Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.151
Filtrar
1.
PLoS One ; 15(8): e0237252, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32764801

RESUMEN

BACKGROUND: Botswana introduced the HBV vaccine at birth for all newborns in 2000. To the best of our knowledge, since the introduction of HBV vaccination, there have been limited data for vaccine response to HBV and its impact on early childhood HBV infections among children HIV exposed but uninfected in Botswana. AIMS: To determine the prevalence of hepatitis B surface antigen (HBsAg) and HBV vaccine response in 18 months old children HIV exposed but uninfected in Botswana. METHODS: Stored plasma samples from 304 children at 18 months of age and 287 mothers from delivery were tested for HBsAg. Mothers with positive HBsAg had HBV DNA level tested, and their HBV genotypes were determined by amplifying a 415-base pair (bp) region of the surface gene. Plasma samples from children exposed to HIV were tested for hepatitis B surface antibody (anti-HBs) titers. RESULTS: No children (0 of 304) were positive for HBsAg at 18 months while 5 (1.74%) of 287 HIV-positive mothers were HBsAg positive. Four of the HBsAg positive mothers were infected with genotype A1, while 1 was infected with genotype E. The median anti-HBs titer in children was 174 mIU/mL [QR: 70, 457]. Three (1.1%) of 269 children had an inadequate vaccine response (<10 mIU/mL), while 266 (98.9%) of 269 had protective immunity. However, when using the ≥100mIU/mL threshold, only 170 (63.2%) of 269 children had complete protection. CONCLUSION: No HBsAg positivity was identified in a cohort of children HIV exposed but uninfected. The absence of HBsAg positives was associated with good HBV vaccine responses and low maternal HBsAg prevalence in Botswana.


Asunto(s)
Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Vacunas contra Hepatitis B/uso terapéutico , Virus de la Hepatitis B/inmunología , Hepatitis B/prevención & control , Adulto , Botswana/epidemiología , Hepatitis B/sangre , Hepatitis B/epidemiología , Hepatitis B/inmunología , Anticuerpos contra la Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/inmunología , Vacunas contra Hepatitis B/inmunología , Humanos , Lactante , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Prevalencia
2.
Artículo en Inglés | MEDLINE | ID: mdl-32326203

RESUMEN

Background: The number of homeless families has increased considerably since the 1990s in France. We aimed to estimate the homeless children vaccination coverage (VC) for diphtheria, tetanus, polio, measles-mumps-rubella and hepatitis B and identify factors associated with insufficient VC according to birthplace. Methods: A cross-sectional survey was conducted among homeless shelter families in the greater Paris area. A nurse conducted face-to-face interviews and collected vaccination records. We analyzed factors associated with insufficient VC, stratified by birthplace and vaccine, using robust Poisson regression. Results: The study included 214 children born in France and 236 born outside France. VC in French-born homeless children was high (>90% at 24 months for most vaccinations) and similar to levels observed in the general population, whereas VC in those born outside France was low (<50% at 24 months for all vaccines). Factors significantly associated with insufficient VC among children born outside France were age, parents with French-language difficulties, and changing residence at least twice in the previous year. Children in contact with the healthcare system at least once in the previous year had significantly higher VC, irrespective of vaccine and birthplace. Conclusion: Special attention should be paid to homeless children born outside France, with recent European and French recommendations confirming the need for catch-up vaccination in children with undocumented VC.


Asunto(s)
Vacuna contra Difteria, Tétanos y Tos Ferina , Difteria , Vacunas contra Hepatitis B , Jóvenes sin Hogar , Vacuna contra el Sarampión-Parotiditis-Rubéola , Sarampión , Paperas , Poliomielitis , Rubéola (Sarampión Alemán) , Tétanos , Cobertura de Vacunación , Niño , Estudios Transversales , Vacuna contra Difteria, Tétanos y Tos Ferina/uso terapéutico , Femenino , Vacunas contra Hepatitis B/uso terapéutico , Humanos , Masculino , Vacuna contra el Sarampión-Parotiditis-Rubéola/uso terapéutico , Encuestas y Cuestionarios , Vacunación
3.
Medicine (Baltimore) ; 99(16): e19886, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32312015

