Universal Hepatitis B Antibody Screening and Vaccination in Pregnancy: A Cost-Effectiveness Analysis.

OBJECTIVE: To evaluate the cost effectiveness of universal screening for hepatitis B immunity and vaccination among pregnant women in the United States. METHODS: We designed a decision-analytic model to evaluate the outcomes, costs, and cost effectiveness associated with universal hepatitis B virus (HBV) immunity screening in pregnancy with vaccination of susceptible individuals compared with no screening. A theoretical cohort of 3.6 million women, the approximate number of annual live births in the United States, was used. Outcomes included cases of HBV, hepatocellular carcinoma, decompensated cirrhosis, liver transplant and death, in addition to cost and quality-adjusted life-years (QALYs). Model inputs were derived from the literature, and the willingness-to-pay threshold was $50,000 per QALY. Univariate sensitivity analyses and Monte Carlo simulation models were performed to evaluate the robustness of the results. RESULTS: In a theoretical cohort of 3.6 million women, universal HBV immunity screening and vaccination resulted in 1,702 fewer cases of HBV, seven fewer cases of decompensated cirrhosis, four fewer liver transplants, and 11 fewer deaths over the life expectancy of a woman after pregnancy. Universal screening and vaccination were found to be cost effective, with an incremental cost-effectiveness ratio of $1,890 per QALY. Sensitivity analyses demonstrated the model was robust even when the prevalence of HBV immunity was high and the annual risk of HBV acquisition low. CONCLUSION: Among pregnant women in the United States, universal HBV immunity screening and vaccination of susceptible persons is cost effective compared with not routinely screening and vaccinating.

A Model of Care Optimized for Marginalized Remote Population Unravels Migration Pattern in India.

BACKGROUND AND AIMS: Access to basic health needs remains a challenge for most of world's population. In this study, we developed a care model for preventive and disease-specific health care for an extremely remote and marginalized population in Arunachal Pradesh, the northeasternmost state of India. APPROACH AND RESULTS: We performed patient screenings, performed interviews, and obtained blood samples in remote villages of Arunachal Pradesh through a tablet-based data collection application, which was later synced to a cloud database for storage. Positive cases of hepatitis B virus (HBV) were confirmed and genotyped in our central laboratory. The blood tests performed included liver function tests, HBV serologies, and HBV genotyping. HBV vaccination was provided as appropriate. A total of 11,818 participants were interviewed, 11,572 samples collected, and 5,176 participants vaccinated from the 5 westernmost districts in Arunachal Pradesh. The overall hepatitis B surface antigen (HBsAg) prevalence was found to be 3.6% (n = 419). In total, 34.6% were hepatitis B e antigen positive (n = 145) and 25.5% had HBV DNA levels greater than 20,000 IU/mL (n = 107). Genotypic analysis showed that many patients were infected with HBV C/D recombinants. Certain tribes showed high seroprevalence, with rates of 9.8% and 6.3% in the Miji and Nishi tribes, respectively. The prevalence of HBsAg in individuals who reported medical injections was 3.5%, lower than the overall prevalence of HBV. CONCLUSIONS: Our unique, simplistic model of care was able to link a highly resource-limited population to screening, preventive vaccination, follow-up therapeutic care, and molecular epidemiology to define the migratory nature of the population and disease using an electronic platform. This model of care can be applied to other similar settings globally.

An economic reappraisal of hepatitis B virus testing strategy for blood donors in Taiwan.

