Predicting COVID-19 new cases in California with Google Trends data and a machine learning approach.

BACKGROUND: Google Trends data can be a valuable source of information for health-related issues such as predicting infectious disease trends. OBJECTIVES: To evaluate the accuracy of predicting COVID-19 new cases in California using Google Trends data, we develop and use a GMDH-type neural network model and compare its performance with a LTSM model. METHODS: We predicted COVID-19 new cases using Google query data over three periods. Our first period covered March 1, 2020, to July 31, 2020, including the first peak of infection. We also estimated a model from October 1, 2020, to January 7, 2021, including the second wave of COVID-19 and avoiding possible biases from public interest in searching about the new pandemic. In addition, we extended our forecasting period from May 20, 2020, to January 31, 2021, to cover an extended period of time. RESULTS: Our findings show that Google relative search volume (RSV) can be used to accurately predict new COVID-19 cases.  We find that among our Google relative search volume terms, "Fever," "COVID Testing," "Signs of COVID," "COVID Treatment," and "Shortness of Breath" increase model predictive accuracy. CONCLUSIONS: Our findings highlight the value of using data sources providing near real-time data, e.g., Google Trends, to detect trends in COVID-19 cases, in order to supplement and extend existing epidemiological models.

Outcomes of liver transplantation for hepatopulmonary syndrome in patients with concomitant respiratory disease.

BACKGROUND & AIMS: Concomitant respiratory disease is a common finding in patients with hepatopulmonary syndrome (HPS). Among patients who underwent liver transplantation (LT) for HPS, we compared characteristics and outcome of patients with versus without concomitant respiratory disease. METHODS: This single center retrospective observational study included patients with HPS who underwent LT between 1999 and 2020. RESULTS: During the study period, 32 patients with HPS received a LT; nine (28%) with concomitant respiratory disease of whom one required a combined lung-liver transplantation. Patients with concomitant respiratory disease had higher PaCO2 (38 vs. 33 mm Hg, p = .031). The 30-day postoperative mortality was comparable, but the estimated cumulative probability of resolution of oxygen therapy after LT in HPS patients with versus those without concomitant respiratory disease was lower: 63% versus 91% at 12 months and 63% versus 100% at 18 months (HR 95% CI .140-.995, p = .040). In addition to the presence of concomitant respiratory disease (p = .040), history of smoking (p = .012), and high baseline 99mTcMAA shunt fraction (≥20%) (p = .050) were significantly associated with persistent need of oxygen therapy. The 5-year estimated cumulative probability of mortality in patients with concomitant respiratory disease was worse: 50% versus 23% (HR 95% CI .416-6.867, p = .463). CONCLUSIONS: The presence of a concomitant respiratory disease did not increase the short-term postoperative mortality after LT in patients with HPS. However, it resulted in a longer need for oxygen therapy.

Hepatocellular carcinoma risk in sub-Saharan African and Afro-Surinamese individuals with chronic hepatitis B living in Europe.