RESUMEN

BACKGROUND: This study aims at evaluating the benefits and harms of hepatitis B immune globulin (HBIG) and hepatitis B vaccine (HBVac) in preventing mother to child transmission in HBV surface antigen (HBsAg) positive pregnant women during antenatal period. METHODS: Seven electronic databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Database, Chinese Biomedical Literature Database (CBM), VIP Database for Chinese Technical Periodicals (VIP), and 3 clinical trial registry platforms were searched from inception date to December 2017. Only randomized controlled trials (RCTs) were included in this study. The Cochrane risk of bias tool was applied to assessing the risk of bias. The outcomes were analyzed by Review Manager 5.3 software. RESULTS: Sixteen RCTs involving 2440 HBsAg positive pregnant women were included in the meta-analysis. Compared with placebo group, HBIG and HBVac group had a significant decrease in the number of newborns who were HBsAg positive (relative risks [RR]: 0.2, 95% confidence interval [CI] [0.18, 0.40], P < .00001) and HBV-DNA positive (RR: 0.25, 95% CI [0.09, 0.71], P = .010), and had a significant increase in the number of anti-HBs positive newborns (RR: 3.95, 95% CI [3.11, 5.00], P < .00001). After 1-year follow up, the number of HBsAg positive newborns continued to decline (RR: 0.09, 95% CI [0.04, 0.20], P < .00001) and the number of anti-HBs positive newborns continued to increase in HBIG and HBVac group (RR: 1.30, 95% CI [1.22, 1.38], P < .00001). Compared with HBIG group, HBIG and HBVac group had no significant difference in the number of HBsAg positive newborns (RR: 1.68, 95% CI [0.66, 4.30], P = .28), and had a significant decrease in the number of HBsAg positive newborns (RR: 0.31, 95% CI [0.12, 0.84], P = .02). Additionally, only 1 study reported 2 swelling cases, 4 studies were reported no adverse events, and 11 studies were not report adverse reaction. CONCLUSIONS: HBIG and HBVac could be an effective alternative for HBsAg positive pregnant women to prevent mother to child transmission. However, due to the limitations of the study, the long-term efficacy and safety of HBIG and HBVac still need long-term and high-quality research to confirm.


Asunto(s)
Vacunas contra Hepatitis B/administración & dosificación , Hepatitis B/tratamiento farmacológico , Inmunoglobulinas/administración & dosificación , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , China/epidemiología , ADN Viral/genética , Femenino , Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/inmunología , Vacunas contra Hepatitis B/uso terapéutico , Virus de la Hepatitis B/inmunología , Humanos , Inmunoglobulinas/uso terapéutico , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Atención Prenatal/normas , Ensayos Clínicos Controlados Aleatorios como Asunto
4.
Obstet Gynecol ; 135(4): 808-811, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32168212

RESUMEN

Recommendations for screening for hepatitis B immunity in pregnancy and vaccinating susceptible women vary among professional societies. The American College of Obstetricians and Gynecologists recommends vaccinating high-risk women for hepatitis B. However, only one fourth of U.S. adults have received a complete hepatitis B vaccination series. Because two thirds of individuals with chronic hepatitis B are unaware of their diagnosis, risk-based screening for immunity followed by vaccination of susceptible women may not identify and protect all women at risk. Acquisition of hepatitis B poses short-term and long-term risks to maternal and fetal health, an outcome that can be prevented by vaccination. Hepatitis B vaccination in pregnancy is safe and efficacious and can be completed during the course of prenatal care. Universal screening for hepatitis B immunity and vaccination of susceptible women in pregnancy should be a priority during prenatal care. Cost-effectiveness studies are needed to validate this approach.


Asunto(s)
Hepatitis B/diagnóstico , Servicios de Salud Materna , Complicaciones Infecciosas del Embarazo/diagnóstico , Diagnóstico Prenatal , Femenino , Hepatitis B/prevención & control , Vacunas contra Hepatitis B/uso terapéutico , Humanos , Tamizaje Masivo , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Estados Unidos , Atención de Salud Universal , Vacunación
5.
Isr Med Assoc J ; 22(3): 148-153, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32147978

RESUMEN

BACKGROUND: Opposition to neonatal Hepatitis B vaccination is a growing trend in Israel. OBJECTIVES: To assess the sociodemographic factors and attitudes associated with non-vaccination of term singleton newborns. METHODS: This prospective, pair-matched, controlled trial was conducted in a tertiary university-affiliated hospital. Data on maternal sociodemographic parameters, delivery, and infant care practices were gathered. Knowledge and references of Hepatitis B virus (HBV) vaccination, vaccination schedule, and health government policies were assessed. A follow-up telephone survey was completed at the age of 7 weeks postpartum regarding vaccine catch-up rate. RESULTS: Mothers in the study group were mostly Jewish white middle class married multiparous women with some higher education. Hepatitis B serology was not tested in most. Higher rates of rooming-in and exclusive breastfeeding were observed. Knowledge about HBV was stated, multiple sources of information were significantly associated with newborn non-vaccination. Many objected to the timing of the vaccine and its necessity. Multiple medical encounters are viewed as missed opportunities. CONCLUSIONS: Multiple sources of vaccine information are associated with non-vaccination. Medical encounters prior and post-delivery should be used for vaccination education and may improve vaccination coverage.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Vacunas contra Hepatitis B/uso terapéutico , Cuidado del Lactante/métodos , Educación del Paciente como Asunto/métodos , Vacunación/estadística & datos numéricos , Adulto , Femenino , Humanos , Cuidado del Lactante/estadística & datos numéricos , Recién Nacido , Israel , Masculino , Embarazo , Estudios Prospectivos
6.
Nat Nanotechnol ; 15(5): 406-416, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32123380

