalent vaccination program in India and other south Asian countries. Hum Vaccin Immunother 2016; 10:2062-5. [PMID: 25424816 DOI: 10.4161/hv.28785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Penta-valent-vaccine is a combination vaccine administered in a 3-dose schedule, offers protection against diphtheria, tetanus, pertussis (DPT), hepatitis B, and Haemophilus influenza type B (Hib). The vaccine is widely recommended by WHO and GAVI as a substitute for prevailing vaccination practices against the above mentioned diseases and viruses. The vaccine has met with both positive and negative responses, which leads to uncertainties about the vaccine's safety. The pros and cons of the vaccine are to be evaluated carefully before the same is added to routine immunization schedule.
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Affiliation(s)
- Sreelakshmi Sreedhar
- a Department of Pharmacy Practice; National College of Pharmacy; Kozhikode, Kerala, India
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16
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Dumaidi K, Al-Jawabreh A. Persistence of Anti-HBs Among Palestinian Medical Students After 18 - 22 Years of Vaccination: A Cross-Sectional Study. HEPATITIS MONTHLY 2015; 15:e29325. [PMID: 26834785 PMCID: PMC4717190 DOI: 10.5812/hepatmon.29325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/15/2015] [Accepted: 08/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatitis B infection is a global public health problem affecting various sectors in the society. Vaccination is the first line measure to prevent the disease. OBJECTIVES To assess the persistence of anti-HBs marker among medical students after 18 - 22 of vaccination as an indicator for Hepatitis B virus vaccine efficacy. PATIENTS AND METHODS In this study, 249 Palestinian medical students vaccinated at birth, 1, and 6 months of age using Engerix™-B starting from 1992 were studied. About 58% (144/249) of the students were Palestinians holding Israeli citizenship, while 42% (105/249) were Palestinians from the West Bank. Students were tested serologically for anti-HBs, as a marker for vaccine-induced immunity. RESULTS Over 75% (188/248) of students had levels of anti-HBs greater than 10 mIU/mL indicating immunity and protection. Five cases had positive results for anti-HBc indicating exposure to HBV infection; however, none of these cases showed any sign of HBV-DNA indicating effective clearance of the virus by the vaccine. Around 57% of the study group had anti-HBs level of 100 - 1000 mIU/mL. No significant association was found between anti-HBs level and age, sex, locality and level of anti-HBc (P > 0.05). The students were aware of different aspects of hepatitis B infection regarding the virus, symptoms, prevention and mode of transmission. CONCLUSIONS The Palestinian and Israeli official policies to give a booster dose for risk groups like medical students at anti-HBs level below 10 mIU/mL should continue to ensure absolute protection. The currently-used vaccine and its time program cleared virus from students believed to have been exposed to the virus during their lifetime.
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Affiliation(s)
- Kamal Dumaidi
- Department of Medical Laboratory Sciences, Faculty of Allied Medical Sciences, Arab American University, Jenin, Palestine
| | - Amer Al-Jawabreh
- Department of Medical Laboratory Sciences, Faculty of Allied Medical Sciences, Arab American University, Jenin, Palestine
- Al-Quds Public Health Society, Jerusalem, Palestine
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17
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Bekondi C, Zanchi R, Seck A, Garin B, Giles-Vernick T, Gody JC, Bata P, Pondy A, Tetang SM, Ba M, Ekobo CS, Rousset D, Sire JM, Maylin S, Chartier L, Njouom R, Vray M. HBV immunization and vaccine coverage among hospitalized children in Cameroon, Central African Republic and Senegal: a cross-sectional study. BMC Infect Dis 2015; 15:267. [PMID: 26164361 PMCID: PMC4499446 DOI: 10.1186/s12879-015-1000-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/26/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hepatitis B is a major health concern in Africa. The vaccine against hepatitis B virus (HBV) was introduced into the Expanded Programme on Immunization (EPI) of Cameroon and Senegal in 2005, and of CAR (Central African Republic) in 2008. A cross-sectional study was conducted to assess HBV immunization coverage following the vaccine's introduction into the EPI and factors associated with having been vaccinated. METHODS All hospitalized children, regardless of the reasons for their hospitalization, between 3 months and 6 years of age, for whom a blood test was scheduled during their stay and whose condition allowed for an additional 2 mL blood sample to be taken, and who provided the parent's written consent were included. All children anti-HBs- and anti-HBc + were tested for HBsAg. Vaccination coverage was assessed in three different ways: immunization card, maternal recall and serologic anti-HBs profile. RESULTS 1783 children were enrolled between April 2009 and May 2010. An immunization card was only available for 24 % of the children. The median age was 21 months. Overall HBV immunization coverage based on immunization cards was 99 %, 49 % and 100 % in Cameroon, CAR and Senegal, respectively (p < 0,001). The immunization rate based on maternal recall was 91 %, 17 % and 88 % in Cameroon, CAR and Senegal, respectively (p < 0,001). According to serology (anti-HBs titer ≥ 10 mUI/mL and anti-HBc-), the coverage rate was 68 %, 13 % and 46 % in Cameroon, CAR and Senegal, respectively (p < 0,001). In Senegal and Cameroon, factors associated with having been vaccinated were: mother's higher education (OR = 2.2; 95 % CI [1.5-3.2]), no malnutrition (OR = 1.6; 95 % CI [1.1-2.2]), access to flushing toilets (OR = 1.6; 95 % CI [1.1-2.3]), and < 24 months old (OR = 2.1; 95 % CI [1.3-3.4] between 12 and 23 months and OR = 2.7; 95 % CI [1.6-4.4] < 12 months). The prevalence of HBV-infected children (HBsAg+) were 0.7 %, 5.1 %, and 0.2 % in Cameroon, CAR and Senegal, respectively (p < 0.001). CONCLUSIONS Assessing immunization coverage based on immunization cards, maternal recall or administrative data could be usefully reinforced by epidemiological data combined with immunological profiles. Serology-based studies should be implemented regularly in African countries, as recommended by the WHO. Malnutrition, lack of maternal education and poverty are factors associated with vaccine non-compliance. The countries' vaccination programs should actively address these problems.