BACKGROUND & AIMS: Sub-Saharan African (SSA) ethnicity has been associated with a higher risk of hepatocellular carcinoma (HCC) among individuals with chronic hepatitis B in cross-sectional studies. However, the incidence of HCC and performance of HCC risk scores in this population are unknown. METHODS: We conducted an international multicenter retrospective cohort study of all consecutive HBV-monoinfected individuals of SSA or Afro-Surinamese (AS) ethnicity managed at sites in the Netherlands, the United Kingdom and Spain. We assessed the 5- and 10-year cumulative incidences of HCC in the overall study population, among different clinically relevant subgroups and across (m)PAGE-B subgroups. Next, we explored the different risk factors for HCC. RESULTS: During a median follow-up of 8 years, we analyzed 1,473 individuals of whom 34 developed HCC. The 5- and 10-year cumulative incidences of HCC were 1% and 2.4%. The 10-year cumulative incidence of HCC was 0.7% among individuals without advanced fibrosis at baseline, compared to 12.1% among individuals with advanced fibrosis (p <0.001). Higher age (adjusted hazard ratio [aHR] 1.05), lower platelet count (aHR 0.98), lower albumin level (aHR 0.90) and higher HBV DNA log10 (aHR 1.21) were significantly associated with HCC development. The 10-year cumulative incidence of HCC was 0.5% among individuals with a low PAGE-B score, compared to 2.9% in the intermediate- and 15.9% in the high-risk groups (p <0.001). CONCLUSIONS: In this unique international multicenter cohort of SSA and AS individuals with chronic hepatitis B, we observed 5- and 10-year cumulative HCC risks of 1% and 2.4%, respectively. The risk of HCC was negligible for individuals without advanced fibrosis at baseline, and among individuals with low baseline (m)PAGE-B scores. These findings can be used to guide HCC surveillance strategies. IMPACT AND IMPLICATIONS: Sub-Saharan African ethnicity has been associated with a higher risk of hepatocellular carcinoma among individuals with chronic hepatitis B. In this international multicenter cohort study of sub-Saharan African and Afro-Surinamese individuals living with chronic hepatitis B in Europe, we observed 5- and 10-year cumulative incidences of hepatocellular carcinoma of 1% and 2.4%, respectively. The risk was negligible among individuals without advanced fibrosis and a low baseline (m)PAGE-B score. These findings can be used to guide HCC surveillance strategies in this population.

Association of social vulnerability and influenza vaccination rates for Annual Medicare Enrollees at the county-level in the United States.

INTRODUCTION: Influenza is a preventable acute respiratory illness with a high potential to cause serious complications and is associated with high mortality and morbidity in the US. We aimed to determine the specific community-level vulnerabilities for different race/ethnic communities that are most predictive of influenza vaccination rates. METHODS: We conducted a machine learning analysis (XGBoost) to identify community-level social vulnerability features that are predictive of influenza vaccination rates among Medicare enrollees across counties in the US and by race/ethnicity. RESULTS: Population density per square mile in a county is the most important feature in predicting influenza vaccination in a county, followed by unemployment rates and the percentage of mobile homes. The gain relative importance of these features are 11.6%, 9.2%, and 9%, respectively. Among whites, population density (17% gain relative importance) was followed by the percentage of mobile homes (9%) and per capita income (8.7%). For Black/African Americans, the most important features were population density (12.8%), percentage of minorities in the county (8.0%), per capita income (6.9%), and percent of over-occupied housing units (6.8%). Finally, for Hispanics, the top features were per capita income (8.4%), percentage of mobile homes (8.0%), percentage of non-institutionalized persons with a disability (7.9%), and population density (7.6%). CONCLUSIONS: Our study may have implications for the success of large vaccination programs in counties with high social vulnerabilities. Further, our findings suggest that policies and interventions seeking to increase rates of vaccination in race/ethnic minority communities may need to be tailored to address their specific socioeconomic vulnerabilities.

Performance Evaluation of Urine Osmolality Measurement on Sysmex UF-5000 and the Effect of Molecules and Particles in Urine.

BACKGROUND: Urine osmolality determines the concentration ability of the kidney. Therefore, it is used to assess the body's hydration status, electrolyte levels, and acid-base disturbances. We aimed to evaluate the analytical performance of osmolality measurement of the Sysmex UF-5000 (UF-5000), to examine the effect of different molecules and particles in the urine on the osmolality measurement. METHODS: Complete urinalysis and conductivity-based osmolality analysis with UF-5000 and osmolality analysis with Advanced® Model 3320 Micro-Osmometer (AI-3320) by freezing point reduction method were performed in the urine samples. Samples were grouped as negative, glucosuria, proteinuria, hematuria, pyuria, crystalluria, and urobilinogen. RESULTS: Total impressions were calculated as < 5% and accuracy values were < 1.66% in both analyzers. The regression equation was found to be y = -12.54 + 0.956x and the relative difference between the analyzers was 8.7% in 586 samples. When patients with Glucose > 2+ were excluded the regression equation of 507 samples was found as y = 5.10 + 0.948x and the relative difference was 4.6%. The percentages of samples with a difference greater than the allowable difference were 18.8%, 11.6%, 35.9%, 13.7%, 18.7%, and < 12.2% in all samples, all samples without glucosuria > 2+, glucosuria, glucosuria < 3+, proteinuria, and other subgroups, respectively. CONCLUSIONS: Considering the good accessibility of the automated routine complete urine analyzer, UF-5000 can be considered to determine whether urine osmolality is within reference or should be measured by methods based on colligative properties. Thus, referral of patients to a clinic that uses the colligative measurement method may be used more effectively.

