Significación de los marcadores infecciosos para identificar portadores de hepatitis B en donantes de sangre / Significance of hepatitis B surface antigen, IgM/IgG core antibody and hepatitis B virus DNA in blood donors

Resumen Introducción: La identificación de portadores del virus de la hepatitis B en donantes de sangre es imperativo para evitar la transmisión de la enfermedad a través de transfusiones sanguíneas. Objetivo: Determinar si los donantes de sangre con resultados positivos de los marcadores serológicos HbsAg y anti-HBc eran portadores de ADN del virus de la hepatitis B. Métodos: Se recolectaron 12 745 muestras de seis bancos de sangre ecuatorianos, las cuales fueron analizadas con pruebas serológicas para identificar los marcadores infecciosos HBsAg, anti-HBc, anti-HBs mediante prueba ELISA automatizada. Todas las muestras positivas para uno, dos o los tres marcadores fueron analizadas con técnica molecular para determinar la presencia de ADN viral. Resultados: Se identificó que 27.5 % de las muestras reactivas solo a anti-HBc y 100 % de las muestras con resultados positivos de HBsAg/anti-HBc-IgM/IgG presentaron ADN del virus de la hepatitis B (p = 0.001). Conclusiones: La elección de los marcadores de infección y los métodos de detección definen los resultados. Es importante la realización de dos pruebas serológicas y una molecular para identificar a los portadores del virus de la hepatitis B y evitar su transmisión.

Abstract Introduction: Identification of hepatitis B virus carriers in blood donors is imperative in order to avoid transmission of the disease via blood transfusion. Objective: To determine if blood donors with positive results for serological markers HBsAg and anti-HBc were hepatitis B virus DNA carriers. Methods: 12,745 samples were collected from six Ecuadorian blood banks and analyzed for HBsAg, anti-HBc and anti-HBs infectious markers by automated ELISA. All samples that tested positive for one, two or all three markers were analyzed with molecular techniques to determine the presence of viral DNA. Results: 27.5 % of the samples that were reactive for anti-HBc alone and 100 % of those with positive results for HbsAg and IgM/IgG anti-HBc were identified to contain hepatitis B virus DNA (p = 0.001). Conclusions: The selection of infection markers, as well as the detection methods define the results. Performing two serological and one molecular test is important in order to identify hepatitis B virus carriers and prevent its transmission.

Patterns of hepatitis B virus exposure and associated predictors in Vietnam: A crosssectional study

Objective: To examine the magnitude of isolated anti-HBc and other HBV serological patterns and associated predictors among adults seeking general health check-up at a large health center in Vietnam. Methods: All 564 outpatients seeking general health checkup between January 2016 and December 2016 were asked to undertake HBV surface antigen, surface antibody, IgG and IgM core antibody (anti-HBc total), platelet counts, and liver function testing. An administered questionnaire was used to collect information regarding demography, in-house sources of infection, lifestyle, health condition and treatment, and HBV vaccination. Results: Male gender (P=0.043), age (P=0.000), living in urban areas (P=0.040), HBV vaccination status (P=0.033), and ALT (P=0.040) were associated with isolated anti-HBc. HBV infection was associated with HBV vaccination status (P=0.001), ALT levels (P=0.010), AST levels (P=0.020), and platelet counts (P=0.007). Past/resolved HBV infection was associated with AST levels (P=0.005), ALT levels (P=0.014), and age (P=0.000). Conclusions: Isolated anti-HBc is quite prevalent. Predictors of isolated anti-HBc include male gender, living in rural areas, and HBV non-vaccination. The prevalence of isolated anti-HBc also increases with age. To timely detect occult HBV infection and prevent transmission, anti-HBc testing should be included in the health check-up for high risk individuals and screening program where HBV nucleic acid test is not available. To prevent transmission, clinicians need to pay more attention on those who are at risk of having isolated anti-HBc and closely follow-up patients with isolated anti-HBc and educate them about the prevention of HBV infection.

Patterns of hepatitis B virus exposure and associated predictors in Vietnam: A crosssectional study

Objective: To examine the magnitude of isolated anti-HBc and other HBV serological patterns and associated predictors among adults seeking general health check-up at a large health center in Vietnam. Methods: All 564 outpatients seeking general health checkup between January 2016 and December 2016 were asked to undertake HBV surface antigen, surface antibody, IgG and IgM core antibody (anti-HBc total), platelet counts, and liver function testing. An administered questionnaire was used to collect information regarding demography, in-house sources of infection, lifestyle, health condition and treatment, and HBV vaccination. Results: Male gender (P=0.043), age (P=0.000), living in urban areas (P=0.040), HBV vaccination status (P=0.033), and ALT (P=0.040) were associated with isolated anti-HBc. HBV infection was associated with HBV vaccination status (P=0.001), ALT levels (P=0.010), AST levels (P=0.020), and platelet counts (P=0.007). Past/resolved HBV infection was associated with AST levels (P=0.005), ALT levels (P=0.014), and age (P=0.000). Conclusions: Isolated anti-HBc is quite prevalent. Predictors of isolated anti-HBc include male gender, living in rural areas, and HBV non-vaccination. The prevalence of isolated anti-HBc also increases with age. To timely detect occult HBV infection and prevent transmission, anti-HBc testing should be included in the health check-up for high risk individuals and screening program where HBV nucleic acid test is not available. To prevent transmission, clinicians need to pay more attention on those who are at risk of having isolated anti-HBc and closely follow-up patients with isolated anti-HBc and educate them about the prevention of HBV infection.