RESUMEN

Chronic hepatitis B is caused by prolonged infection with the hepatitis B virus (HBV), which can substantially increase the risk of developing liver disease. Despite the development of preventive vaccines against HBV, a therapeutic vaccine inducing an effective antibody response still remains elusive. The preS1 domain of the large HBV surface protein is the major viral attachment site on hepatocytes and thus offers a therapeutic target; however, its poor immunogenicity limits clinical translation. Here, we design a ferritin nanoparticle vaccine that can deliver preS1 to specific myeloid cells, including SIGNR1+ dendritic cells (which activate T follicular helper cells) and lymphatic sinus-associated SIGNR1+ macrophages (which can activate B cells). This nanoparticle vaccine induces a high-level and persistent anti-preS1 response that results in efficient viral clearance and partial serological conversion in a chronic HBV mouse model, offering a promising translatable vaccination strategy for the functional cure of chronic hepatitis B.


Asunto(s)
Antígenos de Superficie de la Hepatitis B/uso terapéutico , Vacunas contra Hepatitis B/uso terapéutico , Virus de la Hepatitis B/inmunología , Hepatitis B Crónica/prevención & control , Nanopartículas/uso terapéutico , Precursores de Proteínas/uso terapéutico , Animales , Formación de Anticuerpos , Femenino , Antígenos de Superficie de la Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/administración & dosificación , Hepatitis B Crónica/inmunología , Masculino , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Células Mieloides/inmunología , Nanopartículas/administración & dosificación , Precursores de Proteínas/administración & dosificación
7.
Rev. cuba. salud pública ; 46(1): e1252, ene.-mar. 2020. tab
Artículo en Español | LILACS, CUMED | ID: biblio-1126831

RESUMEN

Introducción: El personal de salud se encuentra expuesto a contraer enfermedades infecto contagiosas en el ejercicio de su labor, una de ellas es la hepatitis B. Los estudiantes de atención prehospitalaria no se encuentran exentos de sufrir esta enfermedad, sobre todo por el contexto de las emergencias y desastres donde se desenvuelven. Objetivo: Determinar la prevalencia de seroprotección para el virus de hepatitis B en estudiantes de atención prehospitalaria en una universidad en Colombia. Métodos: Estudio descriptivo de corte transversal realizado a estudiantes de atención prehospitalaria en el periodo febrero-junio de 2017. No se utilizó ninguna técnica de muestreo porque se incluyó la totalidad de los estudiantes en práctica. Se aplicó un cuestionario con preguntas de datos sociodemográficos, registro del esquema de vacunación para hepatitis B y el resultado de los anticuerpos (Anti-HBs). Para el análisis estadístico se utilizó Microsoft Excel 2010, se construyeron estadísticas descriptivas. Las variables numéricas se describieron con base en medidas de tendencia central y variabilidad, las variables categóricas se describieron con base en prevalencias y distribuciones porcentuales. Resultados: En la caracterización de los 103 estudiantes evaluados se encontró que el 98 por ciento obtuvo títulos de anticuerpos (Anti-HBs) mayores a 10 UI/ml, considerándose como reactivos a las dosis de las vacunas, alcanzando títulos protectores. Sin embargo, el 93 por ciento no cumplió con el esquema de vacunación establecido. Conclusiones: Los resultados obtenidos evidencian la efectividad de las dosis aplicadas de vacuna para el virus de hepatitis B para obtener los títulos de anticuerpos a estudiantes de atención prehospitalaria en una universidad en Colombia. Pero existen incumplimientos en los tiempos recomendados para la aplicación de cada una de las dosis y en el tiempo de toma de los títulos(AU)


Introduction: Health personnel are at risk of infectious diseases when doing their job. One of them is hepatitis B. Prehospital care students are not free from suffering this disease, especially due to the emergencies and disasters context in which they work. Objective: To determine the prevalence of seroprotection for the hepatitis B virus in prehospital care students at a university in Colombia. Methods: Descriptive cross-sectional study carried out on prehospital care students during the period February-June 2017. No sampling technique was used because all the students in practice were included. A questionnaire was applied with questions of social-demographic data, registration of the vaccination schedule for hepatitis B and result of (Anti-HBs) antibodies. For statistical analysis, Microsoft Excel 2010 was used and descriptive statistics were designed. Numerical variables were described based on measures of central tendency and variability, categorical variables were described based on prevalence and percentage distributions. Results: In the depiction of the 103 students who were evaluated, it was found that 98 percent obtained antibody titers (Anti-HBs) bigger than 10 IU / ml, being considered as reactive to the doses of the vaccines and getting protective titles. However, 93 percent did not fill the established vaccination schedule. Conclusions: It can be concluded that the results obtained show the effectiveness of the applied doses of vaccine for the hepatitis B virus to obtain antibody titers to prehospital care students at a university in Colombia. But there are breaches in the recommended times for the application of each of the doses and in the time of taking the antibody titers(AU)