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Affiliation(s)
- Claudine Bekondi
- Laboratoire des Virus Oncogènes, Institut Pasteur de Bangui, rue Pasteur, BP 923, Bangui, République Centrafricaine.
| | - Roberta Zanchi
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015, Paris, France.
| | - Abdoulaye Seck
- Laboratoire de Biologie Médicale, Institut Pasteur de Dakar, 36 Avenue Pasteur, Dakar, Sénégal.
| | - Benoit Garin
- Institut Pasteur de Madagascar, BP 1274, Antananarivo, Madagascar.
| | - Tamara Giles-Vernick
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015, Paris, France.
| | - Jean Chrysotome Gody
- Services des soins intensifs, Complexe Pédiatrique, BP 911, Bangui, République Centrafricaine.
| | - Petulla Bata
- Complexe Pédiatrique, BP 911, Bangui, République Centrafricaine.
| | - Angèle Pondy
- Centre Mère-Enfant, Fondation Chantal Biya, Yaoundé, Cameroun.
| | | | | | | | - Dominique Rousset
- Laboratoire de Virologie, Institut Pasteur Guyane, 23 avenue Pasteur, BP 6010, 97306, Cayenne, France.
| | - Jean-Marie Sire
- Département de virologie, Hôpital Saint Louis, Paris, France. .,Institut National de la Santé et de la Recherche Médicale, Faculté de Médecine Paris-Diderot, Paris, France.
| | - Sarah Maylin
- Service de Microbiologie CHU St Louis, 75010, Paris, France.
| | - Loïc Chartier
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015, Paris, France.
| | - Richard Njouom
- Service de Virologie, Centre Pasteur du Cameroun, P.O.Box 1274, Yaoundé, Cameroun.
| | - Muriel Vray
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 rue du Docteur Roux, 75015, Paris, France.
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Locarnini S, Hatzakis A, Chen DS, Lok A. Strategies to control hepatitis B: Public policy, epidemiology, vaccine and drugs. J Hepatol 2015; 62:S76-86. [PMID: 25920093 DOI: 10.1016/j.jhep.2015.01.018] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/07/2015] [Accepted: 01/13/2015] [Indexed: 12/04/2022]
Abstract
The last 50 years of hepatitis B research has resulted in the development of effective screening assays for surveillance, vaccines for prevention and antiviral drugs that significantly improve patient clinical outcomes. Not surprisingly then, the global epidemiology of hepatitis B virus (HBV) is set to change dramatically over the next decade. For example, the success and the high coverage of universal HBV vaccination and the ageing cohorts of patients with chronic hepatitis B (CHB) will result in reductions of incidence and prevalence of chronic hepatitis, cirrhosis and probably hepatocellular carcinoma. This will be further accelerated by the impressive progress in the treatment outcomes for patients with CHB. In spite of this success, challenges remain, such as planning for the impact of migration from countries with high prevalence rates to those countries with low rates of HBV infection. The recent establishment of the World Health Organisation Global Hepatitis Program with the provision of a framework for global action has become the cornerstone for all countries to now frame their own particular national responses to control hepatitis B. An effective policy framework can prevent new infections, ensure people can access clinical care, and in doing so reduce the burden of infection at an individual, country and regional level. These developments present a real opportunity to reduce the significant, social and economic burden of global hepatitis B, ultimately the critical next steps to render the world hepatitis B free.
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Affiliation(s)
- Stephen Locarnini
- Research & Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia.
| | - Angelos Hatzakis
- Department of Hygiene & Epidemiology & Medical Statistics, Athens University Medical School, Athens, Greece
| | - Ding-Shinn Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Anna Lok
- Division of Gastroenterology, University of Michigan Medical Centre, Ann Arbor, MI, USA
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Yentur Doni N, Simsek Z, Keklik Z, Gurses G, Zeyrek FY. Epidemiology of hepatitis B in the reproductive-age female farmworkers of southeastern Turkey. HEPATITIS MONTHLY 2014; 14:e22120. [PMID: 25598790 PMCID: PMC4286707 DOI: 10.5812/hepatmon.22120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/26/2014] [Accepted: 10/24/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are limited data on the prevalence of the hepatitis B virus (HBV) infection in the agricultural population worldwide. OBJECTIVES This study aimed to determine the prevalence of HBV infection and associated risk factors in the reproductive-age female farmworker. MATERIALS AND METHODS This cross-sectional study was conducted between January and April 2013 in southeastern region (SAR) of Turkey. A community-based representative agricultural sample (n = 705) from the agricultural areas of nine provinces of SAR was randomly determined by clustering method using Epi Info software. Questionnaires including demographic information and risk factors of HBV were administered to participants. The presence of HBsAg, anti-HBs, anti-HBc, and anti-HBe antibodies in blood samples were measured by ELISA. RESULTS The prevalence of the HBsAg, anti-HBs, anti-HBc, anti-HBe antibodies, and seropositivity were 5.7%, 25.9%, 28.9%, 16.4%, and 36.7%, respectively. There was no association between the HBsAg and the size of the household, age, education level, parity, and place of birth while the prevalence of HBsAg was higher in seasonal migratory farmworkers and people living in urban areas and the prevalence of anti-HBs antibody was significantly higher in women ≥ 35 years of age, those with a high parity, and those who gave birth without the assistance of health professionals (P < 0.05). The risk for HBV infection in the seasonal migratory group was 4.3 times higher in comparison to local workers (P = 0.00; OR = 4.3; 95% CI, 2.2-8.4), with a prevalence rate of 11%. CONCLUSIONS The monitoring of at-risk groups like seasonal migratory farmworkers is necessary to strengthen the healthcare service provided to this population.