Predicting mobility using limited data during early stages of a pandemic.

The COVID-19 pandemic has changed consumer behavior substantially. In this study, we explore the drivers of consumer mobility in several metropolitan areas in the United States under the perceived risks of COVID-19. We capture multiple dimensions of perceived risk using local and national cases and death counts of COVID-19, along with real-time Google Trends data for personal protective equipment (PPE). While Google Trends data are popular inputs in many studies, the risk of multicollinearity escalates with the addition of more relevant terms. Therefore, multicollinearity-alleviating methods are needed to appropriately leverage information provided by Google Trends data. We develop and utilize a novel optimization scheme to induce linear models containing strictly significant covariates and minimal multicollinearity. We find that there are a variety of unique factors that drive mobility in different geographic locations, as well as several factors that are common to all locations.

Hepatitis C prevalence in incarcerated settings between 2013-2021: a systematic review and meta-analysis.

BACKGROUND: The introduction of highly effective direct-acting antiviral therapy has changed the hepatitis C virus (HCV) treatment paradigm. However, a recent update on HCV epidemiology in incarcerated settings is necessary to accurately determine the extent of the problem, provide information to policymakers and public healthcare, and meet the World Health Organization's goals by 2030. This systematic review and meta-analysis were performed to determine the prevalence of HCV Ab and RNA in incarcerated settings. METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and Web of Science for papers published between January 2013 and August 2021. We included studies with information on the prevalence of HCV Ab or RNA in incarcerated settings. A random-effects meta-analysis was done to calculate the pooled prevalence and meta-regression to explore heterogeneity. RESULTS: Ninety-two unique sources reporting data for 36 countries were included. The estimated prevalence of HCV Ab ranged from 0.3% to 74.4%. HCV RNA prevalence (available in 46 sources) ranged from 0% to 56.3%. Genotypes (available in 19 sources) 1(a) and 3 were most frequently reported in incarcerated settings. HCV/HIV coinfection (available in 36 sources) was highest in Italy, Estonia, Pakistan, and Spain. Statistical analysis revealed that almost all observed heterogeneity reflects real differences in prevalence between studies, considering I2 was very high in the meta-analysis. CONCLUSIONS: HCV in incarcerated settings is still a significant problem with a higher prevalence than in the general population. It is of utmost importance to start screening for HCV (Ab and RNA) in incarcerated settings to give clear, reliable and recent figures to plan further treatment. This is all in the context of meeting the 2030 WHO targets which are only less than a decade away. TRIAL REGISTRATION: PROSPERO: CRD42020162616.

Comparison of the Effect of Ketamine and Dexmedetomidine Combined with Total Intravenous Anesthesia in Laparoscopic Cholecystectomy Procedures: A Prospective Randomized Controlled Study.