Asunto(s)
Humanos , Masculino , Femenino , Vacunas contra Hepatitis B/uso terapéutico , Educación Premédica , Atención Prehospitalaria , Hepatitis Viral Humana/epidemiología , Epidemiología Descriptiva , Estudios Transversales , Colombia
8.
Am J Emerg Med ; 38(2): 296-299, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31353159

RESUMEN

BACKGROUND: There is limited data regarding the use of emergency departments (EDs) for infectious disease screening and vaccination in resource-limited regions. In these settings, EDs are often the only contact that patients have with the healthcare system, turning an ED visit into an opportune time to deliver preventative health services. METHODS: In this pilot study, patients that met inclusion criteria were prospectively tested for hepatitis B surface antigen test (HBsAg). Previously unvaccinated patients who tested negative for HBsAg were offered HBV vaccination. The study setting was a public infectious disease hospital in Cordoba, Argentina. The primary outcomes were new HBV diagnoses, as well as vaccination completion between screening modalities (Point-of-Care-Testing-POCT vs. laboratory testing) and same vs. different day vaccination. RESULTS: We screened 100 patients for HBV (75 POCT & 25 laboratory). The median age of participants was 35 years (IQR 24-52) and 55% were male. No patients tested positive for HBsAg. All patients who completed first dose vaccination were initially screened with the POCT. No patients screened with laboratory testing returned for vaccination. Patients who were scheduled for vaccination the same day were more likely to complete vaccination compared to those scheduled for another day (75% vs. 14%, p < .001). CONCLUSION: Our study supports the use of HBV POCTs in the ED in conjunction with vaccination of HBV-negative individuals. In regions with low HBV endemicity, direct vaccination without HBsAg testing may be more cost effective. We believe that this acute-care screening model is applicable to other resource-limited settings.


Asunto(s)
Servicio de Urgencia en Hospital , Vacunas contra Hepatitis B/uso terapéutico , Hepatitis B/prevención & control , Tamizaje Masivo/métodos , Vacunación/estadística & datos numéricos , Adulto , Argentina , Femenino , Antígenos de Superficie de la Hepatitis B/sangre , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pruebas en el Punto de Atención , Estudios Prospectivos , Pruebas Serológicas , Adulto Joven
9.
Gut ; 69(2): 343-354, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-30926653

RESUMEN

OBJECTIVE: This study aimed to develop a novel therapeutic vaccine based on a unique B cell epitope and investigate its therapeutic potential against chronic hepatitis B (CHB) in animal models. METHODS: A series of peptides and carrier proteins were evaluated in HBV-tolerant mice to obtain an optimised therapeutic molecule. The immunogenicity, therapeutic efficacy and mechanism of the candidate were investigated systematically. RESULTS: Among the HBsAg-aa119-125-containing peptides evaluated in this study, HBsAg-aa113-135 (SEQ13) exhibited the most striking therapeutic effects. A novel immunoenhanced virus-like particle carrier (CR-T3) derived from the roundleaf bat HBV core antigen (RBHBcAg) was created and used to display SEQ13, forming candidate molecule CR-T3-SEQ13. Multiple copies of SEQ13 displayed on the surface of this particulate antigen promote the induction of a potent anti-HBs antibody response in mice, rabbits and cynomolgus monkeys. Sera and purified polyclonal IgG from the immunised animals neutralised HBV infection in vitro and mediated efficient HBV/hepatitis B virus surface antigen (HBsAg) clearance in the mice. CR-T3-SEQ13-based vaccination induced long-term suppression of HBsAg and HBV DNA in HBV transgenic mice and eradicated the virus completely in hydrodynamic-based HBV carrier mice. The suppressive effects on HBsAg were strongly correlated with the anti-HBs level after vaccination, suggesting that the main mechanism of CR-T3-SEQ13 vaccination therapy was the induction of a SEQ13-specific antibody response that mediated HBV/HBsAg clearance. CONCLUSIONS: The novel particulate protein CR-T3-SEQ13 suppressed HBsAg effectively through induction of a humoural immune response in HBV-tolerant mice. This B cell epitope-based therapeutic vaccine may provide a novel immunotherapeutic agent against chronic HBV infection in humans.


Asunto(s)
Epítopos de Linfocito B/inmunología , Antígenos de Superficie de la Hepatitis B/sangre , Vacunas contra Hepatitis B/inmunología , Hepatitis B Crónica/inmunología , Adyuvantes Inmunológicos , Animales , Antivirales/uso terapéutico , Terapia Combinada , ADN Viral/sangre , Relación Dosis-Respuesta Inmunológica , Femenino , Anticuerpos contra la Hepatitis B/biosíntesis , Vacunas contra Hepatitis B/uso terapéutico , Virus de la Hepatitis B/genética , Hepatitis B Crónica/terapia , Hepatitis B Crónica/virología , Inmunidad Humoral/inmunología , Inmunoterapia/métodos , Macaca fascicularis , Masculino , Ratones Endogámicos BALB C , Ratones Transgénicos , Conejos
10.
Aust N Z J Obstet Gynaecol ; 60(1): 93-100, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31259386