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Affiliation(s)
- Nebiye Yentur Doni
- Department of Medical Microbiology, Vocational School of Health Services, Harran University, Sanliurfa, Turkey
- Corresponding Author: Nebiye Yentur Doni, Department of Medical Microbiology, Vocational School of Health Services, Harran University, Sanliurfa, Turkey. Tel: +90-4143183212, Fax: +90-4143183211, E-mail:
| | - Zeynep Simsek
- Department of Public Health, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Zehra Keklik
- Department of Public Health, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Gulcan Gurses
- Department of Medical Microbiology, Vocational School of Health Services, Harran University, Sanliurfa, Turkey
| | - Fadile Yildiz Zeyrek
- Department of Medical Microbiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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20
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Levi M, Ahmad A, Bechini A, Boccalini S, Nguyen QV, Veldhuijzen I, Richardus JH, Reintjes R, Bonanni P. Hepatitis B: are at-risk individuals vaccinated if screened and found negative for HBV? Results of an online survey conducted in six EU countries. Vaccine 2014; 32:6415-20. [PMID: 25280438 DOI: 10.1016/j.vaccine.2014.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/18/2014] [Accepted: 09/22/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Vaccination is the best way to prevent hepatitis B infection and its consequences. The aim of the present study is to analyze the current vaccination practices within various population subgroups who are offered screening for hepatitis B, when found negative, in Germany, Hungary, Italy, the Netherlands, Spain and the UK. METHODS Online surveys were conducted in the six countries. In total, 1181 experts from six different health professions were invited to participate. Descriptive analyses of data were performed. RESULTS Less than half of the respondents in the Netherlands, only about 1/4 in Germany and none in Hungary reported that the vaccine is commonly offered to people who inject drugs. Less than half of the respondents in Germany reported vaccinating sex workers or HIV positive patients against hepatitis B as common practice. None in Hungary stated that vaccinating sex workers is common practice, and only according to a minority (17%) HIV patients are commonly vaccinated. 1/4 to 1/3 of respondents in Germany, the Netherlands, Italy, Hungary and the UK, indicated that HCV positive patients are only sporadically immunized. Only in Spain almost half of the respondents reported that migrants from hepatitis B endemic areas who are screened negative are commonly vaccinated. Widespread uncertainty about vaccination practices for asylum seekers was reported. CONCLUSIONS By showing the gaps between current practices and policies in place, our findings can help to increase the success of future vaccination programmes. Implementation of training for health care professional, e.g. introducing vaccinology and vaccination policy courses in the medical and paramedical curriculum, could contribute to a more homogenous application of the recommendations regarding immunization against hepatitis B. Our results show, nonetheless, that the universal vaccination approach, coupled with targeted programmes for immigrants, represents the only way to make the elimination of hepatitis B a foreseeable, realistic objective.
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Affiliation(s)
- Miriam Levi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Amena Ahmad
- Department of Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Angela Bechini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Quang Vinh Nguyen
- Department of Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Irene Veldhuijzen
- Division of Infectious Disease Control, Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ralf Reintjes
- Department of Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy.
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Papaloukas O, Giannouli G, Papaevangelou V. Successes and challenges in varicella vaccine. THERAPEUTIC ADVANCES IN VACCINES 2014; 2:39-55. [PMID: 24757524 DOI: 10.1177/2051013613515621] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Varicella is a highly contagious disease caused by primary infection with varicella zoster virus (VZV). VZV infection, as well as varicella vaccination, induces VZV-specific antibody and T-cell-mediated immunity, essential for recovery. The immune responses developed contribute to protection following re-exposure to VZV. When cell-mediated immunity declines, as occurs with aging or immunosuppression, reactivation of VZV leads to herpes zoster (HZ). It has been almost 20 years since universal varicella vaccination has been implemented in many areas around the globe and this has resulted in a significant reduction of varicella-associated disease burden. Successes are reviewed here, whilst emphasis is put on the challenges ahead. Most countries that have not implemented routine childhood varicella vaccination have chosen to vaccinate high-risk groups alone. The main reasons for not introducing universal vaccination are discussed, including fear of age shift of peak incidence age and of HZ incidence increase. Possible reasons for not observing the predicted increase in HZ incidence are explored. The advantages and disadvantages of universal vs targeted vaccination as well as different vaccination schedules are discussed.
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Affiliation(s)
- Orestis Papaloukas
- Second Department of Pediatrics, University of Athens Medical School, P&A Kyriakou Childrens' Hospital, Greece
| | - Georgia Giannouli
- Second Department of Pediatrics, University of Athens Medical School, P&A Kyriakou Childrens' Hospital, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, University of Athens Medical School, General University Hospital 'ATTIKON', Rimini 1, Chaidari 124 62, Greece
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22
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Bresse X, Goergen C, Prager B, Joura E. Universal vaccination with the quadrivalent HPV vaccine in Austria: impact on virus circulation, public health and cost–effectiveness analysis. Expert Rev Pharmacoecon Outcomes Res 2014; 14:269-81. [DOI: 10.1586/14737167.2014.881253] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
A new hepatitis B vaccine (FENDrix, GlaxoSmithKline Biologicals) containing as active substance 20 microg of recombinant hepatitis B virus surface antigen produced in Saccharomyces cerevisiae has recently been licensed in Europe. It is prepared with a novel adjuvant system: aluminum phosphate and 3-O-desacyl-4 -monophosphoryl lipid A. It is intended for use in adults from the age of 15 years onwards for active immunization against hepatitis B virus infection for patients with renal insufficiency (including prehemodialysis and hemodialysis patients). It is applied in a four-dose scheme: day 0, month 1, 2 and 6 after day 0. Due to the improved adjuvant system it induces higher antibody concentrations that reach protective levels in a faster fashion. Furthermore, due to higher titers reached after the primary immunization course, protective levels are retained for a longer period of time. Vaccination with FENDrix induces more transient local symptoms, with pain at the injection site being the most frequently reported solicited local symptom. Other symptoms such as fatigue, gastrointestinal disorders and headaches were also frequently observed but resolved without sequelae. The higher risk of hepatitis B transmission in patients with end-stage renal disease and the often immunocompromised status of these patients afford a tailored vaccination strategy that, up to now, has consisted of injecting double doses of ordinary hepatitis B vaccines. With the introduction of FENDrix there now exists an efficient alternative with superior immunogenicity that is, despite comparatively higher reactogenicity, well tolerated.
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Affiliation(s)
- Michael Kundi
- Center for Public Health, Medical University of Vienna, Vienna, Austria.