The dynamic characteristics and predictive value of hepatitis B core antibody titers in chronic hepatitis B patients treated with interferon / 中华传染病杂志

Objective To observe the dynamic characteristics of hepatitis B core antibody (anti-HBc) titers in chronic hepatitis B (CHB) patients treated with interferon and to explore the predictive value of anti-HBc for response to interferon.Methods The clinical information of the patients diagnosed with CHB in Department of Infectious Diseases , the First Affiliated Hospital of Xi′an Jiaotong University from October 2011 to October 2014 were collected.HBV DNA, liver function and HBV serological markers of CHB patients were tested dynamically during and after interferon treatment.The dynamic characteristics of anti-HBc titers in patients with different virological responses were analyzed.The predictive values of anti-HBc titer for the efficacy of interferon treatment of CHB patients were analyzed by binary logistic regression .Results Of the 42 CHB patients aging(30.8 ±10.1) years old, 34 patients were hepatitis B e antigen (HBeAg) positive and 8 were negative.All patients completed 48-week interferon treatment and 24-week follow-up after the end of treatment. Among them, 28.6%( 12/42), 26.2%( 11/42 ) and 45.2%( 19/42 ) of patients achieved sustained virological response (SVR), virological relapse ( VR) and non-response ( NR), respectively.Patients with different virological response presented various characteristics of anti -HBc titers.Compared with NR group, the anti-HBc titers at baseline and week 12 were significantly higher in SVR group (at baseline: [4.93 ±0.30] vs [4.70 ±0.33] lg IU/mL, t ＝2.147, P ＝0.013; at week 12: [4.83 ± 0.23] vs [4.44 ± 0.41] lg IU/mL, t＝3.032, P＝0.007).The anti-HBc titers in SVR group at week 12 and week 24 were significantly higher than those in VR group (at week 12: [4.83 ±0.23] vs [4.67 ±0.51] lg IU/mL, t＝2.400, P＝0.039; at week 24: [4.73 ±0.21] vs [4.55 ±0.50] lg IU/mL, t＝2.542, P＝0.039).By multivariate logistic regression analysis, the anti-HBc titer at baseline was the independent predictive factor for SVR in CHB patients treated with interferon (OR＝6.000, 95%CI: 1.118 -20.486, P＝0.037).The area under receiver operating characteristics curve was 0.753 and the optimal cutoff value of anti-HBc titer for the response to interferons in CHB patients was 5.03 lg IU/mL, with positive predictive value of 64.3%and negative predictive value of 89.3%.Conclusions Dynamic pattern of anti-HBc titers is correlated with different virological responses in CHB patients treated with interferon , and the baseline anti-HBc titer is the independent predictive factor for SVR.

Clinical features of 212 hepatitis B core antibody positive patients with liver injury / 中华传染病杂志

Objective To investigate the clinical features of hepatitis B core antibody (anti-HBc)positive patients with liver injury.Methods A total of 212 anti-HBc positive and HBsAg negative patients who were primarily diagnosed with liver injury from August 2013 to August 2014 at Ruijin Hospital were collected for this study.The patients were divided into cirrhosis group (n=60) and non-cirrhosis group (n =152) according to the status of cirrhosis.The 60 cases with cirrhosis were further compared with 60 cases with post-hepatitis B cirrhosis.The general information,biochemistry and immunology data were assessed.ANOVA was used to compare multiple groups of means,and Wilcoxon rank-sum test was used for non-parametric comparisons of the two groups.Results Only one case was positive for HBV DNA with the positivity rate of 0.5％.The causes for liver injury were as follows,60 cases with cryptogenic cirrhosis,which accounted for 28.3 ％;45 cases with drug-induced hepatitis,which accounted for 21.2 ％;33 cases with unexplained liver injury,which accounted for 15.6％;28 cases with acute hepatitis E,which accounted for 13.2％ and 15 cases with autoimmune hepatitis,which accounted for 7.1％.There were significant differences of T cell subpopulation,hepatitis B surface antibody (HBsAg) and hepatitis B e antibody (anti-HBe) quantitative level,red blood cells (RBC),platelet counts (PLT),prealbumin,albumin,alamine aminotransferase (ALT),aspartate transaminase (AST),international normalized ratio (INR),hyaluronic acid (HA),collagen Ⅲ (COL-Ⅲ) and collagen Ⅳ (COL-Ⅳ) between the cirrhosis group and non-cirrhosis group (all P＜0.05).The CD3+ CD4+ and CD3+ CD8+ counts,white blood cells (WBC),ALT,AST,total bilirubin (TBil) and albumin in anti-HBc-positive cirrhosis group were statistically different from those in post-hepatitis B cirrhosis group (all P＜0.05).Conclusions Some patients with positive anti-HBc still have HBV replication and infectivity.HBV anti-HBc positivity and HBsAg negativity may be associated with some cryptogenic cirrhosis and primary liver cancer.Patients with positive anti-HBc are prone to be complicated with drug-induced hepatitis,autoimmune hepatitis,and other liver damage related to immune mechanisms.Patients with cirrhosis have a higher risk to induce immune tolerance and progress to chronic disease than non-cirrhotic patients.Quantitative anti-HBc might be used as an indicator to predict disease progression after HBV infection.Disease condition in cirrhotic group with positive anti-HBc and negative HBsAg is less severe than that in post-hepatitis B cirrhosis group.