This randomized prospective clinical study aimed to investigate the effects of dexmedetomidine or ketamine administration to total intravenous anesthesia (TIVA) on postoperative analgesia in subjects undergoing elective laparoscopic cholecystectomy procedures. 90 adults, American Society of Anesthesiologists (ASA) physical status 1 and II patients, who underwent elective laparoscopic cholecystectomy procedures were included in the study and randomized into three groups equally. Remifentanil, propofol, and rocuronium infusions were used for TIVA guided by the bispectral index. In group KETA, 10 µg/kg/min ketamine was added to TIVA before surgery, and in group DEX, 0.5 µg/kg/h dexmedetomidine was added to TIVA before surgery. Normal saline infusions were infused in the control group. Postoperative analgesia was provided with intravenous patient-controlled analgesia (PCA) morphine (1 mg bolus morphine, 5 min lockout time). Hemodynamic parameters, scores of visual analogue scale (VAS) for pain, rescue morphine requirements, and side effects such as sedation, nausea, and vomiting were recorded for 48 hours after surgery. Postoperative first analgesic requirement time was longer in group KETA (P < 0.001), and it was longer in group DEX than in the control group (P < 0.001). Pain scores were lower in group KETA and group DEX than in the control group at all corresponding times throughout the 48 h period of observation. Intravenous PCA morphine consumptions were higher in the control group than in group KETA (P < 0.001 for all followed-up times), and they were higher in group DEX than in group KETA (P < 0.001 for all followed-up times). It is concluded that the use of dexmedetomidine or ketamine infusions can be suitable as an additive for TIVA in the intraoperative period. Furthermore, the addition of both drugs to the TIVA protocol may improve postoperative pain relief and decrease opioid consumption.

C-Reactive Protein to Albumin Ratio in Patients with Prediabetes and Diabetes Mellitus: HbA1c and Inflammation.

BACKGROUND: Inflammation has a significant status in both the pathogenesis and complications of diabetes mellitus (DM). The aim of this study is to compare the C-reactive protein (CRP) to albumin ratio (CAR) values in controlled DM, uncontrolled DM, prediabetes groups grouped by HbA1c as well as in a group of healthy individuals. METHODS: In this retrospective study, 6,993 DM patients, 770 prediabetes patients, and 1,340 healthy individuals were included. According to their HbA1c levels, DM patients were divided into two groups as controlled DM (HbAlc < 6.5%, n = 4,115) and uncontrolled DM (HbAlc ≥ 6.5%, n = 2,878). RESULTS: The CRP and CAR levels were significantly higher in the DM and prediabetes group than in the control group (p < 0.05, for both). Albumin levels were significantly lower in the DM group than in both the prediabetes and control groups (p < 0.05, for both). In the uncontrolled DM group, CRP and CAR values were found to be significantly higher than the control and controlled DM groups, while albumin values were significantly lower than the control group, prediabetes group, and controlled DM group (p < 0.05, for all). CONCLUSIONS: It is thought that CAR, a liver related inflammatory marker, can be applied as an inflammation marker in both prediabetes, determined by HbA1c, and patients diagnosed with DM. Further prospective studies will better demonstrate the utility of CAR values as an inflammatory marker in DM and prediabetes.

Cascade of care among hepatitis B patients in Maastricht, the Netherlands, 1996 to 2018.

Background & aims: There are approximately 49,000 people (0.34%) in the Netherlands with a chronic hepatitis B virus (HBV) infection. It is unclear how many are linked to care and under follow-up in hepatitis outpatient clinics. This study determined the cascade of care and identified predictors for not being linked to care and loss to follow-up in Maastricht, the Netherlands. Methods: All hepatitis B surface antigen (HBsAg)-positive patients between December 1, 1996 and September 30, 2018 were retrospectively identified. Results: In total, 644 HBsAg-positive patients were identified; of whom 75 had acute HBV infection, 471 chronic HBV infection and 98 unknown. Out of 569 individuals with a chronic/unknown HBV status, 134/569 (23.6%) were not linked to care and 58.7% (195/332 after excluding those who died or achieved HBsAg-seroclearance) were loss to follow-up (LTFU). A predictor for not being linked to care was Caucasian ethnicity (odds ratio (OR) = 2.76 (95% Confidence Interval (CI) = 1.21-6.29); p = .015). Predictors for LTFU were older age (OR = 0.97 (CI = 0.94-0.99); p = .008), HBV DNA >20,000 IU/mL (OR = 0.44 (CI = 0.21 - 0.93); p = .033) and Asian ethnicity (OR = 0.46, (CI = 0.21-1.00); p = .050). Rates of not being linked to care and LTFU decreased over time from 12.7% in 1996 to 4.4% in 2018 and from 79.2% in 1996 to 37.2% in 2018, respectively. Conclusions: A considerable amount of HBsAg-positive individuals were not linked to care or LTFU. This study indicates that ethnicity plays a role in linkage to care and follow-up. Further research is needed to elaborate on those results.