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24
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Reframing cervical cancer prevention. Expanding the field towards prevention of human papillomavirus infections and related diseases. Vaccine 2013. [PMID: 23199951 DOI: 10.1016/j.vaccine.2012.05.090] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The reframed paradigm of cervical cancer prevention will include strategic combinations of at least four major components: 1) routine introduction of human papillomavirus (HPV) vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. On a global scale, vaccination of newborns and infants is well established and has developed a successful working infrastructure. The hepatitis B virus (HBV) vaccination programs offer a model for HPV introduction in which newborn and infant immunization achieves a rapid reduction in the prevalence of the HBV carrier rates in immunized cohorts of children, and of liver cirrhosis and liver cancer decades later. In contrast, screening for cervical pre-cancer is largely restricted to industrialized populations and upper social classes in developing countries. The expertise gained by vaccination programs worldwide needs to be coordinated with the traditional cervical cancer prevention community of gynecologists and pathologists. Significant political and advocacy efforts at the Global level (World Health Organization, other United Nations agencies and The GAVI Alliance) need to be organized and reinforced to achieve a meaningful reduction in HPV transmission and its related health conditions and cancers. This desirable goal is now scientifically and technologically attainable, and great progress is being made in obtaining financing for global HPV immunization. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV-1. THE LANCET. INFECTIOUS DISEASES 2013; 12:966-76. [PMID: 23174382 DOI: 10.1016/s1473-3099(12)70243-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV and hepatitis B virus co-infection leads to substantially increased morbidity and mortality compared with either infection alone. Immunisation with hepatitis B virus vaccine is the most effective way to prevent the infection in people with HIV; however, these patients have decreased vaccine responses and a short duration of protection compared with immunocompetent individuals. Control of HIV replication with highly active antiretroviral therapy and increased CD4 cell counts are associated with improved immune responses to hepatitis B vaccination. New vaccination strategies, such as increased vaccine dose, use of the intradermal route, and addition of adjuvants, could improve response rates in adults with HIV.
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Yan K, Cai W, Cao F, Sun H, Chen S, Xu R, Wei X, Shi X, Yan W. Genetic effects have a dominant role on poor responses to infant vaccination to hepatitis B virus. J Hum Genet 2013; 58:293-7. [DOI: 10.1038/jhg.2013.18] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Boccalini S, Pellegrino E, Tiscione E, Pesavento G, Bechini A, Levi M, Rapi S, Mercurio S, Mannelli F, Peruzzi M, Berardi C, Bonanni P. Sero-epidemiology of hepatitis B markers in the population of Tuscany, Central Italy, 20 years after the implementation of universal vaccination. Hum Vaccin Immunother 2013; 9:636-41. [PMID: 23354158 DOI: 10.4161/hv.23259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Italy was one of the first industrialized countries to introduce a program of universal vaccination against hepatitis B in 1991. Twenty years later we verified the impact of universal immunisation on the epidemiology of hepatitis B infection by analyzing the prevalence of specific viral markers (anti-HBs, anti-HBc and HBsAg). The ELISA tests were performed on residual blood samples collected by 0.05% of the resident population aged 1-50 years in Tuscany (Italy). About 63% of subjects aged < 30 years were anti-HBs positive compared to about 25% in older subjects, without differences between genders. About 22% of subjects over 40 years were anti-HBc-positive compared to 5% in the younger age groups. The number of HBsAg-positive subjects was almost 10 fold higher in the unvaccinated age groups than in the cohorts involved in the universal vaccination program. The results of our study show the persisting high anti-HBs reactivity in vaccinated cohorts, while HBV markers related to natural exposure or persistent infection remain remarkably higher in older age groups. This sero-epidemiological study supports with prevalence data the downward incidence trend of acute hepatitis B highlighted by epidemiological surveillance systems, and corroborates the forecast for elimination of hepatitis B in Italy in a few decades.
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Affiliation(s)
- Sara Boccalini
- Department of Health Sciences; University of Florence; Florence, Italy
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Hepatitis B vaccines. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025] Open
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Prevalence estimates of diagnosed viral hepatitis B, liver condition outcomes and hospitalization costs: a population record-linkage study in Tayside, Scotland. Epidemiol Infect 2012. [PMID: 23200407 DOI: 10.1017/s095026881200266x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We estimated prevalence and incidence of liver condition outcomes, and costs to the health service of diagnosed hepatitis B virus (HBV) in Tayside, UK. HBV patients were identified from electronic virology data between 1989 and 2003. The health resource costs of HBV for surface antigen-positive (HBsAg+) patients and HBV (HBsAg+ or immune, i.e. recovered) patients were calculated. A total of 633 patients had HBV (275 HBsAg+), and were more likely to be male (62% vs. 48%), older (mean age 42.6 vs. 39 . 2 years) and deprived than the general population. The prevalence of immune individuals increased steadily. Post-HBV diagnosis, 24% of immune and 13% of HBsAg+ patients were diagnosed with a liver condition. The median cost per immune patient (£3023) was greater than per HBsAg+ patient (£1498) (P=0.02). While increasing prevalence of immune HBV patients highlights an increase in screening and treatment, the costs associated with this group are high.
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Aypak C, Yüce A, Yıkılkan H, Görpelioğlu S. Persistence of protection of hepatitis B vaccine and response to booster immunization in 2- to 12-year-old children. Eur J Pediatr 2012; 171:1761-6. [PMID: 22895894 DOI: 10.1007/s00431-012-1815-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 07/27/2012] [Accepted: 08/02/2012] [Indexed: 12/11/2022]
Abstract
UNLABELLED Neonatal vaccination against hepatitis B virus (HBV) infection was launched in 1998 in Turkey. The aim was to evaluate the persistence of seroprotection after HBV vaccination in order to determine the necessity of a single booster dose in 2- to 12-year-old children. This study was conducted retrospectively using hospital records of the children aged 2-12 years old who attended the pediatric outpatient clinics of Diskapi Training and Research Hospital, Ankara, Turkey between January 2010 and June 2011. Children who had received three doses of HBV vaccination in their infancy were included. A total of 530 children enrolled into the study, and 352 (66.4 %) of them had protective antibody to hepatitis surface antigens (anti-HBs) titer greater than 10 mIU/ml. The proportions of children with low, intermediate, and high anti-HB titers are different for those under 3 years of age. The majority were in the intermediate category. Those aged 4-10 years and 11 or older represented two-thirds of the children with high titers (p = 0.000). None of the children had chronic HBV infection. Unprotected children responded well after receiving the booster dose. The mean anti-HB concentration after the booster dose was more than 200 times higher than the mean antibody concentration before (p < 0.001). CONCLUSION Our data suggest that HBV vaccination may confer long-term immunity. Use of routine booster doses of vaccine at these ages does not appear necessary to maintain long-term protection in successfully vaccinated immunocompetent children in the region.
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Affiliation(s)
- Cenk Aypak
- Department of Family Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, 06110 Ankara, Turkey.