BACKGROUND AND OBJECTIVES: Taiwan is among the few hepatitis B virus (HBV) high-endemic countries that implement universal mini-pool nucleic acid testing (MP-NAT) and hepatitis B surface antigen (HBsAg) testing together with confirmatory individual donor nucleic acid testing (ID-NAT) for its blood supply since 2013. The aim of this study was to reappraise the value of HBsAg test in Taiwan's HBV testing strategy. MATERIALS AND METHODS: A Markov model was constructed, and cost-effectiveness analysis was conducted in order to reappraise the existing HBV screening strategy in Taiwan. RESULTS: The incremental cost-effectiveness ratio (ICER) for the current testing strategy in Taiwan was estimated to be $US 443 154 per quality-adjusted life year (QALY) gained. This is almost six times the willingness-to-pay (WTP) threshold that reflects local preferences. CONCLUSION: Universal HBsAg and MP-8-NAT together with confirmatory ID-NAT testing prevents a significant amount of HBV infections from entering the Taiwan blood supply. However, this comes at a disproportionate increase in cost.

Assessment on the Effects of Hepatitis B Prevention and Control Measures in Western China: A Comparison of Three Population-based Serosurveys.

OBJECTIVE: Despite the remarkable progress in efforts to control disease spread, the nationwide elimination of hepatitis B in China is still hindered by the persistently high rate of hepatitis B virus (HBV) infection in Western China. This study aimed to evaluate the strategy of hepatitis B prevention and control in Western China and identify potential areas and strategies for improvement. METHODS: Susceptible population vaccination, health education, professional training of doctors, and other prevention and control measures have been implemented in Wuwei city since 2010. Data were obtained from three representative cross-sectional serosurveys conducted in 2010, 2013, and 2015. The serum samples were subjected to enzyme-linked immunosorbent assays to detect the following seromarkers: HBV surface antigen (HBsAg), antibody against hepatitis B surface antigen (anti-HBs), and antibody against hepatitis B core antigen (anti-HBc). Estimates of variance were determined using Taylor series linearization methods. RESULTS: The three serosurveys revealed decreases in the prevalence of HBsAg (7.19% in 2010 vs. 6.51% in 2013 vs. 5.87% in 2015) and anti-HBc positivity (43.89% vs. 32.87% vs. 28.46%) and an increase in the prevalence of anti-HBs positivity (49.07% vs. 53.66% vs. 53.72%) over time. From 2010 to 2015, the legally reported incidence of hepatitis B in Wuwei city decreased from 686.53/100,000 to 53.72/100,000. Notably, persistently high HBsAg-positive rates (above 5.40%) were observed among subjects aged 20-69 years old in the three serosurveys; the prevalence of HBsAg was above 1% among children younger than 10 years old. Furthermore, rural subjects had higher rates of HBsAg and anti-HBc positivity than their urban counterparts (6.04% vs. 4.83% and 30.26% vs. 20.35%, respectively) in 2015 but had a lower rate of anti-HBs positivity (49.68 vs. 55.18%). Multivariate regression analysis showed that age, urban and rural areas, and education level were the main factors affecting HBV infection. CONCLUSION: Although vaccine-based prevention and control measures reduced the rate of HBV infection in Wuwei City over time, the hepatitis B infection rate in children younger than 10 years was still higher than the national average level. Therefore, the prevention and control of mother-to-child transmission and the management of the infected should be the focus of future prevention and control work.

Occult hepatitis B infections and anti-HBc prevalence at a resource-limited blood bank in Mexico.

OBJECTIVES: To identify blood donors with occult hepatitis B infections (OBIs), determine the prevalence of antibody to hepatitis B core antigen (anti-HBc) positivity and estimate the impact of anti-HBc screening on donor deferral at CETS-Veracruz (Mexico). BACKGROUND: Hepatitis B virus infection is a major concern in transfusion medicine. Mexican regulations only mandate screening for hepatitis B surface antigen (HBsAg), and there are no requirements regarding testing for anti-HBc or use of a nucleic acid test (NAT). There is, therefore, limited information about the prevalence of anti-HBc positivity and occult hepatitis B among blood donors in Mexico. METHODS: This retrospective study examined individuals who donated blood to CETS-Veracruz from June 2014 to June 2017. All donors were serologically examined according to Mexican health regulations, and the prevalence of anti-HBc positivity was determined. A NAT was used to identify individuals with OBIs. RESULTS: We analysed the data of 28 016 blood donors. Over 4 years, the average prevalence of anti-HBc positivity was 1.05%. The risk factors for anti-HBc positivity were low education and age over 50 years. There were nine donors with OBIs. CONCLUSION: The presence of donors with OBIs in CETS-Veracruz and other Mexican blood banks highlights the need to mandate the implementation of anti-HBc screening in Mexico.