Timing of primary three-dose hepatitis B vaccination and postvaccination serologic testing among a large cohort of healthy adults.

This study evaluated the optimal timing of a primary three-dose hepatitis B vaccination and postvaccination serologic testing (PVST) among a large group of healthy naïve adults in the Netherlands. Data were collected from the Ease Travel Clinic hepatitis B vaccination database. The study population consisted of 22,997 adults who received three hepatitis B vaccinations. Seroprotection was attained in 97.3% individuals. When compared with PVST performed at 1-2 months (98.2%) after the final dose, lower seroprotection rates were observed with <1 (97.3%, p = 0.128), 3-6 (90.6%, p < 0.001), and ≥7 (88.4%, p < 0.001) months after vaccination. Among the subpopulation with a PVST 1-2 months, no statistically significant difference was observed for the various intervals between the first and second vaccination (<1, 1-2, 3-4, or ≥5 months). When compared with 4-5 months between the second and third vaccine dose, lower seroprotection rates were observed with <4 (odds ratio [OR]: 0.29, p = 0.020) and ≥12 (OR: 0.22, p < 0.001) months, although comparable rates were observed with 6-11 months interval (OR: 0.85, p = 0.262). Our data indicate that PVST should be obtained 1-2 months after the last vaccination and a delayed PVST was the major determinant of a lower seroprotection rate after primary three-dose hepatitis B vaccination schedule. Based on our data, the hepatitis B vaccination also leaves room for flexibility for the second dose and the third dose without the necessity of restarting the vaccination series or confirmation of the immune response to the vaccine.

Analytical Performance Evaluation of Siemens Sysmex CS-2500 and Sekisui CP-3000.

BACKGROUND: Automatic coagulation analyzers have been used in the last 50 years and have been developed considerably. Newly developed tests and methods cannot be conducted in routine laboratories without evaluating their performance. Therefore, their performance must be evaluated and approved before being used routinely. The aim of this study is to evaluate the analytical performance of Sysmex Coagulation System-2500 (CS-2500) and Sekisui CP-3000 automatic coagulation analyzer (CP-3000). METHODS: For APTT, PT, and D-dimer tests, reference range verification study, a method comparison study was performed in both analyzers in accordance with CLSI protocols, and precision and accuracy were evaluated using internal and external quality control samples. In the evaluation of precision and accuracy, CV% and bias% values were calculated. Bland-Altman, Passing-Bablok regression analysis, and correlation coefficient were used in the comparison study. RESULTS: The CV% values calculated for APTT and PT in both analyzers were found to be below the CLSI recommendation of 5%. D-dimer test results meet the quality criteria recommended by CLSI. Accuracy for both analyzers was within the acceptable limits. The reference ranges recommended by the manufacturer have been veryfied. Regression equations for APTT, PT, and D-dimer are y = -3.313 + 1.188x, y = -0.0399 + 1.048x, and y = 0.155 + 0.655x, respectively, and r values were 0.904, 0.978, and 0.974, respectively. CONCLUSIONS: CS-2500 and CP-3000 analyzers are suitable for laboratory use for routine coagulation. Since the CP-3000 device is newly used in our country, it needs to be supported by more comparison studies.

A decision analytic approach for social distancing policies during early stages of COVID-19 pandemic.