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Kalantari H, Davari M, Akbari M, Hejazi SM, Kalantari M, Zakerin S, Shahshahan Z. The estimation of direct medical costs of treating patients with chronic hepatitis B and C in iran. Int J Prev Med 2012; 3:191-6. [PMID: 22448312 PMCID: PMC3309633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 12/21/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objective of this study is to estimate the average diagnosis and treatment costs of chronic hepatitis B and C, with respect to different therapeutic strategies in Iran. METHODS This is a descriptive, analytical, and cross-sectional study carried out on patients with hepatitis B and C, who were referred to the Liver Disease Research Center for Prevention and Treatment of Hepatitis, Isfahan University of Medical Sciences, in 2011. We have estimated the direct medical costs including doctors' fees, cost of para-clinical tests, medical treatments, and liver biopsy, in different treatment strategies. FINDINGS The results of this study showed that the total cost of diagnostic services for hepatitis B virus (HBV) and hepatitis C virus (HCV) patients, with state medical tariffs, was US$ 1499.07 and US$ 2084.89, respectively. The patients' profiles showed that there were currently seven therapeutic strategies available to treat HBV patients. The total cost of treatment strategies varied significantly from US$ 73 to US$ 8256. There were also four main strategies for HCV patients, each of these could be applied in two periods of time. The total cost of these treatment strategies showed a high discrepancy from US$ 242 to US$ 8256. CONCLUSION The results confirmed that the total direct medical cost for an HBV patient in Iran exceeded US$ 5.5 Milliard in 2011. The results implied that the market price of direct medical cost of HBV and HCV patients in Iran is much higher than the estimated state costs. These costs would likely be saved or reduced by effective disease management and early prevention.
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Affiliation(s)
- Hamid Kalantari
- Department of Gastroenterology, Isfahan Liver Disease Research Center, Isfahan, Iran
| | - Majid Davari
- Health Management and Economics Research Center, Isfahan, Iran
| | - Mojtaba Akbari
- Department of Epidemiologist, School of Medicine, Isfahan, Iran
| | - Seyed Mehdi Hejazi
- Department of Academic Member of Medical Informatics, School of Health Management and Information Sciences, Isfahan, Iran
| | - Maryam Kalantari
- Architect, Young Researchers Club, Khorasgan Branch, Islamic Azad University, Isfahan, Iran
| | - Shahram Zakerin
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Shahshahan
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Asso. Prof. Zahra Shahshahan, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Patel DA, Gupta PA, Kinariwala DM, Shah HS, Trivedi GR, Vegad MM. An investigation of an outbreak of viral hepatitis B in modasa town, gujarat, India. J Glob Infect Dis 2012; 4:55-9. [PMID: 22529628 PMCID: PMC3326959 DOI: 10.4103/0974-777x.93762] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Most outbreaks of viral hepatitis in India are caused by hepatitis E. Recently in the year 2009, Modasa town of Sabarkantha district in Gujarat witnessed the outbreak of hepatitis B. PURPOSE An attempt was made to study the outbreak clinically and serologically, to estimate the seropositivity of hepatitis B Virus among the cases and their contacts and to know the seroprevalence of hepatitis B envelope antigen (HBeAg) and IgM antibody against hepatitis B core antigen (IgM HBcAb) out of all the Hepatitis B surface Antigen (HBsAg) positive ones. MATERIALS AND METHODS Eight hundred and fifty-six (856) cases and 1145 contacts were evaluated for hepatitis B markers namely HBsAg, HBeAg and IgM HBcAb by enzyme-linked immuno Sorbent Assay (ELISA) test. RESULTS This outbreak of viral hepatitis B in Modasa, Gujarat was most likely due to unsafe injection practices. Evidence in support of this was collected by Government authorities. Most of the patients and approximately 40% of the surveyed population gave history of injections in last 1.5-6 months. Total 664/856 (77.57%) cases and 20/1145 (1.75%) contacts were found to be positive for HBsAg. 53.41% of the positive cases and 52.93% of the positive contacts were HBeAg-positive and thus in a highly infectious stage. CONCLUSIONS Inadequately sterilized needles and syringes are an important cause of transmission of hepatitis B in India. Our data reflects the high positivity rate of a hepatitis B outbreak due to such unethical practices. There is a need to strengthen the routine surveillance system, and to organise a health education campaign targeting all health care workers including private practitioners, especially those working in rural areas, as well as the public at large, to take all possible measures to prevent this often fatal infection.
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Affiliation(s)
- Disha A Patel
- Department of Microbiology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Praveg A Gupta
- Department of Microbiology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Deepa M Kinariwala
- Department of Microbiology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Hetal S Shah
- Department of Microbiology, GMERS Medical College, Sola, Ahmedabad, India
| | - Grishma R Trivedi
- Department of Microbiology, SBKS Medical Institute and Research Centre, Waghodia, Baroda, India
| | - Mahendra M Vegad
- Department of Microbiology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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Sheikh NS, Sheikh AS, Sheikh AA, Yahya S, Rafi-U-Shan, Lateef M. Sero-prevalence of hepatitis B virus infection in Balochistan Province of Pakistan. Saudi J Gastroenterol 2011; 17:180-4. [PMID: 21546720 PMCID: PMC3122087 DOI: 10.4103/1319-3767.80380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 05/14/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/AIM The objective was to evaluate the sero-prevalence of hepatitis B surface antigen (HBsAg) and IgM antibodies to hepatitis core antigen in Balochistan Province of Pakistan. DESIGN OF THE STUDY A cross-sectional, population-based study. Place and time of the study: The study was conducted in Balochistan from 1 st January 2004 to 31 st December, 2008. The screening areas included Barkhan, Eashani, Khuzdar, Kodi Zikriani, Kohlu, Rakhni and Turbat. MATERIALS AND METHODS A total of 15,260 subjects were enrolled; 11,900 (78%) agreed to undergo screening. Fresh serum samples were tested for the presence of hepatitis B surface antigen and IgM antibodies to hepatitis B core antigen. RESULTS HBsAg was detected in 1166 (9.8%) while anti-HBc IgM was found in 117 (10.0%). HBsAg positivity was seen in 875 (12.7%) males and 291 (5.8%) females. The prevalence of hepatitis B in Balochistan varies from 3.3% in Khuzdar to 17.0% in Kodi Zikriani. CONCLUSIONS It is utmost important to educate the public, to take proper measures to control the spread of infection and vaccination in order to interrupt transmission of this threatening public health problem in Balochistan province of Pakistan.