Rapid quantification of tenofovir in umbilical cord plasma and amniotic fluid in hepatitis B mono-infected pregnant women during labor by ultra-performance liquid chromatography/tandem mass spectrometry.

RATIONALE: Tenofovir (TFV) is a first-line antiviral agent against hepatitis B virus (HBV) and is recommended for the prevention of mother-to-infant transmission of HBV. To study the distribution of TFV in umbilical cord plasma and amniotic fluid of HBV-infected pregnant women, a rapid and sensitive method for TFV determination was developed and validated. METHODS: The quantification method was developed using liquid chromatography coupled to tandem mass spectrometry (LC/MS/MS). The analytes were separated on an Acquity UPLC HSS T3 column under gradient elution with methanol and 0.01% ammonia solution in 10 mM ammonium acetate/water. This is the first reported method for the determination of TFV using alkaline rather than acidic mobile phases. Linearity, accuracy, precision, limit of quantification, specificity and stability were assessed. RESULTS: Detection of TFV was achieved within 4 min. The calibration curves for TFV quantification showed excellent linearity in the range of 1-500 ng/mL. The intra- and interbatch precision and accuracy ranged from -4.35% to 6.92%. This method was successfully applied to determination of samples from 50 HBV mono-infected women undergoing tenofovir disoproxil fumarate therapy. The mean concentrations of TFV in the umbilical cord and amniotic fluid samples were 29.2 (4.6-86) and 470.9 (156-902) ng/mL, respectively, which showed a moderate positive correlation (r = 0.5299, P<0.001). CONCLUSIONS: A simple, rapid but sensitive bioanalytical method to determine TFV concentration in both umbilical cord plasma and amniotic fluid using LC/MS/MS was developed and applied to HBV-infected women during labor who were undergoing TDF therapy, which will help us understand the efficacy and safety of tenofovir during pregnancy.

Estimates of Prenatal HIV, Hepatitis B Virus, and Hepatitis C Virus Testing Among Pregnant People Enrolled in Wisconsin Medicaid, 2011-2015.

BACKGROUND: The opioid epidemic and rising rates of injection drug use are increasing the risk of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among pregnant people. According to national clinical guidelines, pregnant people should be universally tested for HIV and HBV, and risk-based tested for HCV. The aim of this study was to determine the proportion and characteristics of prenatal HIV, HBV, and HCV testing and diagnosis among pregnant people with Wisconsin Medicaid coverage between 2011 and 2015. METHODS: Wisconsin birth certificates and Medicaid enrollment data were used to identify the sample. Standard billing and diagnosis codes were used to assess study variables. Data for each pregnancy were analyzed to describe the proportion of pregnancies that had evidence of testing, diagnoses, and yearly trends. RESULTS: Of the 78,917 pregnancies, prenatal testing estimates were 67% for HIV, 73% for HBV, and 6% for HCV. The estimated rate of infections during the study period was 1.82 for HIV, 2.09 for HBV, and 3.52 for HCV per 1000 pregnancies. Compared to the other race/ethnicity groups, pregnant people who were Black were most likely to be tested for HIV (78%) and HBV (80%), and pregnant people who were White were most likely to be tested for HCV (7%). CONCLUSIONS: Clinical testing guidelines have not been effectively translated to practice. Additionally, compared to HIV and HBV, HCV infections during pregnancy are becoming more prevalent, yet current national HCV screening guidelines are the least comprehensive.

HCV and HBV prevalence based on home blood self-sampling and screening history in the general population in 2016: contribution to the new French screening strategy.