Analysis on serological and molecular biological characteristics of occult HBV infection among qualified young blood donors with anti-HBc positive in Suzhou area / 国际检验医学杂志

Objective To explore the biological and serological characteristics of occult HBV infection among qualified young blood donors with anti-HBc positive in Suzhou area .Methods 120 young blood donors with negative HBsAg and reactivity in NAT in our hospital from October 2013 to June 2016 were selected as the research subjects .The anti-HBs quantitative detection and two pairs of semi-hepatitis B detection were performed .The samples of anti-HBc positive were conducted the viral nucleic acid extraction and nested PCR at the basic core promoter(BCP) region ,pre-core(PC) region and S region .The samples with positive amplification results were performed the gene sequencing and sequential analysis .Results Among 120 volunteer blood donors ,anti-HBc(+ ) had 31 cases ,in which 25 cases were in the 22-25 years old group and 6 cases in the 18-21 years old group ,the difference was statisti-cally significant(P<0 .05);anti-HBs(+ ) had 89 cases ,among them ,16 cases were in the 22 -25 years old group and 73 cases in the 18-21 years old group .The nest PCR was used to conduct PCR amplification in 31 samples of anti-HBc(+ ) ,in which 1 case was BCP region positive and 2 cases were S region positive ,all belonged to the 22-25 years old group .In the typing and sequencing for the samples of S region positive ,the results showed that all 2 cases were B type HBV .Compared with wild type DNA sequence , among them 1 cases had amino acid sequence E44U variation and 1 cases had T532G mutation .Conclusion For the anti-HBc(+ ) young blood donors qualified in HBsAg detection ,it is not guaranteed that their blood do not contain HBV DNA .It is still needed to further increase the sensitivity of nucleic acid detection method in hepatitis B highly prevalent areas fro decreasing the risk of HBV transmission by blood transfusion .

Serological and virological epidemiology characterization of occult hepatitis B virus infection in Jiaxing volunteer blood donors / 中国输血杂志

Objective To research and analyze serological and virological epidemiology charactererization of occult hepatitis B virus infection in Jiaxing volunteer blood donors.Methods 52 698 samples were screened by ELISA(HBsAg、antiHCV 、anti-HIV、anti-TP) and Nucleic acid amplification technique(NAT),then NAT positive samples were further identified to detect virus type.HBsAg-/HBV-DNA+ samples were collected in three different kinds of qualitative HBsAg detection of ELISA kit.The quantitative determination of HBsAg and anti-HBs were used by chemiluminescencemethod.At the same time,real-time fluorescence quantitative PCR (QPCR) was used to measure the viral load of HBV.Further analysis and study on the serological and virological distribution of OBI combined with five markers of hepatitis B virus (HBV),with tracing general epidemiological data (sex,age and age).Results The prevalence rate of OBI was 0.89‰ (1 ∶ 1 121) in all donors with OBI infection,and 2 cases of window period (WP) were found in 52698 donors (1 ∶ 26 349).The results of HBsAg and HBeAg were negative in 49 HBsAg-/HBV-DNA+ samples,and 6OBI serological profiles were found.Anti-HBs quantitative concentration(＞100 mIU/mL)accounted for 27.66％ (13/47),while anti-HBc+ positive rate was 91.49％ (43/47).HBV-DNA nucleic acid quantitative ranged from 4.10 to 1.82× 103(IU/mL) (median of 15.83),whereas HBsAg+/HBV-DNA+positive viral load was in the range of 61.47 to 1.28× 104(IU/mL) (median of 538.15).The difference was significant in viral load between experiment group and control group(P＜0.05).Male donors of more than 40 years were higher in prevalence rate of OBI infection (P＜0.05),meanwhile there was a significant difference in OBI infection rate between repeated blood donors and fnrst blood donors(0.01＜P＜0.05).Conclusion The viral load was low in OBI infected donors,and anti-HBc+ was the main manifestation.NAT had the ability to detect OBI,shorten the window period,and contributed to ensure the safety of clinical blood.