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Affiliation(s)
- Nadeem S. Sheikh
- Department of Haematology & Transfusion Medicine, Bolan Medical College Complex, Quetta, Balochistan, Pakistan
| | - Azeem S. Sheikh
- Department of Cardiology, Addenbrooke’s Hospital NHS Trust, Cambridge, UK
| | - Aqleem A. Sheikh
- Department of Gastroenterology, Shaikh Zayed Hospital, Lahore, Pakistan
| | - Samira Yahya
- Department of Obstetrics & Gynaecology, Royal Free Hospital NHS Trust, London, UK
| | | | - Majid Lateef
- Institute of Public Health, Quetta, Balochistan, Pakistan
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Romano' L, Paladini S, Van Damme P, Zanetti AR. The worldwide impact of vaccination on the control and protection of viral hepatitis B. Dig Liver Dis 2011; 43 Suppl 1:S2-7. [PMID: 21195368 DOI: 10.1016/s1590-8658(10)60685-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Viral hepatitis B is a leading cause of acute and chronic liver disease worldwide, including cirrhosis and hepatocellular carcinoma. Vaccination is the most effective measure for controlling and preventing hepatitis B and its severe long-term sequelae. According to the World Health Organization (WHO), by the end of 2008 177 countries had introduced hepatitis B vaccination into their national routine neonatal, infant and/or adolescent immunisation programmes, and Italy was one of the first countries to implement a universal strategy of hepatitis B vaccination. The implementation of such vaccination programmes has globally resulted in a marked decrease in disease burden, in the carrier rate and in hepatitis B-related morbidity and mortality. Despite this success, work remains to be done to fully achieve the WHO goal of control of hepatitis B and HBV-related diseases on a global scale.
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Affiliation(s)
- Luisa Romano'
- Dipartimento di Sanità Pubblica - Microbiologia - Virologia, Università degli Studi di Milano, Milano, Italy
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Global implementation of human papillomavirus (HPV) vaccine: Lessons from hepatitis B vaccine. Gynecol Oncol 2010; 117:S32-5. [DOI: 10.1016/j.ygyno.2010.01.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 01/20/2010] [Indexed: 11/18/2022]
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Strategies for global prevention of hepatitis B virus infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 659:175-88. [PMID: 20204764 DOI: 10.1007/978-1-4419-0981-7_14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Heffernan ME, Garland SM, Kane MA. Global reduction of cervical cancer with human papillomavirus vaccines: insights from the hepatitis B virus vaccine experience. Sex Health 2010; 7:383-90. [DOI: 10.1071/sh09134] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 04/06/2010] [Indexed: 01/03/2023]
Abstract
Background: Worldwide, prophylactic vaccines against two major human cancers are now commercially available: hepatitis B virus (HBV) vaccines (first licensed in 1982) against primary hepatocellular carcinoma and human papillomavirus (HPV) vaccines (first licensed 2006) against cervical cancer. Initial implementation strategies for HBV vaccination were not successful in preventing disease in the community: it took 15 years for significant global reduction in the burden of this disease. Methods: We compare and contrast HBV vaccine experiences to challenges for successful global HPV vaccination strategies, and make recommendations accordingly. Results: Lessons from HBV immunisation for successful outcomes with HPV immunisation showed that several factors need to be met: (i) the engagement of key stakeholders in all aspects of planning and delivery of HPV vaccine strategies; (ii) understanding the specific characteristics of targeted population groups; (iii) global cooperation and support with WHO recommendations; (iv) Government supported mass immunization programs and cooperation between public and private entities; (v) affordable HPV vaccines for some regions; (vi) culturally appropriate and diverse public education programs in targeted health promotion strategies; (vii) pro-active health providers and parents in encouraging adolescents to undertake HPV vaccination; and (vii) eventual immunisation of infants. Conclusions: The key to success will be affordable, readily deliverable HPV vaccines to young girls as universal campaigns.
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O’Leary C, Hong Z, Zhang F, Dawood M, Smart G, Kaita K, Wu J. A mathematical model to study the effect of hepatitis B virus vaccine and antivirus treatment among the Canadian Inuit population. Eur J Clin Microbiol Infect Dis 2009; 29:63-72. [DOI: 10.1007/s10096-009-0821-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 09/24/2009] [Indexed: 11/29/2022]
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Tu HAT, Woerdenbag HJ, Kane S, Riewpaiboon A, van Hulst M, Postma MJ. Economic evaluations of hepatitis B vaccination for developing countries. Expert Rev Vaccines 2009; 8:907-20. [PMID: 19538116 DOI: 10.1586/erv.09.53] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Economic evaluations, in particular cost-effectiveness, are important determinants for policy makers and stakeholders involved in decision-making for health interventions. Up until now, most evaluations of cost-effectiveness of hepatitis B vaccination have been performed in developed countries. Appropriate health-economic studies on this topic specifically targeted at the developing world are essential in order to justify adding another vaccine into the existing Expanded Program on Immunization in these countries. We present a systematic review of economic evaluations of vaccination against HBV for developing and less-developed countries. Vaccine price, the discount rate, incidence and prevalence of HBV infection were found to be major drivers of cost-effectiveness. Data accuracy and reliability were also major issues, with major potentials for improvement in studies of these countries. The choice between monovalent or combination vaccines (diphteria, tetanus and polio-hepatitis B) poses new challenges to cost-effectiveness analysis. It is concluded that for many developing countries implementation of universal immunization against HBV to reduce the level of endemicity of hepatitis B is an appropriate strategy, and probably cost effective in many settings. Given their limited financial resources, developing countries should properly plan how to achieve this. Further country-specific economic evaluations and related gathering of high-quality data must be conducted in developing countries in order to raise both public awareness of the effectiveness and economic attractiveness of universal immunization against HBV.
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Affiliation(s)
- Hong-Anh T Tu
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
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Tsai SM, Lin SK, Lee KT, Hsiao JK, Huang JC, Wu SH, Ma H, Wu SH, Tsai LY. Evaluation of redox statuses in patients with hepatitis B virus-associated hepatocellular carcinoma. Ann Clin Biochem 2009; 46:394-400. [PMID: 19641006 DOI: 10.1258/acb.2009.009029] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Excess reactive oxygen species related to neoplasia of liver has been established. Essentially, the human body has developed different antioxidant systems for defence against these attacks. To evaluate the redox status in hepatocellular carcinoma (HCC) induced by hepatitis B virus (HBV), the most important aetiological factor in Taiwan, changes in O2(.) generation, lipid peroxidation as well as antioxidant status in the blood of HCC patients with HBV carriers for more than 20 years were measured. METHODS Superoxide anion radical (O2(.-)) generation and the levels of malondialdehyde (MDA) served as an index of lipid peroxidation along with the analyses of activities of superoxide dismutase (SOD), glutathione peroxidase (GPx) and glutathione reductase (GRx); also, glutathione status, including reduced glutathione (GSH) and oxidized glutathione (GSSG), and the levels of vitamins A, C and E were determined. RESULTS In 54 patients, the levels of O2(.-), MDA and GSSG, and the activities of SOD and GRx of blood were significantly higher than those of 57 controls. Conversely, the levels of GSH and total GSH, and GSH/GSSG ratio, and vitamins A and C were significantly decreased. Additionally, there were no significant changes in the activity of GPx and the levels of vitamin E. CONCLUSIONS Our data suggest that the redox statuses in patients with HBV-associated HCC were elevated or decreased in certain parameters. However, the increased activities of antioxidant enzymes may be a compensatory up-regulation and the decrease antioxidant statuses were responses to the enhanced oxidative stress in those patients.