RESUMEN

BACKGROUND: Hepatitis B virus (HBV) immunisation is the first vaccine of infant life and one of the most commonly refused immunisations on the Australian Immunisation Schedule. AIMS: To quantify the frequency of declined HBV immunisation birth-doses, investigate reasons for refusal, and determine information sources used by parents. MATERIALS AND METHODS: A cross-sectional study using a questionnaire was conducted on postnatal women who declined their newborn's HBV birth-dose immunisation during December 2016-July 2017 at an Australian tertiary referral hospital. Mothers who were non-English-speaking, unwell or medically unstable, or otherwise unavailable were excluded. RESULTS: One hundred and thirty-seven of the 1574 (8.7%) eligible reviewed infants had HBV immunisation birth-doses documented as declined; 113 mothers consented to complete the questionnaire. The most common reasons for declining the dose were: 'baby too young' (55.8%); preference for two, four and six-month HBV immunisations only (56.6%); perceived low risk of contracting HBV (45.1%); and a fear of 'overloading' their baby's immune system (42.5%). General practitioners or nurses/midwives (43.3%) and the internet/media (33.6%) were the predominant information sources consulted, and 58.4% felt satisfied with the information they received antenatally. Eighty-eight of 113 mothers (77.9%) would still consider future immunisations for their infant. CONCLUSIONS: The majority of postnatal women decline HBV birth-dose immunisation for their newborns citing age-related safety concerns and vaccine misconceptions. Informal information sources such as the internet and media are often consulted. Addressing the need for antenatal and health professional education toward the birth-dose may be instrumental in improving uptake.


Asunto(s)
Vacunas contra Hepatitis B/uso terapéutico , Madres/psicología , Negativa a la Vacunación/psicología , Adulto , Australia , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Hepatitis B/prevención & control , Humanos , Inmunización/estadística & datos numéricos , Recién Nacido , Masculino , Persona de Mediana Edad , Padres/psicología , Encuestas y Cuestionarios , Vacunación/estadística & datos numéricos , Negativa a la Vacunación/estadística & datos numéricos , Adulto Joven
11.
J Dig Dis ; 21(1): 46-51, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31794121

RESUMEN

OBJECTIVE: The prevalence of inflammatory bowel disease (IBD) has been increasing worldwide, and the risk of infection has increased due to the use of immunosuppressive and biologic medications. Some of these infections can be prevented with vaccinations. The aim of this study was to evaluate the vaccination practices of Chinese gastroenterologists for patients with IBD. METHODS: Questionnaires based on quick response codes were sent using email and the WeChat platform to gastroenterologists at 20 hospitals in China. The vaccination practices of the gastroenterologists, including vaccinating for hepatitis B, hepatitis A, and varicella, were assessed. RESULTS: Of the 468 gastroenterologists who received the questionnaire, 307 (65.6%) completed it. Of the gastroenterologists who were most concerned about hepatitis B; 83.4% always or frequently asked about an infection history, 53.7% took an immunization history, and 73.6% tested patients for hepatitis B infection. However, few gastroenterologists did so for hepatitis A or varicella. The proportion of patients who were asked about an infection and immunization history and tested for varicella infection was 16.0%, 15.0%, and 9.4%, respectively. Only a few gastroenterologists recommended vaccination for patients without an infection before IBD medical treatment (26.7% for hepatitis A, 45.6% for hepatitis B, and 28% for varicella vaccination). CONCLUSION: Vaccination practices for patients with IBD used by Chinese gastroenterologists vary greatly, suggesting that education about immunization is needed.


Asunto(s)
Fármacos Gastrointestinales/efectos adversos , Hepatitis Viral Humana/prevención & control , Enfermedades Inflamatorias del Intestino/terapia , Vacunación , Infección por el Virus de la Varicela-Zóster/prevención & control , Vacunas Virales/uso terapéutico , Productos Biológicos/efectos adversos , Productos Biológicos/uso terapéutico , Vacuna contra la Varicela/uso terapéutico , China/epidemiología , Femenino , Gastroenterología/estadística & datos numéricos , Fármacos Gastrointestinales/uso terapéutico , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Vacunas contra la Hepatitis A/uso terapéutico , Vacunas contra Hepatitis B/uso terapéutico , Hepatitis Viral Humana/etiología , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/epidemiología , Masculino , Práctica Profesional/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Infección por el Virus de la Varicela-Zóster/etiología , Vacunas contra Hepatitis Viral/uso terapéutico
12.
Ann Rheum Dis ; 79(1): 39-52, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31413005