The COVID-19 pandemic has become a crucial public health problem in the world that disrupted the lives of millions in many countries including the United States. In this study, we present a decision analytic approach which is an efficient tool to assess the effectiveness of early social distancing measures in communities with different population characteristics. First, we empirically estimate the reproduction numbers for two different states. Then, we develop an age-structured compartmental simulation model for the disease spread to demonstrate the variation in the observed outbreak. Finally, we analyze the computational results and show that early trigger social distancing strategies result in smaller death tolls; however, there are relatively larger second waves. Conversely, late trigger social distancing strategies result in higher initial death tolls but relatively smaller second waves. This study shows that decision analytic tools can help policy makers simulate different social distancing scenarios at the early stages of a global outbreak. Policy makers should expect multiple waves of cases as a result of the social distancing policies implemented when there are no vaccines available for mass immunization and appropriate antiviral treatments.

Impact of Florida's prescription drug monitoring program on drug- related fatal vehicle crashes: a difference-in-differences approach.

BACKGROUND: Prescription drug use has soared in the USA within the last two decades. Prescription drugs can impair motor skills essential for the safe operation of a motor vehicle, and therefore can affect traffic safety. As one of the epicentres of the opioid epidemic, Florida has been struck by high opioid misuse and overdose rates, and has concurrently suffered major threats to traffic disruptions safety caused by driving under the influence of drugs. To prevent prescription opioid misuse in Florida, Prescription Drug Monitoring Programs (PDMPs) were implemented in September 2011. OBJECTIVE: To examine the impact of Florida's implementation of a mandatory PDMP on drug-related MVCs occurring on public roads. METHODS: We employed a difference-in-differences approach to estimate the difference in prescription drug-related fatal crashes in Florida associated with its 2011 PDMP implementation relative to those in Georgia, which did not use PDMPs during the same period (2009-2013). The analyses were conducted in 2020. RESULTS: In Florida, there was a significant decline in drug-related vehicle crashes during the 22 months post-PDMP. PDMP implementation was associated with approximately two (-2.21; 95% CI -4.04 to -0.37; p<0.05) fewer prescribed opioid-related fatal crashes every month, indicating 25% reduction in the number of monthly crashes. We conducted sensitivity analyses to investigate the impact of PDMP implementation on central nervous system depressants and stimulants as well as cocaine and marijuana-related fatal crashes but found no robust significant reductions. CONCLUSIONS: The implementation of PDMPs in Florida provided important benefits for traffic safety, reducing the rates of prescription opioid-related vehicle crashes.

Hepatitis C reinfection in former and active injecting drug users in Belgium.

BACKGROUND: There is currently no systematic screening for hepatitis C (HCV) reinfection in people who inject drugs (PWID) after treatment in Belgium. However, in a recent meta-analysis, the overall HCV reinfection rate was 5.9/100 person-years (PY) among PWID. Accordingly, this study was undertaken to investigate the reinfection rate in former and active PWID who achieved the end of treatment response after direct-acting antiviral (DAA) treatment in Belgium. METHODS: This observational cross-sectional study recruited individuals with a history of injecting drug use who had achieved the end of treatment response to any DAA treatment between 2015 and 2020. Participants were offered a post-treatment HCV RNA test. RESULTS: Eighty-five potential participants were eligible to participate and contacted, of whom 60 participants were enrolled in the study with a median age of 51.0 (IQR 44.3-56.0) years; it was reported that 23.3% continued to inject drugs intravenously after DAA treatment. Liver cirrhosis was present in 12.9%. The majority had genotype 1a (51.7%) or genotype 3 (15.0%) infection. We detected no reinfections in this study population. The total time patients were followed up for reinfection in the study was 78.5 PY (median 1.0 years IQR 0.4-2.0). CONCLUSION: Reinfection after successful treatment with DAA initially appears to be very low in Belgian PWID. Therefore, efforts should be made to screen individuals with persistent risk behaviors for reinfection systematically. In addition, a national HCV registry should be established to accurately define the burden of HCV infection and reinfection in Belgium and support the elimination of viral hepatitis C in Europe. Trial registration clinicaltrials.gov NCT04251572, Registered 5 Feb 2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04251572 .