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Affiliation(s)
- Shih-Meng Tsai
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Zepp F, Schmitt HJ, Cleerbout J, Verstraeten T, Schuerman L, Jacquet JM. Review of 8 years of experience with Infanrix hexa (DTPa-HBV-IPV/Hib hexavalent vaccine). Expert Rev Vaccines 2009; 8:663-78. [PMID: 19485747 DOI: 10.1586/erv.09.32] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Combination vaccines that include multiple antigens within one formulation are now widely accepted as an effective means of eliciting protection against several diseases at the same time. Owing to improvements in quality and convenient modes of administration, they have become part of routine pediatric practice. Hexavalent vaccines, including diphtheria, tetanus, pertussis, hepatitis B, polio and Haemophilus influenzae type b antigens represent the latest advance in the development of combination vaccines. Over 8 years since its first licensure, this review looks at the immunogenicity, efficacy and safety profile of the only hexavalent pediatric vaccine currently in use--Infanrix hexa (diphtheria, tetanus, acellular pertusis-hepatitis B virus-inactivated poliovirus vaccine/Haemophilus influenzae type b vaccine [DTPa-HBV-IPV/Hib]; GlaxoSmithKline Biologicals, Rixensart, Belgium)--through published clinical trials and postmarketing surveillance data. These data show DTPa-HBV-IPV/Hib to be highly immunogenic and well tolerated across a range of different primary and booster vaccination schedules, as well as when administered concomitantly with other licensed vaccines (e.g., pneumococcal conjugate vaccine). Additional issues surrounding the use of hexavalent vaccines are also reviewed.
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Affiliation(s)
- Fred Zepp
- University Hospital, Department of Pediatrics, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany.
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Abstract
Hepatitis B virus infection is a global health problem. Worldwide, about 360 million people are chronically infected with the virus. They continue to spread the virus to others and are themselves at risk of chronic liver diseases and hepatocellular carcinoma. The infection can now be treated by antivirals or interferons and the transmission route can be interrupted. Nevertheless, the most effective means is to immunize all susceptible individuals, especially young children, with safe and efficacious vaccines. The combined efforts of vaccination, effective treatment and interruption of transmission make elimination of the infection plausible and may eventually lead to eradication of the virus. Because hepatitis B vaccination has a key role in the control of hepatitis B, properties of this vaccine, its effectiveness in pre-exposure and post-exposure settings, duration of protection after vaccination and the need of booster doses are discussed. Mass hepatitis B vaccination in children decreases the carriage of the virus, and the diseases associated with acute and chronic infection, including hepatocellular carcinoma. Challenges that need to be solved to expand mass vaccination, and the strategies towards elimination and eventual eradication of hepatitis B in the world are also discussed.
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Sociocultural factors that potentially affect the institution of prevention and treatment strategies for prevention of hepatitis B in Chinese Canadians. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:31-6. [PMID: 19172206 DOI: 10.1155/2009/608352] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite the availability of screening for chronic hepatitis B (CHB) infection and effective treatments now available, many at-risk individuals fail to seek appropriate medical attention. OBJECTIVE To identify the barriers to care for CHB infection in a Chinese Canadian community. METHODS A survey conducted in English or Chinese collected information from individuals with CHB infection that evaluated the level of understanding and identified the barriers that may prevent Chinese patients from undergoing monitoring, screening and/or treatment for CHB infection. RESULTS Among the 204 patients enrolled, common misconceptions were that sharing food transmits hepatitis B and that patients with severe disease are always symptomatic. Patients with a better understanding of hepatitis B were better educated, younger and were being followed at a tertiary care centre (P<0.01 for all). Prominent barriers to health care were time, inconvenience and language difficulties. Patients under the care of family physicians who had extended office hours were less likely to cite time (P=0.06) and distance (P=0.05) as barriers. CONCLUSION Patient misconceptions that severe liver disease due to hepatitis B infection is symptomatic may factor into the unwillingness to spare the time and undergo the inconvenience associated with regular medical follow-up. Implementation of programs that increase awareness of the silent progression of CHB infection and provide culturally responsive clinics, better able to work within patients' time constraints may improve Chinese patients' access to health care.
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Zanetti AR, Van Damme P, Shouval D. The global impact of vaccination against hepatitis B: a historical overview. Vaccine 2008; 26:6266-73. [PMID: 18848855 DOI: 10.1016/j.vaccine.2008.09.056] [Citation(s) in RCA: 278] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 09/15/2008] [Indexed: 12/16/2022]
Abstract
Hepatitis B virus (HBV) infection is a world wide public health problem of major concern. HBV infection may lead to chronic liver disease, including cirrhosis and hepatocellular carcinoma (HCC). Vaccination is the most effective measure to control and prevent hepatitis B and its long-term serious sequelae on global scale, both in terms of cost-effectiveness and benefit-cost ratios. According to the WHO recommendations, universal vaccination has been currently implemented in 168 countries world wide with an outstanding record of safety and efficacy. The effective implementation of such programmes of vaccination has resulted in a substantial decrease in disease burden, in the carrier rate and in hepatitis B-related morbidity and mortality. A future challenge is to overcome the social and economic hurdles which still hamper the introduction of hepatitis B vaccination on a global scale.
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Affiliation(s)
- Alessandro R Zanetti
- Department of Public Health-Microbiology-Virology, Faculty of Medicine, University of Milan, Via C. Pascal 36, 20133 Milan, Italy.