RESUMEN

To update the European League Against Rheumatism (EULAR) recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD) published in 2011. Four systematic literature reviews were performed regarding the incidence/prevalence of vaccine-preventable infections among patients with AIIRD; efficacy, immunogenicity and safety of vaccines; effect of anti-rheumatic drugs on the response to vaccines; effect of vaccination of household of AIIRDs patients. Subsequently, recommendations were formulated based on the evidence and expert opinion. The updated recommendations comprise six overarching principles and nine recommendations. The former address the need for an annual vaccination status assessment, shared decision-making and timing of vaccination, favouring vaccination during quiescent disease, preferably prior to the initiation of immunosuppression. Non-live vaccines can be safely provided to AIIRD patients regardless of underlying therapy, whereas live-attenuated vaccines may be considered with caution. Influenza and pneumococcal vaccination should be strongly considered for the majority of patients with AIIRD. Tetanus toxoid and human papilloma virus vaccination should be provided to AIIRD patients as recommended for the general population. Hepatitis A, hepatitis B and herpes zoster vaccination should be administered to AIIRD patients at risk. Immunocompetent household members of patients with AIIRD should receive vaccines according to national guidelines, except for the oral poliomyelitis vaccine. Live-attenuated vaccines should be avoided during the first 6 months of life in newborns of mothers treated with biologics during the second half of pregnancy. These 2019 EULAR recommendations provide an up-to-date guidance on the management of vaccinations in patients with AIIRD.


Asunto(s)
Antirreumáticos/uso terapéutico , Enfermedades Autoinmunes/tratamiento farmacológico , Infecciones Bacterianas/prevención & control , Enfermedades Reumáticas/tratamiento farmacológico , Vacunas/uso terapéutico , Virosis/prevención & control , Composición Familiar , Hepatitis A/prevención & control , Vacunas contra la Hepatitis A/uso terapéutico , Hepatitis B/prevención & control , Vacunas contra Hepatitis B/uso terapéutico , Herpes Zóster/prevención & control , Vacuna contra el Herpes Zóster/uso terapéutico , Humanos , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/uso terapéutico , Tétanos/prevención & control , Toxoide Tetánico/uso terapéutico , Vacunas Atenuadas/uso terapéutico
13.
Dig Dis Sci ; 65(1): 204-214, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31376084

RESUMEN

PURPOSE: HBV precore (PC) and basal core promoter (BCP) mutants are associated with liver disease severity, yet have been suggested to protect against HBV vertical transmission. HBV within peripheral blood mononuclear cells (PBMC) has been reported in association with intrauterine HBV infection. We analyzed HBV replication status in PBMC and PC/BCP mutants in PBMC from pregnant chronic hepatitis B (CHB) patients. METHODS: Pregnant CHB carriers were assessed for HBeAg, HBV-DNA, ALT in second-third trimester and liver stiffness measurement (LSM) postpartum. HBV-DNA, HBV-cccDNA, and HBV-mRNA were tested in PBMC by in-house PCR. BCP/PC variants were determined by Sanger sequencing and analyzed using MEGA7. RESULTS: In 37 CHB pregnant carriers, median age 32 years, 53% Asian, median ALT 19 versus 26 U/L, median HBV-DNA 2.6 versus 8.1 logIU/mL (untreated vs. treated), eight HBeAg+, with genotype 10%A, 29%B, 21%C, 10%D, 19%E, eight received tenofovir in pregnancy to reduce vertical transmission risk. HBV-DNA was detected in ~ 55% (25/45) PBMC, and PC/BCP mutations were found in 36% (9/25) and 4% (1/25), respectively. All infants received HBV immunoprophylaxis and tested HBV surface antigen negative at 9-12 months of age. During a median 4 years (IQR 3-5), follow-up all mothers showed normal LSM, with no significant change in ALT, HBeAg status, or HBV-DNA levels compared to baseline in untreated CHB carriers. CONCLUSION: In this multiethnic cohort of pregnant CHB carriers, HBV replicative intermediates and PC/BCP mutants were found in significant proportion of PBMC, but were not associated with increased risk of HBV immunoprophylaxis failure or liver disease severity over long-term follow-up.


Asunto(s)
ADN Viral/genética , Antígenos del Núcleo de la Hepatitis B/genética , Virus de la Hepatitis B/genética , Hepatitis B Crónica/virología , Leucocitos Mononucleares/virología , Mutación , Complicaciones Infecciosas del Embarazo/virología , Regiones Promotoras Genéticas , Adulto , Antivirales/uso terapéutico , Femenino , Estudios de Seguimiento , Genotipo , Vacunas contra Hepatitis B/uso terapéutico , Virus de la Hepatitis B/efectos de los fármacos , Virus de la Hepatitis B/crecimiento & desarrollo , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/transmisión , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/prevención & control , Cirrosis Hepática/virología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Carga Viral , Replicación Viral
15.
J Prev Med Hyg ; 60(3): E184-E190, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31650052