BACKGROUND: The advent of effective direct-acting antivirals (DAAs), has prompted an assessment of the French Hepatitis C virus (HCV) screening strategy, which historically targeted high-risk groups. One of the options put forward is the implementation of combined (i.e., simultaneous) HCV, Hepatitis B virus (HBV) and HIV screening for all adults at least once during their lifetime ("universal combined screening"). However, recent national survey-based data are lacking to guide decision-making regarding which new strategy to implement. Accordingly, we aimed to provide updated data for both chronic hepatitis C (CHC) and B (CHB) prevalence and for HCV and HBV screening history, using data from the BaroTest and 2016 Health Barometer (2016-HB) studies, respectively. METHODS: 2016-HB was a national cross-sectional phone based health survey conducted in 2016 among 20,032 randomly selected individuals from the general population in mainland France. BaroTest was a virological sub-study nested in 2016-HB. Data collected for BaroTest were based on home blood self-sampling on dried blood spots (DBS). RESULTS: From 6945 analyzed DBS, chronic hepatitis C (CHC) and B (CHB) prevalence was estimated at 0.30% (95% Confidence Interval (CI): 0.13-0.70) and 0.30% (95% CI: 0.13-0.70), respectively. The proportion of individuals aware of their status was estimated at 80.6% (95% CI: 44.2-95.6) for CHC and 17.5% (95% CI: 4.9-46.4) for CHB. Universal combined screening would involve testing between 32.6 and 85.3% of 15-75 year olds according to whether we consider only individuals not previously tested for any of the three viruses, or also those already tested for one or two of the viruses. CONCLUSIONS: Our data are essential to guide decision-making regarding which new HCV screening recommendation to implement in France. They also highlight that efforts are still needed to achieve the WHO's targets for eliminating these diseases. Home blood self-sampling may prove to be a useful tool for screening and epidemiological studies.

Modelling cost-effectiveness of tenofovir for prevention of mother to child transmission of hepatitis B virus (HBV) infection in South Africa.

BACKGROUND: International sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the need to optimize strategies for prevention, diagnosis and treatment of hepatitis B virus (HBV) infection. An important priority for Africa is to have affordable, accessible and sustainable prevention of mother to child transmission (PMTCT) programmes, delivering screening and treatment for antenatal women and implementing timely administration of HBV vaccine for their babies. METHODS: We developed a decision-analytic model simulating 10,000 singleton pregnancies to assess the cost-effectiveness of three possible strategies for deployment of tenofovir in pregnancy, in combination with routine infant vaccination: S1: no screening nor antiviral therapy; S2: screening and antiviral prophylaxis for all women who test HBsAg-positive; S3: screening for HBsAg, followed by HBeAg testing and antiviral prophylaxis for women who are HBsAg-positive and HBeAg-positive. Our outcome was cost per infant HBV infection avoided and the analysis followed a healthcare perspective. RESULTS: Based on 10,000 pregnancies, S1 predicts 45 infants would be HBV-infected at six months of age, compared to 21 and 28 infants in S2 and S3, respectively. Relative to S1, S2 had an incremental cost of $3940 per infection avoided. S3 led to more infections and higher costs. CONCLUSION: Given the long-term health burden for individuals and economic burden for society associated with chronic HBV infection, screening pregnant women and providing tenofovir for all who test HBsAg+ may be a cost-effective strategy for South Africa and other low/middle income settings.

World hepatitis day in Burkina Faso, 2017: seroprevalence and vaccination against hepatitis B virus to achieve the 2030 elimination goal.