On-site testing and case management to improve hepatitis C care in drug users: a prospective, longitudinal, multicenter study in the DAA era.

BACKGROUND: Screening and treatment of hepatitis C virus (HCV) infection in people who use drugs (PWUD) remains insufficient. Reducing the burden of HCV infection in PWUD requires interventions focusing on the different steps of the HCV care cascade. METHODS: We performed a prospective, multicenter study, evaluating the impact of an HCV care model on the HCV care cascade among PWUD attending an addiction care center in Belgium between 2015 and 2018. Interventions within the care model consisted of pre-test counseling, on-site HCV screening and case management services. A multiple logistic regression model was performed to identify the independent factors influencing the outcomes. RESULTS: During the study period, 441 PWUD were registered at the addiction care center, 90% (395/441) were contacted, 88% (349/395) were screened for HCV infection. PWUD were more likely to be screened if they had ever injected drugs (p < .001; AOR 6.411 95% CI 3.464-11.864). In 45% (157/349), the HCV antibody (Ab) test was positive, and in 27% (94/349) HCV RNA was positive. Within the Belgian reimbursement criteria (fibrosis stage ≥ F2), 44% (41/94) were treated. Specialist evaluation at the hospital was lower for PWUD receiving decentralized opioid agonist therapy (p = .005; AOR 0.430 95% CI 0.005-0.380), PWUD with unstable housing in the past 6 months before inclusion (p = .015; AOR 0.035 95% CI 0.002-0.517) or if they were recently incarcerated (p = .001; AOR 0.010 95% CI 0.001-0.164). CONCLUSIONS: This HCV care model demonstrated high screening, linkage to care, and treatment initiation among PWUD in Belgium. Using the cascade of care to guide interventions is easy and necessary to monitor results. This population needs guidance, not only for screening and treatment initiation but also for the long-term follow-up since one in six had cirrhosis and could develop hepatocellular carcinoma. Further interventions are necessary to increase linkage to care and treatment initiation. Universal access to direct-acting antiviral therapy from 2019 will contribute to achieving HCV elimination in the PWUD population. TRIAL REGISTRATION: Clinical trial registration details: www.clinicaltrials.gov ( NCT03106194 ).

A multicentre interventional study to assess blood-borne viral infections in Belgian prisons.

BACKGROUND: Prevalence data on viral hepatitis B (HBV), hepatitis C (HCV), and HIV infection in prison are often scarce or outdated. There is currently no systematic screening for these blood-borne viral infections (BBV) in Belgian prisons. There is an urgency to assess the prevalence of these BBV to inform policymakers and public healthcare. METHODS: This was a multicentre, interventional study to assess the prevalence of BBV using opt-in screening in prisons across Belgium, April 2019 - March 2020. Prisoners were tested using a finger prick and BBV risk factors were assessed using a questionnaire. A generalized linear mixed model was used to investigate the association between the various risk factors and HCV. RESULTS: In total, 886 prisoners from 11 Belgian prisons were screened. Study uptake ranged from 16.9 to 35.4% in long-term facilities. The prevalence of HCV antibodies (Ab), hepatitis B surface antigen (Ag) and HIV Ab/Ag was 5.0% (44/886), 0.8% (7/886), and 0.2% (2/886). The adjusted odds for HCV Ab were highest in prisoners who ever injected (p < 0.001; AOR 24.6 CI 95% (5.5-215.2). The prevalence of detectable HCV RNA in the total cohort was 2.1% (19/886). Thirteen (68.4%) prisoners were redirected for follow-up of their HCV infection. CONCLUSIONS: Opt-in testing for viral hepatitis B, C and HIV was relatively well-accepted in prisons. Compared with the general population, prisoners have a higher prevalence of infection with BBV, especially for HCV. Systematic screening for these BBV should be recommended in all prisons, preferably using opt-out to optimize screening uptake. TRIAL REGISTRATION: Retrospectively registered at clinical trials NCT04366492 April 29, 2020.