Clinical significance of quantitative level of hepatitis B core antibody / 中华肝脏病杂志

Hepatitis B core antibody (anti-HBc) targets viral core protein and is produced in patients with hepatitis B virus (HBV) infection, and seroconversion occurs in the early stage of infection and often lasts for a lifetime. Qualitative detection of anti-HBc has been used in clinical practice for many years, while the clinical significance of its quantitative level remains unclear. A novel anti-HBc immunoassay based on double-antigen sandwich ELISA has been developed in recent years and lays a foundation for illustrating the change in the quantitative level of anti-HBc (qAnti-HBc) in HBV infection and its clinical significance. Several recent studies have revealed that qAnti-HBc is associated with the degree of hepatitis activity and response to pharmacotherapy and may become an important basis for selecting antiviral drugs, optimizing therapeutic regimen, and predicting treatment outcome.

Infección oculta por el virus de la hepatitis B en pacientes hemodializados cubanos / Occult hepatitis B virus infection in hemodialysis patients

Introducción: la infección oculta por el virus de la hepatitis B se caracteriza por la presencia en suero o plasma del genoma viral y anticuerpos contra la proteína de la cápsida (anti-HBc) en ausencia del marcador de infección.Objetivos: detectar la IOB en los pacientes hemodializados e identificar la posible relación de la IOB con la infección por el virus de la hepatitis C y variables sociodemográficas y epidemiológicas.Métodos: se estudiaron 709 muestras de pacientes provenientes de 18 unidades de hemodiálisis de Cuba. Se determinaron marcadores de infección, exposición e inmunidad al virus de la hepatitis B. Las muestras con HBsAg negativo, anti-HBc positivo y niveles de anti-HBs < 50 UI/L se les analizó la detección de ADN del virus de la hepatitis B y marcadores de lvirus de la hepatitis C.Resultados: las prevalencias de la infección y la exposición al virus de la hepatitis B fueron de 6,9 por ciento y 28,6 por ciento, respectivamente. El 4,3 por ciento de las muestras tuvieron criterio de infección oculta por el virus de la hepatitis B ; esta se detectó en el 58,1 por ciento (18/31) de los casos, con cargas virales menores de 105 UI/mL. La prevalencia global de infección oculta por el virus de la hepatitis B fue de 2,5 por ciento (18/709). No se encontró asociación significativa entre las variables analizadas.Conclusiones: la infección oculta por el virus de la hepatitis B fue frecuente en pacientes hemodializados con bajos niveles de anti-HBs, principalmente en aquellos con concentraciones no protectoras. Este estudio ratifica la necesidad de mantener la estrategia de prevención contra las hepatitis virales de transmisión parenteral en las unidades de diálisis(AU)

Introduction: occult hepatitis B virus infection is characterized by the presence of the viral genome and antibodies to the capside protein in serum or plasma (anti-HBc) that test negative for the infection marker.Objectives: to detect the occult hepatitis B virus in hemodialysis patients and to identify the possible relationship between occult hepatitis B infection and hepatitis C virus infection and the epidemiological and demographic variables.Methods: seventy thousand and nine serum samples from patients treated in 18 hemodialysis units were included. Serological markers for HBV infection, exposure and immunity were tested. Samples with negative HBsAg , positive anti-HBc and anti-HBs titers <50 IU/L were tested for detection of HBV-DNA and HCV markers.Results: the prevalence of HBV infection and exposure were 6.9 percent and 28.6 percent respectively. In the group, 4.3 percent of samples met occult hepatitis B infection criteria, the HBV-DNA was detected in 58.1 percent (18/31) of the samples, with viral loads below 105 IU/mL. Overall occult hepatitis B infection prevalence was 2.5 percent (18/709). There was no significant association among the analyzed variables.Conclusions: occult hepatitis B infection was frequent in hemodialysis patients with low levels of anti-HBs mainly in those with non protected titers. This study supports the need of keeping the prevention strategies against parenterally transmitted viral hepatitis in dialysis units(AU)

New perspectives of biomarkers for the management of chronic hepatitis B

With recent advances in molecular and genomic investigations, the impact of hepatitis B viral and host factors on the progression of chronic HBV infection has been explored. For viral factors, hepatitis B viral load is a strong predictor for liver disease progression. Hepatitis B viral kinetics appear to be important for successful anti-viral therapy. Serum HBsAg level serves as a complementary marker to viral load for the prediction of HBV-related adverse outcomes in patients with low viral load. In those with low viral load, high serum HBsAg level is associated with higher risks of cirrhosis and HCC. Hepatitis B core-related antigen (HBcrAg) induces host immune responses, and the reduction of the HBcrAg level as well as the increment of total anti-HBc level are significantly associated with favorable outcomes. HBV genotypes (genotype C/D) and mutants (basal core promoter and deletion mutation in pre-S genes) are well known viral genetic markers to predict disease progression. For host factors, serum inflammatory biomarkers have been developed to evaluate the HBV-associated hepatic necroinflammation and fibrosis. Host single nucleotide polymorphism on sodium taurocholate cotransporting polypeptide (NTCP, an HBV entry receptor) may be associated with a decreased risk for cirrhosis and HCC. In conclusion, patients with chronic hepatitis B should be evaluated with relevant viral and host markers to identify those who are at a higher risk of liver disease progression and then receive timely antiviral therapy.