BACKGROUND: Burkina Faso is a high endemicity country for HBV infection. However, there are few data on vaccine coverage against HBV. The aim of this study was to contribute to the improvement of HBV vaccine coverage in Ouagadougou through HBV screening. METHODS: Awareness campaigns and voluntary hepatitis B screening were organized in the twelve districts of Ouagadougou by the "SOS Hepatitis Burkina" association. A rapid HBsAg detection test (Abon Biopharma Guangzhou, Co., Ltd. Chine) was performed on 2216 individuals, who voluntarily answered a series of questions. Vaccination against hepatitis B was proposed to HBV negative participants. RESULTS: In a sample of 2216 participants, aged 1 to 78 years (mean age 29.7 ± 14.7 years); a prevalence of 10.4% (230/2216) of HBsAg was obtained. This prevalence was high in the age groups 31 to 40 years (14.5%) and 41 to 50 years (15.0%). The prevalence of HBV was higher in the sixth district (14.3%) of Ouagadougou. At the end of the screening, 1202/1986 HBV negative participants were vaccinated, resulting in a vaccination rate of 60.5%. Vaccination coverage ranged from 44.5 to 73.7% all twelve districts. CONCLUSIONS: This study still reports a high prevalence of HBV infection among young people with a peak in the sixth district of Ouagadougou. The study achieved high vaccination coverage in all age groups and districts of Ouagadougou. TRIAL REGISTRATION: The present study has been approved by the Ethics Committee for Health Research of Burkina Faso. CERS201501006 Registered 14 January 2015.

A novel method for sensitive, low-cost and portable detection of hepatitis B surface antigen using a personal glucose meter.

Hepatitis B virus (HBV) infection is the major public health problem leading cause of death worldwide. The most important diagnostic marker for this infection is hepatitis B surface antigen (HBsAg). In this study, a novel, inexpensive, portable and sensitive ELISA method was designed and investigated for diagnosis of HBsAg based on the functionalized Fe3O4 and Al2O3 nanoparticles, with the strategy for detecting the concentration of glucose using a cheap and accessible personal glucose meter (PGM). The ELISA system was constructed using hepatitis B antibody against HBsAg immobilized on streptavidin coated magnetic iron oxide particles (S-Fe3O4) as the capture antibody (Ab1). In addition, another hepatitis B antibody against different epitope of HBsAg (Ab2) and glucoamylase both were immobilized on Al2O3 nanoparticles. After formation of the sandwich immune complex between Ab1 and Ab2 immobilized on S-Fe3O4 and Al2O3 NPs, respectively, through HBsAg, starch was converted into glucose using glucoamylase. Then, the glucose concentration was measured using PGM. The concentration of HBsAg was calculated based on the linear relation between the concentrations of HBsAg and glucose. Under optimal conditions, this assay showed detection limit values of 0.3 to 0.4 ng ml-1 for "ay" and "ad" subtypes of HBsAg, respectively. The results indicate that the designed assay is comparable to the commercial kits in terms of sensitivity, on-site, specificity, cost, simplicity, portability and reproducibility. The presented method can be used in disadvantaged areas of the world and blood transfusion centers. To the best of our knowledge, this is the first report of using PGMs for HBSAg detection.

Is laboratory screening prior to antiretroviral treatment useful in Johannesburg, South Africa? Baseline findings of a clinical trial.

BACKGROUND: Screening for renal, hepatic and haematological disorders complicates the initiation of current first-line antiretroviral therapy (ART). Each additional test done adds substantial costs, both through direct laboratory expenses, but also by increasing the burden on health workers and patients. Evaluating the prevalence of clinically relevant abnormalities in different population groups could guide decisions about what tests to recommend in national guidelines, or in local adaptations of these. METHODS: As part of enrolment procedures in a clinical trial, 771 HIV-positive adults, predominantly from inner-city primary health care clinics, underwent laboratory screening prior to ART. Participants had to be eligible for ART, based on the then CD4 eligibility threshold of 350 cells/µL, antiretroviral naïve and have no symptoms of peripheral neuropathy. RESULTS: Participants were mostly female (57%) and a mean 34 years old. Creatinine clearance rates were almost all above 50 mL/min (99%), although 5% had microalbuminuria. Hepatitis B antigenaemia was common (8% of participants), of whom 40% had a raised AST/ALT, though only 2 had transaminase levels above 200 IU/L. Only 2% of participants had severe anaemia (haemoglobin <8 g/dl) and 1% neutropaenia (neutrophils <0.75 × 10^9/L). Costs per case detected of hepatitis B infection was USD135, but more than USD800 for a raised creatinine. CONCLUSIONS: Hepatitis B continues to be a common co-infection in HIV-infected adults, and adds complexity to management of ART switches involving tenofovir. Routine renal and haematological screening prior to ART detected few abnormalities. The use of these screening tests should be assessed among patients with higher CD4 counts, who may even have fewer abnormalities. Formal evaluation of cost-effectiveness of laboratory screening prior to ART is warranted.