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Abstract
Despite the availability of safe and effective hepatitis B virus (HBV) vaccines for >20 years, strategies targeting risk groups failed to sufficiently control hepatitis B disease at the population level; this is mainly because of difficulties in risk identification and in program implementation. Hence, the global burden of disease of HBV still is substantial. The World Health Organization recommends universal vaccination against hepatitis B to ultimately eliminate HBV; this recommendation had been progressively implemented to reach 168 countries with a universal program by the end of 2006. However, hepatitis B immunization is currently becoming endangered of losing its place on the agendas of governments, agencies, and international organizations, mainly because of the increasing success of these immunization programs and the interest in newer vaccine-preventable diseases and the related programs.This publication aims to show that vaccination programs targeting newborns and infants are preferable to achieve this goal. The benefits of universal HBV vaccination for newborns and infants are: higher impact on chronic carrier rate and transmission; established potential of high vaccine coverage in this age group; opportunities to combine HBV vaccination with existing universal vaccination programs for newborns and infants; and impact on perinatal transmission, if vaccination is started shortly after birth. Moreover, the safety, immunogenicity, and long-term efficacy of newborn and infant HBV vaccination have been proven extensively. In summary, newborn and infant HBV vaccination programs should be considered the preferred strategy, capable of providing important and sustained impact on global HBV incidence, even if they have a delayed impact on sexual transmission of HBV.
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Wright TC, Van Damme P, Schmitt HJ, Meheus A. Chapter 14: HPV vaccine introduction in industrialized countries. Vaccine 2008; 24 Suppl 3:S3/122-31. [PMID: 16949999 DOI: 10.1016/j.vaccine.2006.05.118] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 05/29/2006] [Indexed: 11/25/2022]
Abstract
Introduction of a vaccine requires the achievement of three initial milestones. These are licensure by a national control authority that determines the vaccine is safe and effective, development of recommendations for use by expert advisory bodies on immunization, and obtaining funding for vaccination. Once these milestones have been achieved, a successful vaccination program requires that a number of interlinked programmatic components be brought together in a coordinated fashion. These include vaccine purchase and supply, vaccination service delivery, high coverage rates, surveillance of the vaccination program, immunization finance policies and practices, and political will. Human papillomavirus (HPV) vaccination provides unique challenges in all of these areas because of the many gaps in our knowledge.
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Affiliation(s)
- Thomas C Wright
- Department of Pathology, Columbia University, 630 W. 168th Street, New York, NY 10032, USA.
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Mathew JL, El Dib R, Mathew PJ, Boxall EH, Brok J. Hepatitis B immunisation in persons not previously exposed to hepatitis B or with unknown exposure status. Cochrane Database Syst Rev 2008:CD006481. [PMID: 18677780 DOI: 10.1002/14651858.cd006481.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The benefits and harms of hepatitis B vaccination in persons not previously exposed to hepatitis B infection or with unknown exposure status have not been established. OBJECTIVES To assess the benefits and harms of hepatitis B vaccination in people not previously exposed to hepatitis B infection or with unknown exposure status. SEARCH STRATEGY Trials were identified from The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS,Science Citation Index Expanded (last search, March 2007). Additionally, we contacted experts and vaccine manufacturers, and read through reference lists for eligible trials. SELECTION CRITERIA Randomised clinical trials comparing hepatitis B vaccine versus placebo, no intervention, or another vaccine in persons not previously exposed to hepatitis B (HBsAg negative) or with unknown exposure status. DATA COLLECTION AND ANALYSIS The primary outcome was hepatitis B infection (detecting HBsAg, HBeAg, HBV DNA, or anti-HBc). Secondary outcomes were lack of sero-protection, antibody titre, clinical complications, adverse events, lack of compliance, and cost-effectiveness. Dichotomous outcomes were reported as relative risk (RR) with 95% confidence interval (CI), using intention-to-treat analysis assuming an unfavourable event for missing data. Sensitivity analyses based on methodological quality (risk of bias), available data analysis, intention-to-treat analysis assuming a favourable event for missing data, best-case scenario, and worst-case scenario were conducted. MAIN RESULTS Twelve trials were eligible. All had high risk of bias and reporting was inconsistent. Hepatitis B vaccine did not show a clear effect on the risk of developing HBsAg (RR 0.96, 95% CI 0.89 to 1.03, 4 trials, 1230 participants) and anti-HBc (RR 0.81, 95% CI 0.61 to 1.07; 4 trials, 1230 participants, random-effects) when data were analysed using intention-to-treat analysis assuming an unfavourable event for missing data. Analysis based on data of available participants showed reduced risk of developing HBsAg (RR 0.12, 95% CI 0.03 to 0.44, 4 trials, 576 participants) and anti-HBc (RR 0.36, 95% CI 0.17 to 0.76, 4 trials, 576 participants, random-effects). Intention-to-treat analysis assuming favourable outcome for missing data showed similar reduction in risk. Hepatitis B vaccination had an unclear effect on the risk of lacking protective antibody levels (RR 0.57, 95% CI 0.26 to 1.27, 3 trials, 1210 participants, random-effects). Development of adverse events was sparsely reported. AUTHORS' CONCLUSIONS In people not previously exposed to hepatitis B, vaccination has unclear effect on the risk of developing infection, as compared to no vaccination. The risk of lacking protective antibody levels as well as serious and non-serious adverse events appear comparable among recipients and non-recipients of hepatitis B vaccine.
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Affiliation(s)
- Joseph L Mathew
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medial Education and Research (PGIMER), Chandigarh, India, 160012.
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Munira SL, Fritzen SA. What influences government adoption of vaccines in developing countries? A policy process analysis. Soc Sci Med 2007; 65:1751-64. [PMID: 17644230 DOI: 10.1016/j.socscimed.2007.05.054] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Indexed: 11/25/2022]
Abstract
This paper proposes a framework for examining the process by which government consideration and adoption of new vaccines takes place, with specific reference to developing country settings. The cases of early Hepatitis B vaccine adoption in Taiwan and Thailand are used to explore the relevance of explanatory factors identified in the literature as well as the need to go beyond a variable-centric focus by highlighting the role of policy context and process in determining the pace and extent of adoption. The cases suggest the feasibility and importance of modeling 'causal diversity'-the complex set of necessary and sufficient conditions leading to particular decisional outcomes-in a broad range of country contexts. A better understanding of the lenses through which government decision-makers filter information, and of the arenas in which critical decisions are shaped and taken, may assist both analysts (in predicting institutionalization of new vaccines) and advocates (in crafting targeted strategies to accelerate their diffusion).
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