Prevalence of Hepatitis B Virus and HIV Co-infection in Korea

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) have a common route like sexually transmitted infections (STIs), vertical transmission and blood transfusion, etc. Therefore, it was necessary to be an attempt to confirm the relationship of HBV and HIV in Korea. We investigated the prevalence of Hepatitis B surface antigen (HBsAg) and Hepatitis B core antibody (anti-HBc) in HIV positive groups (n=430) and HIV negative groups (n=434) from January 2014 to October 2015. When comparing the prevalence of anti-HBc between the two groups, HIV positive group (36.0%) showed a higher prevalence than HIV negative group (24.7%), the result was statistically significant (p < 0.05). However, there was a little difference on HBsAg and not significant. Therefore, by showing a clear difference in anti-HBc between the two groups of HIV in Korea, it was confirmed to be associated with co-infections between Hepatitis B and HIV.

Clinical and epidemiological profile of female blood donors with positive serology for viral hepatitis B

ABSTRACTINTRODUCTION:Since women are frequently the minority among blood donors worldwide, studies evaluating this population usually reflect male features. We assessed the features of female blood donors with positive serology for HBV and compared them with those of men.METHODS The study comprised consecutive blood donors referred to a specialized liver disease center to be evaluated due to HBsAg- and/or anti-HBc-positive tests.RESULTS: The study encompassed 1,273 individuals, 219 (17.2%) of whom were referred due to positive HBsAg test and 1,054 (82.8%) due to reactive anti-HBc test. Subjects' mean age was 36.8±10.9 years, and 28.7% were women. Female blood donors referred for positive HBsAg screening tests demonstrated higher prevalence of healthcare workers (9.3% vs 2.5%) and lower prevalence of sexual risk behaviors (15.1% vs 41.1%) and alcohol abuse (1.9% vs 19.8%) compared to men. Women had lower ALT (0.6 vs 0.8×ULN), AST (0.6 vs 0.8×ULN), direct bilirubin (0.2 vs 0.3mg/dL), and alkaline phosphatase (0.5 vs 0.6×ULN) levels and higher platelet count (223,380±50,293 vs 195,020±53,060/mm3). Women also had a higher prevalence of false-positive results (29.6% vs 17.0%). No differences were observed with respect to liver biopsies. Female blood donors referenced for reactive anti-HBc screening tests presented similar clinical, epidemiological, and biochemical characteristics to those reported for positive HBsAg screening tests and similarly had a higher prevalence of false-reactive results.CONCLUSIONS: Compared to men, female blood donors with positive HBsAg and/or anti-HBc screening tests demonstrated higher prevalence of professional risk and false-positive results and reduced alteration of liver chemistry.

Occult HBV infection status among chronic hepatitis C and hemodialysis patients in Northeastern Egypt: regional and national overview

INTRODUCTION: Occult hepatitis B infection (OBI) is considered to be one of the major risks for patients suffering from end-stage renal disease (ESRD) on regular hemodialysis (HD) and patients with chronic hepatitis C virus (HCV) infection. This study compared the prevalence of OBI among these two high-risk groups in the Suez Canal region, Northeastern Egypt, to obtain a better national overview of the magnitude of OBI in this region. METHODS: Serum samples were collected from 165 HD patients and 210 chronic HCV-infected patients. Anti-HCV antibody, hepatitis B surface antigen (HBsAg), total hepatitis B core (anti-HBc) antibody, and hepatitis B surface antibody (anti-HBs) were detected by enzyme-linked immunosorbent assay (ELISA). HCV RNA was detected using a quantitative real-time RT-PCR assay, and HBV was detected using a nested PCR. RESULTS: All patients were negative for HBsAg. A total of 49.1% and 25.2% of the patients in the HD and HCV groups, respectively, were anti-HBc-positive. In addition, more anti-HBs-positive patients were detected in the HD group compared to the HCV group (52.1% and 11.4%, respectively). Three cases were positive for HBV DNA in the HD group, while eighteen positive cases were detected in the HCV group. Both study groups showed significant differences in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level as well as anti-HBc, anti-HBs and HBV-DNA positivity. CONCLUSIONS: OBI was more prevalent among chronic HCV patients than HD patients in the Suez Canal region, Egypt, with rates of 8.5% and 1.8%, respectively. However, more precise assessment of this infection requires regular patient follow-up using HBV DNA detection methods. .