RESUMEN

Hepatitis B virus (HBV) is a main cause of chronic and acute hepatitis. Healthcare workers (HCWs), including medical students and resident doctors, have an occupational risk of HBV infection. The study aimed to evaluate the long-term persistence of protective anti-HBs antibody levels in healthcare students and resident doctors at risk for occupational exposure to HBV at 15 years after primary vaccination course. Further objective was to evaluate the anamnestic response observed in non-seroprotected subjects receiving a booster dose. Data were collected from the clinical documentation filled in during the occupational medical check of medical students and resident doctors undergoing Occupational Health Surveillance by the University of Ferrara. Of the 621 included individuals, 27.7% had an anti-HBs concentration < 10 mIU/mL. Subjects vaccinated during infancy had more frequently a concentration < 10 mIU/mL than those vaccinated during adolescence (42.7% vs 6.9%; p-value < 0.001). Multivariate analysis confirmed the statistical significance of the vaccination age. 94 subjects who had an anti-HBs concentration < 10 mIU/mL received a booster dose. The proportion of subjects who had an anamnestic response was higher in those vaccinated in infancy rather than during adolescence (94.1% vs 77.8% respectively). These findings suggest that the anti-HBs concentration decreases below 10 mIU/mL more frequently in subjects vaccinated during infancy. Immunological memory seems to persist after the decline of the anti-HB titer, as observed in response to a booster dose. In conclusion, vaccinated subjects at increased risk of HBV infection should be monitored and a booster dose administered if anti-HBs titer is below 10 mIU/mL.


Asunto(s)
Anticuerpos contra la Hepatitis B/inmunología , Vacunas contra Hepatitis B/uso terapéutico , Hepatitis B/prevención & control , Cuerpo Médico de Hospitales , Estudiantes de Medicina , Adulto , Estudios Transversales , Femenino , Antígenos de Superficie de la Hepatitis B/inmunología , Humanos , Inmunización Secundaria , Memoria Inmunológica , Internado y Residencia , Masculino , Salud Laboral , Adulto Joven
16.
Expert Rev Gastroenterol Hepatol ; 13(11): 1065-1076, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31663387

RESUMEN

Introduction: Universal infant hepatitis B virus (HBV) vaccination program has reduced HBV infection dramatically in vaccinated young generations. Management of chronically infected children is still challenging concerning high viral load with mostly mild diseases, yet with a nonnegligible proportion of advanced diseases, and long-term effect of antivirals. However, with more potent antivirals approved for pediatric patients, to start antivirals earlier in eligible patients may benefit their outcomes. This review aimed to update the current management of chronic hepatitis B in children.Areas covered: This review covered the natural history of chronic HBV infection, management of chronic hepatitis B in children from the past to the present, current consensus on the treatment of chronic hepatitis B in children, controversies in cessation of oral antivirals, and management of special populations such as pregnancy and co-infections.Expert opinions: Without contraindication, peginterferon is recommended for immune-active children ≥ 3 years old. For those intolerant, decompensating or preferring oral therapy, first-line Nucleos(t)ide analogs (NUC), Entecavir or Tenofovir, may be applied. For immune-tolerant or inactive carriers, close monitoring is crucial. When to stop NUCs and novel therapies for HBV cure await further research.


Asunto(s)
Antivirales/uso terapéutico , Vacunas contra Hepatitis B/uso terapéutico , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis B Crónica/tratamiento farmacológico , Adolescente , Edad de Inicio , Antivirales/efectos adversos , Niño , Preescolar , Quimioterapia Combinada , Femenino , Vacunas contra Hepatitis B/efectos adversos , Virus de la Hepatitis B/genética , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/epidemiología , Hepatitis B Crónica/virología , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Factores de Riesgo , Respuesta Virológica Sostenida , Resultado del Tratamiento , Carga Viral
17.
PLoS One ; 14(10): e0223733, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31609983

RESUMEN

BACKGROUND AND AIM: Vietnam's burden of liver cancer is largely due to its high prevalence of chronic hepatitis B virus (HBV) infection. This study aimed to examine healthcare workers' (HCWs) knowledge, attitude and practices regarding HBV prevention and management. METHODS: A cross-sectional survey among health care workers working at primary and tertiary facilities in two Northern provinces in Vietnam in 2017. A standardized questionnaire was administered to randomly selected HCWs. Multivariate regression was used to identify predictors of the HBV knowledge score. RESULTS: Among the 314 participants, 75.5% did not know HBV infection at birth carries the highest risk of developing chronic infection. The median knowledge score was 25 out of 42 (59.5%). About one third (30.2%) wrongly believed that HBV can be transmitted through eating or sharing food with chronic hepatitis B patients. About 38.8% did not feel confident that the hepatitis B vaccine is safe. Only 30.1% provided correct answers to all the questions on injection safety. Up to 48.2% reported they consistently recap needles with two hands after injection, a practice that would put them at greater risk of needle stick injury. About 24.2% reported having been pricked by a needle at work within the past 12 months. More than 40% were concerned about having casual contact or sharing food with a person with chronic hepatitis B infection (CHB). In multivariate analysis, physicians scored significantly higher compared to other healthcare professionals. Having received training regarding hepatitis B within the last two years was also significantly associated with a better HBV knowledge score. CONCLUSIONS: Findings from the survey indicated an immediate need to implement an effective hepatitis B education and training program to build capacity among Vietnam's healthcare workers in hepatitis B prevention and control and to dispel hepatitis B stigma.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Vacunas contra Hepatitis B/uso terapéutico , Hepatitis B/prevención & control , Adulto , Estudios Transversales , Educación Médica , Femenino , Conductas de Riesgo para la Salud/clasificación , Encuestas Epidemiológicas , Hepatitis B/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Guías de Práctica Clínica como Asunto , Centros de Atención Terciaria , Vietnam , Adulto Joven
18.
Rev Epidemiol Sante Publique ; 67(6): 397-402, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31561941