Paired assessment of liver telomere lengths in hepatocellular cancer is a reliable predictor of disease persistence.

In the present study, we used a small series of highly defined patients, where we had matched timed peripheral blood samples (PBS), as well as paired liver biopsies obtained during collection of blood samples from patients with diagnosed hepatocellular carcinoma (HCC) and compared the correlation between the changes of telomere lengths in these defined samples. Patients included had either HCC alone or in conjunction with either pre-existing hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. PCR-based assay incorporating primers to the telomeric hexamer repeats to polymerize and detect telomeric DNA was used. The average telomere length for each independent assessment was measured by seeing the differences in the intensity of the sample's telomere signal (T) to the signal from a single-copy gene (S-, ß-globin) to estimate the standard ratio. Our results provide the first convincing evidence that PBS may be utilized to assay telomere shortening as a predictor for disease persistence in HCC resulting after HBV or HCV infection, but not in non-infectious cause-stimulated HCC. These findings provide incipient opportunity to develop telomere length assessment as a biomarker tool for prediction of HCC in patients with HBV or HCV infection, as well as to gauge responses to chemotherapy and other treatment modalities.

Evaluación de técnicas de amplificación de ácido nucleico (NAT) para detección del virus de la inmunodeficiencia humana, hepatitis C y hepatitis B en bancos de sangre / Assessment on nucleic acid amplification techniques (nat) for human immunodeficiency, hepatitis C and hepatitis B virus screening in blood banks

CONTEXTO CLÍNICO: Las transfusiones de sangre y hemoderivados constituyen una terapéutica frecuente en la actualidad. Sin embargo, si no se toman las medidas necesarias, quienes reciben las donaciones pueden contraer ciertas enfermedades. Disminuir los riesgos de la transmisión de enfermedades infecciosas es un requisito indispensable para los servicios de medicina transfusional.Para tender a la eliminación de este riesgo, se pueden implementar tres tipos de estrategias: a) tratar los componentes con métodos para inactivación de patógenos, con la finalidad de eliminar agentes infecciosos, b) implementar políticas para la captación del donante no relacionado, habitual y responsable y c) aplicar métodos para detección de infecciones transmisibles con una mayor sensibilidad. En relación a esto último, la detección de marcadores serológicos para infecciones transmisibles por transfusión es muy eficiente y ha reducido de manera importante el impacto de esta complicación transfusional en las últimas décadas.1, 2 Sin embargo, existe un período de ventana, en el cual un donante infectado y potencialmente infectante, no presenta niveles dosables de marcadores serológicos; por este motivo se ha postulado el uso de técnicas que permitan la detección en este período de ventana. Un ejemplo de ellos es la técnica NAT (por sus siglas en inglés: nucleic acid amplification Technology), la cual es una prueba de biología molecular que se ha postulado a nivel mundial desde 1999, para la detección del material genético de los virus de la inmunodeficiencia humana (VIH), hepatitis C (VHC) y hepatitis B (VHB) con el fin de disminuir el período de ventana de no-detección, en las muestras provenientes de donantes infectados. TECNOLOGÍA: NAT se realiza mediante la realización de los siguientes pasos básicos: la preparación de la muestra, la amplificación de secuencias de ácido nucleico, y la detección de productos de amplificación (amplicons). OBJETIVO: Evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura de la técnica de amplificación de ácido nucleico en forma rutinaria para la detección del virus de la inmunodeficiencia humana, el virus de la hepatitis C y el de la hepatitis B en muestras de sangre de donantes. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas (incluyendo Medline, Cochrane y CRD), en buscadores genéricos de Internet, agencias de evaluación de tecnologías sanitarias y financiadores de salud utilizando la siguiente estrategia: (Nucleic Acid Amplification Techniques[Mesh:NoExp] OR Amplification Tech*[tiab] OR Nucleic-Acid Amplificat*[tiab] OR DNA Amplificat*[tiab] OR RNA Amplificat*[tiab] OR NAT[tiab]) AND (Blood Donors[Mesh] OR Blood Don*[tiab] OR Blood Banks[Mesh] OR Blood Bank*[tiab]). Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias y económicas, guías de práctica clínica y políticas de cobertura de otros sistemas de salud cuando estaban disponibles. RESULTADOS: Para el siguiente informe se incluyeron dos estudios observacionales, una revisión no sistemática, cuatro GPC, una ETS, seis normas y dos evaluaciones económicas. CONCLUSIONES: Si bien existe escasa evidencia de moderada calidad metodológica que muestra que la utilización de la técnica de amplificación de ácido nucleico (NAT) es efectiva en la detección de los virus de la inmunodeficiencia humana, hepatitis C y hepatitis B en el período ventana serológico, la magnitud del beneficios de su aplicación en forma rutinaria en muestras de sangre de donantes no ha sido aún aclarada. Si bien el uso de NAT se encuentra muy extendido en el mundo y muchas normativas y guías internacionales lo recomiendan; su implementación no es mandatorio en muchos otros países. La Organización Mundial de la Salud aún no lo recomienda en forma rutinaria para todos los países, sobre todo debido a que se estima que los potenciales beneficios de su aplicación son bajos a expensas de un alto costo. Su uso estaría más justificado en contextos con una mayor prevalencia e incidencia de infecciones transmisibles por la sangre.