Reality of Negative anti-HBc and Positive anti-HBe Results of Testing HBV-M with ELISA / 现代检验医学杂志

Objective To research the reality of ELISA testing results with negative anti-HBc and positive antiHBe.Methods CMIA was carried out to retest antiHBc and antiHBe of 105 samples which were initially tested to have negative antiHBc and positive antiHBe.Results Among the 105 samples retested by CMIA,there were three different results,positive antiH-Bc with positive antiHBe,negative antiHBc with negative antiHBe and positive antiHBc with negative antiHBe,whose pro-portions were 72.38%,21.91% and 5.71% respectively;the fasle negative rates of antiHBc were 78.10% in total and 93.33%,96.15% and 47.37% in 3 subgroup with S/CO 1.00~ 1.20,1.20~2.00 and 2.00~ 3.00,respectively;the true positive rates of antiHBe were 72.38% in total and 42.86%,88.14% and 56.25% in 3 subgroups with S/CO 0.00~0.10, 0.10~0.80 and 0.80 ~ 1.00,respectively.Conclusion HBV-M results with negative antiHBc and positive antiHBe by ELISA could give suggestive value and not reflect true information about antiHBc and antiHBe with three alternatives which would be obtained through retesting by a second assay.

Prevalence of anti-HBV antibody among immunized population and evaluation of different detection methods of anti-HBc antibody / 中国人兽共患病学报

In this study ,we detected the positive rate of anti‐HBs and anti‐HBc antibody among the subject population in Fujian Medical University Union Hospital ,and to evaluate different detection methods of anti‐HBc antibody .The positive rate of anti‐HBs and anti‐HBc antibody were detected by chemiluminescent microparticle immunoassay (CMIA) and one‐step com‐petitive enzyme‐linked immunosorbent assay (ELISA) from the year 2012 to 2013 .The subject population was divided into three groups :group 1 with the age of less than 2 years old ,group 2 with the age of 2‐20 years old ,and group 3 with the age of more than 20 years old .The positive rates of anti‐HBV antibody in the different groups were analyzed .Furthermore ,anti‐HBc antibody of 92 samples selected from the immunized population was detected by CMIA and three kinds of ELISA reagents . Meanwhile ,the detection of anti‐HBc antibody by the same ELISA reagent but different operating modes were performed in these samples .The highest positive rate of anti‐HBs antibody was detected in group 1 ,and there was no significance difference of positive rate between two detection methods of anti‐HBs antibody among three groups .The positive rate of anti‐HBc anti‐body using CMIA was significantly lower than those with ELISA among group 1 and 2 .Among the 92 samples ,the positive rate of anti‐HBc antibody was 2 .2% using CMIA .With three kinds of method of ELISA reagent ,the positive rate of anti‐HBc antibody were 79 .3% ,82 .6% and 94 .6% ,respectively ,and there was no statistical significance among the results of three ELISA reagents .Anti‐HBc was not detected from 19 samples using ELISA methods with different operating modes .It's con‐cluded that the anti‐HBs antibody declined with the increase of age ,and it is necessary to discriminate the specific population to strengthen immune system .The obviously higher positive rate of anti‐HBc antibody was found by ELISA in immunized popula‐tion than that by CM IA . Concerning on the false positive of ELISA , specimen sampling with one specific test item or the CMIA method was recommended to detect the anti‐HBc antibody .

Evaluation of a programme for prevention of vertical transmission of hepatitis B in a rural block in southern India.

Background & objectives: This study was undertaken to evaluate a community based programme of antenatal screening for hepatitis B surface antigen (HBsAg) and selective immunization of children commencing at birth, at a secondary care hospital in south India. The primary objective was to assess immunization coverage among children born to HBsAg positive women; secondary objectives were to study the prevalence of HBsAg among antenatal women, prevalence of HBsAg among immunized children (to estimate vaccine efficacy), seroconversion rate and relationship of maternal hepatitis B e antigen (HBeAg) to hepatitis infection. Methods: The prevalence of hepatitis B antigen among antenatal women and immunization coverage achieved with hepatitis B vaccine in a rural block in Vellore, Tamil Nadu were assessed through examination of records. Children born between May 2002 and December 2007 to hepatitis B positive women were followed up for a serological evaluation, based on which vaccine efficacy and the effect of maternal hepatitis B e antigen (HBeAg) on breakthrough infection was estimated. Results: The prevalence of hepatitis B surface antigen among antenatal women was 1.58 % (95% CI: 1.35-1.81%). Vaccine coverage for three doses as per a recommended schedule (including a birth dose) was 70 per cent, while 82.4 per cent eventually received three doses (including a birth dose). Estimated vaccine efficacy was 68 per cent and seroconversion 92.4 per cent in children aged 6-24 months. Maternal HBeAg was significantly associated with either anti-HBc or HBsAg in immunized children, RR=5.89 (95% CI: 1.21-28.52%). Interpretation & conclusions: The prevalence of hepatitis B among antenatal women in this region was low and a programme of selective immunization was found to be feasible, achieving a high coverage for three doses of the vaccine including a birth dose.