RESUMEN

BACKGROUND: Viral Hepatitis B (HBV) prevalence in Morocco is estimated at 1.81%. University students are an exposed population due to their risky behaviors. Their knowledge about HBV is still unknown. The aim of our study was to assess the knowledge, attitudes and practices of college students in Casablanca about HBV. METHODS: A cross-sectional study was carried out in January 2015 among the students of the eight schools of Hassan II University in Casablanca using a self-administered questionnaire. A knowledge score was calculated to compare the groups with sufficient and insufficient knowledge. A logistic regression adjusted on gender was performed to explore the factors associated with a sufficient knowledge about HBV (P<0.05). RESULTS: The response rate was 90.2% (n=652). The median age was 21 years old. From our sample, 97.5% knew the existence of "hepatitis". The main means of information were media and relatives. The most known way of infection was blood transmission (50.3%) while 11.5% believed in the effectiveness of the traditional methods of treatment. Eating with an HBV infected person was thought to be a risky behavior for 38% of the students. A knowledge level that was deemed to be sufficient was scored by 31.1% of the students. The sufficient knowledge was correlated to being a health care student, being vaccinated and being married. CONCLUSION: Casablanca's student knowledge about HBV remains limited. We believe that improvements in awareness and access to immunization are needed. These measures would likely help decreasing HBV incidence in students and ensure a better social integration of patients.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Hepatitis B , Estudiantes/estadística & datos numéricos , Universidades/estadística & datos numéricos , Adolescente , Adulto , Concienciación , Estudios Transversales , Femenino , Hepatitis B/prevención & control , Hepatitis B/transmisión , Vacunas contra Hepatitis B/uso terapéutico , Humanos , Masculino , Marruecos/epidemiología , Asunción de Riesgos , Estudiantes/psicología , Encuestas y Cuestionarios , Vacunación/métodos , Vacunación/psicología , Adulto Joven
19.
Vaccine ; 37(46): 6894-6899, 2019 10 31.
Artículo en Inglés | MEDLINE | ID: mdl-31562005

RESUMEN

BACKGROUND: Hepatitis B vaccine (HepB) is an effective tool in prevention of hepatitis B virus (HBV) infection. When administered at birth, it prevents mother-to-child transmission of acute and chronic HBV infection. However, despite a decade and half of implementation of HepB birth dose (HepB-BD), uptake has remained persistently low in Enugu State, Nigeria. We assessed the uptake of valid HepB-BD and the reasons given by mothers of infants for not receiving the HepB-BD in Enugu State, South-east Nigeria. METHODS: An hospital-based cross-sectional survey was conducted among mother-infant pairs attending immunization clinics at randomly selected health facilities in Enugu State, Nigeria. Overall, 344 mothers and their infant children in this study were interviewed using structured questionnaire. Data on maternal reasons for non-receipt of valid HepB-BD by their infants and their recommendations on ways to improve valid HepB-BD uptake, were collected. We defined valid birth dose as the receipt of first dose of HepB within 24 h of birth. RESULTS: Overall, 254 (73.8%) infants did not receive valid HepB-BD. Major reasons for its non-receipt were vaccine not available at place of delivery (91.3%, n = 232), delivery did not take place on immunization day (75.6%, n = 192), lack of awareness on timing of valid HepB-BD (72.8%, n = 185), long distance from the health facility (5.1%, n = 13) and fee payment for immunization (6.3%, n = 16). Of the 384 maternal recommendations, 143 (37.2%) emphasized female literacy while 87 (22.7%) indicated pre-positioning the vaccines at labor rooms to improve valid HepB-BD uptake. CONCLUSION: The low receipt of valid HepB-BD among infants attending routine immunization clinics, found in this study were attributed to lack of maternal awareness on timing of HepB-BD and poor integration of child delivery and immunization services. We recommend educating mothers on benefits of a timely HepB-BD and pre-positioning the vaccines at the labor rooms.


Asunto(s)
Hepatitis B/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Vacunación/métodos , Adolescente , Adulto , Estudios Transversales , Femenino , Vacunas contra Hepatitis B/uso terapéutico , Humanos , Programas de Inmunización , Lactante , Recién Nacido , Masculino , Nigeria , Encuestas y Cuestionarios , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...