Factors associated with immunization against Hepatitis B among workers of the Family Health Strategy Program.

UNLABELLED: Cross-sectional study conducted among workers of the Family Health Strategy Montes Claros. OBJECTIVE: To investigate the report of vaccination against Hepatitis B, verification of immunization and the factors associated with dosages of anti-HBs. METHOD: We collected blood samples from those reported that they had one or more doses of the vaccine. We evaluated the association of the dosage of anti- HBs with sociodemographic conditions, occupational and behavioral. The associations were verified by Mann Whitney and Kruskal Wallis and correlation Spermann by linear regression using SPSS® 17.0. RESULTS: Among the 761 respondents, 504 (66.1%) were vaccinated, 52.5 % received three doses, 30.4 % verified immunization. Of the 397 evaluated for the determination of anti-Hbs, 16.4% were immune. CONCLUSION: It was found that longer duration of work was associated with higher levels of anti-HBs, while levels of smoking were inversely associated with anti-HBs. These workers need for vaccination campaigns.

Nationwide large survey on hepatitis B surface antigen quantification use in real-life clinical practice.

BACKGROUND AND AIM: Hepatitis B surface antigen quantification (qHBsAg) is a relevant biomarker assay in the therapeutic management of hepatitis B virus-infected patients; however, little is known about its use in France. The aim of this study was to describe the knowledge of qHBsAg use and the indications for the prescription of qHBsAg in France. METHODS: From March 2014 to May 2014, 135 questionnaires were sent to hepatologists and gastroenterologists from several health centers (private practice, public practice, and outlying health centers). There were 20 items in each questionnaire on the use of qHBsAg. RESULTS: Seventy-six percent of the practitioners had previously used qHBsAg, among whom 88% had prescribed the use of qHBsAg before treatment, 73% had prescribed the use of qHBsAg in combination with hepatitis B virus viral load, 64% had prescribed the use of qHBsAg at week 12 or week 24 of treatment, 62% had prescribed the use of qHBsAg for stopping rules, and 49% had prescribed the use of qHBsAg to identify inactive carriers. The reason for nonprescription of qHBsAg was mainly because of difficulty accessing the test (50% of the practitioners), followed by nonreimbursement of the test (27%); 97% of the practitioners who did not prescribe qHBsAg indicated an interest in accessing the test. CONCLUSION: This survey describes the characteristics of the prescription of qHBsAg in France. More than three out of four practitioners have previously used qHBsAg. The use of the qHBsAg just before treatment was the main reason for prescription. The main reason for nonprescription was because of difficulty in accessing the test.