Hepatitis B virus prevalence in first-time blood donors in Flanders, Belgium: Impact of universal vaccination and migration.

BACKGROUND: Transfusion-transmissible infections such as hepatitis B virus (HBV) remain a major concern for the safety of blood transfusion. This cross-sectional study aimed to assess the trend of HBV prevalence and associated risk factors among a first-time donor population in a low endemic country. STUDY DESIGN AND METHODS: Between 2010 and 2018, blood samples were collected from first-time donors presented at donor collection sites of Belgian Red Cross-Flanders. They were tested for hepatitis B surface antigen (HBsAg), hepatitis B core antibodies (anti-HBc), and HBV DNA, HIV and hepatitis virus C (HCV) antibodies and RNA, and syphilis antibodies. RESULTS: A total of 211,331 first-time blood donors (43.7% males, median age 25 years) were analyzed. HBsAg prevalence decreased from 0.06% in 2010 to 0.05% in 2018 (p = .004) and this declining trend was accompanied by an increased number of donors in the HBV vaccinated birth cohort (p < .001). HBsAg prevalence was 0.33% in foreign-born donors and 0.02% in Belgian natives (p < .001). Multivariate risk profiling showed that anti-HBc positivity was significantly associated with mainly foreign-born donors (odds ratio [OR] = 9.24) but also with older age (OR = 1.06), male gender (OR = 1.32), year of blood donation (OR = 0.94), and co-infections with HCV (OR = 4.31) or syphilis (OR = 4.91). DISCUSSION: The decreasing trend in HBV prevalence could mainly be explained by the introduction of the universal HBV vaccination. Being born in endemic areas was the most important predictor for HBV infection while the co-infections with syphilis suggest unreported sexual risk contacts.

Immunogenicity and safety of HBAI20 Hepatitis B vaccine in non-responders: Double-blinded, randomised, controlled phase 2 trial.

BACKGROUND & AIMS: Approximately 5%-10% of the general population respond inadequately to licensed recombinant hepatitis B vaccines. We assessed the immunogenicity and safety of a new HBAI20 vaccine, consisting of a new AI20 adjuvant (20-µg recombinant human IL-2 attached to 20-µg aluminium hydroxide) in combination with HBVaxPro®-10 µg. METHODS: In a double-blinded, randomised, controlled phase 2 trial, 18- to 59-year-old healthy non-responders (titre <10 mIU/ml after three or more doses of hepatitis B vaccine) were assigned (3:1 ratio) to receive either HBAI20 vaccine or HBVaxPro®-10 µg in a 0, 1 and 2-month schedule. The primary outcome was seroprotection (titre ≥ 10 mIU/ml) measured 1-3 months following the third vaccination. RESULTS: A total of 133 participants were randomised to receive either HBAI20 vaccine (n = 101) or HBVaxPro®-10 µg (n = 32). In the modified intention-to-treat analysis, the seroprotection rate after the third vaccination was 92.0% (80/87) in the HBAI20 group and 79.3% (23/29) in the HBVaxPro®-10-µg group, P = .068. Using a generalised linear mixed model to adjust for stratification factors, a higher odds of seroprotection with HBAI20 vaccine was shown (adjusted odds ratio = 3.48, P = .028). Frequency of mild and moderate local adverse events was greater in the HBAI20 group than in the HBVaxPro®-10 µg. Rates of severe local adverse events and systemic adverse events were low and similar in both groups. CONCLUSIONS: In this group of hepatitis B vaccine non-responders, the HBAI20 vaccine demonstrated a higher seroprotection rate when adjusting for stratification factors and a similar safety profile compared to the licensed recombinant HBVaxPro®-10 µg.