Prevalence of hepatitis B & hepatitis C virus infections in potential blood donors in rural Vietnam.

Background & objectives: Safe blood and blood products should be offered to all patients in need for blood transfusion. The objectives of the present study were to establish prevalence estimates for hepatitis B and hepatitis C virus infections as a foundation for safe blood transfusion in rural Vietnam, and to check the accuracy of the laboratory analysis used for hepatitis testing of blood donors in Vietnam. Methods: A cross-sectional study was conducted in two rural communities in Quang Tri, Vietnam. A total of 1,200 blood samples collected from potential blood donors were tested by an enzyme immunoassay technique (EIA) for detection of hepatitis surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), and antibodies to hepatitis C antigen (anti-HCV). The EIA test outcome was validated by a chemiluminescent micro particle immunoassay technique (CMIA). Results: The prevalence of HBsAg and anti-HBc in the study population was 11.4 per cent (95% CI 9.6 - 13.2) and 51.7 per cent (95% CI 48.8 - 54.5), respectively, the prevalences being higher in males than females. The prevalence of anti-HCV was 0.17 per cent. The test agreement between the EIA and CMIA techniques was high both for HBsAg detection (κ = 0.91; 95% CI: 0.83 - 0.99) and for anti-HBc detection (κ = 0.89; 95% CI 0.81 - 0.97). Compared to CMIA results, the positive and negative predictive values of the EIA tests were found to be 94.9 per cent (95% CI 87.5 - 98.6) and 97.5 per cent (95% CI 86.8 - 99.9) for HBsAg, and 92.4 per cent (95% CI 84.2 - 97.2) and 100 per cent (95% CI 91.2 - 100) for anti-HBc. Interpretation & conclusions: The study shows that hepatitis B virus infection is endemic in rural areas of Vietnam and that almost half of the population is or has been infected. Hepatitis C infection is rare, but false negative test results cannot be ruled out. Also, the results indicate that the EIA performance in blood donor screening in Vietnam may be sub-optimal, missing 2.5 per cent of hepatitis B virus carriers and falsely excluding more than 7 per cent of blood donors. As the prevalence of hepatitis B infection is high, occult hepatitis B infection may represent a threat to safe blood transfusion. Therefore, nucleic acid amplification testing for HBV should be considered for blood donor screening in Vietnam.

Antibody levels in children after 10 years of vaccination against hepatitis B: a brazilian community-based study / Níveis de anticorpos em crianças 10 anos após a vacinação contra hepatite B: um estudo brasileiro de base comunitária

INTRODUCTION: It is known that the hepatitis B (HB) vaccine is effective, but it is alarming that sudden drops of antibody levels may coincide with the onset of adolescence. METHODS: Antibody levels against HB vaccine surface antigen (anti-HBs) and HB vaccine core antigen (anti-HBc) were measured on the blood samples of children with a mean age of 11.4 years. RESULTS: About 54.8% had protective levels of anti-HBs. Of those who were anti-HBc-positive (4.4%), an average of 218.4 anti-HBs mIU/mL was found. CONCLUSIONS: Immunological protection was found in the majority of children. However, more studies are needed to elucidate the heritability of nonresponders and establish strategies against such events.

INTRODUÇÃO: Sabe-se que a vacina contra a hepatite B é eficaz, mas é preocupante que quedas bruscas nos níveis de anticorpos possam coincidir com o início da adolescência. MÉTODOS: Níveis de anticorpos anti-HBs e anti-HBc foram medidos nas amostras de sangue de crianças com idade média de 11,4 anos. RESULTADOS: Cerca de 54,8% apresentaram níveis protetores de anti-HBs. Dos que apresentaram anti-HBc positivo (4,4%), uma média de anti-HBs de 218,4mUI/mL foi encontrada. CONCLUSÕES: Proteção imunológica foi encontrada na maioria das crianças. No entanto, mais estudos são necessários para elucidar a herança de não-respondedores e estabelecer estratégias contra tais acontecimentos.