Fatores associados à imunização contra Hepatite B entre trabalhadores da Estratégia Saúde da Família / Factores asociados con la vacunación contra la hepatitis B entre los trabajadores de la Estrategia Salud de la Familia / Factors associated with immunization against Hepatitis B among workers of the Family Health Strategy Program

Estudo transversal conduzido entre trabalhadores da Estratégia Saúde da Família de Montes Claros. Objetivo: investigar o relato de vacinação contra Hepatite B, a verificação da imunização e os fatores associados às dosagens de anti-HBs. Método: coletaram-se amostras de sangue daqueles que relataram ter recebido uma ou mais doses da vacina. Avaliou-se a associação da dosagem de anti-HBs com condições sociodemográficas, ocupacionais e comportamentais. As associações foram verificadas pelos testes Mann Whitney e Kruskal Wallis e correlação de Spermann seguida pela regressão linear, utilizou-se o SPSS® 17.0. Resultados: dentre os 761 entrevistados, 504 (66,1%) foram vacinados, 52,5% tomaram três doses, 30,4% verificaram a imunização. Dos 397 avaliados quanto à dosagem de anti-HBs, 16,4% estavam imunes. Conclusão: constatou-se que o maior tempo de trabalho foi associado a níveis mais elevados de anti-HBs, enquanto os níveis de tabagismo foram inversamente associados ao anti-HBs. Há necessidade de campanhas de vacinação entre esses trabalhadores. .

Estudio transversal realizado entre trabajadores de la Estrategia Salud de la Familia Montes Claros. Objetivo: investigar el informe de la vacunación contra la hepatitis B, la verificación de la inmunización y los factores asociados con la dosis de anti-HBs. Método: se recogieron muestras de sangre de los que informaron que tenían una o más dosis de la vacuna. Se evaluó la asociación entre la dosis de anti- HBs con las condiciones sociodemográficas, laborales y de comportamiento. Las asociaciones fueron verificadas por Mann Whitney y Kruskal Wallis y Spermann correlación seguida por regresión lineal utilizando el programa SPSS® 17.0. Resultado: entre los 761 encuestados, 504 (66,1%) fueron vacunados, el 52,5 % recibió tres dosis de vacunación, 30,4% verificado. De los 397 evaluados para la determinación de anticuerpos anti-HBs, 16,4 % eran inmunes. Conclusión: se encontró que la mayor duración de la obra se asoció con mayores niveles de anti- HBs, mientras que los niveles de tabaquismo se asoció inversamente con el anti- HBs. La necesidad de campañas de vacunación entre los trabajadores. .

Cross-sectional study conducted among workers of the Family Health Strategy Montes Claros. Objective: to investigate the report of vaccination against Hepatitis B, verification of immunization and the factors associated with dosages of anti-HBs. Method: we collected blood samples from those reported that they had one or more doses of the vaccine. We evaluated the association of the dosage of anti- HBs with sociodemographic conditions, occupational and behavioral. The associations were verified by Mann Whitney and Kruskal Wallis and correlation Spermann by linear regression using SPSS® 17.0. Results: among the 761 respondents, 504 (66.1%) were vaccinated, 52.5 % received three doses, 30.4 % verified immunization. Of the 397 evaluated for the determination of anti-Hbs, 16.4% were immune. Conclusion: it was found that longer duration of work was associated with higher levels of anti-HBs, while levels of smoking were inversely associated with anti-HBs. These workers need for vaccination campaigns. .