Clinical and epidemiological profile of blood donors with positive serology for viral hepatitis in southern Brazil / Perfil clínico e epidemiológico de doadores de sangue com sorologias positivas para hepatites virais no sul do Brasil

INTRODUCTION: Positive serological tests for hepatitis viruses B and C at blood banks are an important reason for blood deferral. Additionally, high residual risk for transfusing hepatitis-contaminated blood has been estimated in southern Brazil. This study aimed to identify risk factors for positive serological tests for viral hepatitis (VH) in blood donors (BD). METHODS: A case-control study included consecutive BD with positive serology for VH, between 2008 and 2009. Cases and controls (BD with negative serology for VH) were paired 1:1 by sex and donation date. Assessment of clinical and epidemiological characteristics related to viral hepatitis was conducted. RESULTS: Among 1,282 blood donors (641 cases and 641 controls), those with positive serology for viral hepatitis had higher mean age (p<0.001); higher proportion of replacement donation (p<0.001); first donation (p<0.001); and interviewer deferment (p=0.037), compared to controls. Furthermore, donors with positive tests were less regular donors (p<0.001), had less previous history of rejection (p=0.003) and showed lower hematocrit median before donation (p=0.019). Multivariate analysis demonstrated that age (OR=1.056, 95 percentCI 1.042-1.069, p<0.001), replacement donation (OR=1.545, 95 percentCI 1.171-2.038, p=0.002) and first donation (OR=9.931, 95 percentCI 7.486-13.173, p<0.001) were independently associated with positivity of serological tests for viral hepatitis. CONCLUSIONS: Specific characteristics of blood donors were associated with positive serology for viral hepatitis. These peculiarities should be taken into account when assessing candidates for blood donation.

INTRODUÇÃO: Testes sorológicos positivos para os vírus de hepatites B e C nos bancos de sangue são importante causa de descarte de bolsas de sangue. Além disso, estima-se um alto risco residual de transfundir sangue contaminado com vírus de hepatite no sul do Brasil. Este estudo objetiva identificar fatores de risco para sorologias positivas para hepatites virais (HV) em doadores de sangue (DS). MÉTODOS: Estudo caso-controle que incluiu, consecutivamente, DS com sorologias positivas para HV entre 2008 e 2009. Casos e controles (DS com sorologias negativas para HV) foram pareados 1:1 de acordo com gênero e data da doação. RESULTADOS: Entre 1.282 doadores de sangue incluídos (641 casos e 641 controles), aqueles positivos para HV, quando comparados aos controles, apresentaram maior média de idade (p<0,001), maior proporção de doações direcionadas (p<0,001), primeira doação (p<0,001) e recusa pelo entrevistador (p=0,037). Outrossim, doadores positivos eram, com menos frequência, doadores regulares de sangue (p<0,001), apresentavam menos história prévia de rejeição na doação (p=0,003) e evidenciaram menor mediana de hematócrito (p=0,019). Análise multivariada demonstrou que idade (OR=1,056; IC95 por cento 1,042-1,069; p<0,001), doação direcionada (OR=1,545; IC95 por cento 1,171-2,038; p=0,002) e primeira doação (OR=9,931; IC95 por cento 7,486-13,173; p<0,001) foram independentemente associadas a testes positivos para HV. CONCLUSÕES: Características específicas de DS foram associadas com sorologias positivas para HV. Estas peculiaridades devem ser levadas em consideração na avaliação de candidatos a doação de sangue.

Heterogeneous distribution of hepatitis B serological markers in rural areas of Mexico

OBJECTIVE: To study the distribution of the hepatitis B antibody (anti-HBc) based on a national serosurvey from 10 Mexican states showing a mean HBV prevalence higher than the national one. MATERIALS AND METHODS: This was a cross-sectional study. During 2003, anti-HBc was analyzed at INSP in 19 907 sera, and the related sociodemographic factors were determined. RESULTS: Anti-HBc prevalence was greater among men, but it was also associated to age, residence in a rural area, low socio-economic status, and illiteracy. Clusters of very high anti-HBc prevalence were found in several rural communities where the prevalence of anti-HBc in adults is 3 to 20 times the national average. CONCLUSIONS: Besides a low endemicity of HBV in Mexico, distribution is heterogeneous as was shown in several of the states studied, where there are rural towns with very high prevalence of HBV markers. National serosurveys are useful tools for identifying communities with hepatitis B hyperendemicity, where focused research and control measures are needed.

OBJETIVO: Estudiar la distribución de anti-HBc en 10 estados con prevalencia mayor a la media nacional en la ENSA 2000. MATERIAL Y MÉTODOS: Durante 2003 se analizó en el INSP anti-HBc en 19 907 muestras de suero, se determinaron factores sociodemográficos relacionados. RESULTADOS: La prevalencia de anti-HBc fue mayor en hombres. Se asoció con la edad, residencia en áreas rurales, bajo nivel socioeconómico y analfabetismo. Se encontraron agrupamientos de alta prevalencia de anti-HBc en comunidades rurales en las cuales la prevalencia de anti-HBc en adultos está entre 3 y 20 veces por arriba de la media nacional. CONCLUSIONES: Contrastando con la baja endemicidad del VHB en México, su distribución es heterogénea. En varios estados se hallaron localidades rurales con muy alta prevalencia de anti-HBc. Las encuestas de salud permiten identificar comunidades donde la hepatitis B es hiperendémica y en las cuales se requiere enfocar la investigación y tomar medidas de control.