Association between hepatitis A seropositivity and bone mineral density in adolescents and adults: a cross-sectional study using NHANES data.

BACKGROUND: Osteoporosis, characterized by decreased bone density and increased fracture risk, imposes significant physical, psychosocial, and financial burdens. Early detection and prevention are crucial for managing osteoporosis and reducing the risk of fractures. OBJECTIVES: To investigate the relationship between Hepatitis A seropositivity and bone mineral density (BMD) in adolescents and adults and to explore the potential link between Hepatitis A infection and osteoporosis risk. DESIGN AND SETTING: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 to evaluate the association between hepatitis A seropositivity and BMD in 15,693 participants. METHODS: Multivariable regression analysis was used to calculate the mean BMD and standard error for adolescents and adults, followed by an independent z-test to determine whether there was a significant difference between the seropositive and seronegative groups. RESULTS: Hepatitis A seropositive adolescents and adults had lower BMD than their seronegative counterparts, with significant differences in lumber spine (mean difference = -0.03 g/cm2, P < 0.01 for both age groups) and pelvis BMDs (mean difference = -0.02 g/cm2, P < 0.01 for the adult age groups), after adjusting for various covariates. CONCLUSIONS: This study confirmed that both adolescent and adult individuals seropositive for Hepatitis A antibodies had reduced BMD among both adolescents and adults, especially in the adult group. This finding suggests a possible link between Hepatitis A infection and risk of osteoporosis.

Prevalence of total hepatitis A antibody among 5 to 7 years old children and their mothers in Cambodia.

This study determined the prevalence of total hepatitis A antibody (anti-HAV) among 5-7 years old children and their mothers in the whole Cambodia, using a nationwide study, and examined the differences between the two cohorts. A total of 4535 dried blood spot-driven (DBS) samples (2021 mothers and their 2514 children of 5-7 years old) and the concomitant 922 whole blood samples (subset of the whole participants) were collected using a multistage random sampling strategy throughout Cambodia in 2017. Total anti-HAV was detected using the chemiluminescence enzyme immunoassay method. Compared to gold standard whole blood samples, the sensitivity and specificity of DBS mediated anti-HAV detection were 94.8% and 98%, respectively. Total anti-HAV prevalence among mothers was 91.2% (95%CI: 90.0-92.5%), and that of their children was 31.5% (95%CI: 29.7-33.3%). In our study, the low prevalence of total anti-HAV among children indicates the country's improvement of safe water and food supply, hygiene and sanitation. If the hygiene and sanitation are consistently improved in Cambodia, the prevalence might be no longer increased when the children become adults.

Hepatitis A vaccine immunogenicity 25 years after vaccination in Alaska.

The hepatitis A vaccine is recommended for all children greater than or equal to 1 year of age, however, the duration of vaccine protection is unknown and protection through adulthood is crucial to prevent symptomatic hepatitis later in life. We report on 25 years of follow-up of a cohort of Alaska Native individuals who were vaccinated in early childhood. We assessed the duration of vaccine protection by calculating the geometric mean concentration and proportion of participants with protective levels of IgG antibody to hepatitis A virus (anti-HAV) (≥20 mIU/mL) every 2 to 3 years. We estimated the amount of time until the anti-HAV dropped below protective levels using survival analyses. At 25 years, 43 of the original 144 participants were available, mean anti-HAV levels were 91.5 mIU/mL, and 35 (81.4%) had protective levels of anti-HAV. Using data from all persons and all time points, a survival analysis estimated 78.7% of participants had protective levels of anti-HAV at 25 years. The high level of protective antibodies in this cohort indicate that supplemental doses of hepatitis A vaccine are not needed 25 years after completion of the vaccine series.

Low immune response rate of HIV-infected patients to a single injection of hepatitis A vaccine.

OBJECTIVES: We aimed to evaluate the immune response of HIV-1 positive patients to a single injection of HAV vaccine in a context of vaccine shortage during the 2017 European outbreak. METHODS: We retrospectively enrolled all HIV-1 positive patients vaccinated by a single injection of HAV vaccine Vaqta 50®. HAV serology was performed before and>30 days after the vaccine injection. RESULTS: Among the 73 patients, HIV-1 viral load was≤50 copies/mL in 93.2% of the cases. Medians of CD4 and median ratio of T CD4/CD8 cells were 658/mm3 and 0.9, respectively. A low immune response rate (59.7%) was observed among the patients. Responders had a significantly higher CD4/CD8 cell ratio than non-responders. CONCLUSIONS: A serologic control should be recommended in this population in the event of a single injection vaccination schedule. During routine follow-up, and prior to any untoward event, physicians should assess the vaccination coverage of HIV-infected patients.

Seroprevalence of hepatitis A virus infection in Central-West of Tunisia.

Hepatitis A infections still represent a major global health concern. During the past years, a transition pattern of the hepatitis A epidemiology was noted in many parts of the world. In Tunisia, there is not a recent survey on age-specific hepatitis A virus seroprevalence. This study aimed to investigate the seroprevalence of hepatitis A virus infection in Central-West Tunisia, representative of regions with lowest socioeconomic level in the country, before vaccine implementation. Sera obtained from the blood samples of subjects were screened for the detection of hepatitis A virus. The seroprevalence was evaluated by detection of total antibodies to hepatitis A virus using commercially available immunoassay kits. A total of 1379 subjects, aged 5-75 years (mean age: 29.0 ± 17.3 years) were studied. The global anti-hepatitis A virus seroplevalence was 84.7% (95% confidence interval: [82.6-86.5]). A higher hepatitis A virus seroprevalence was showed in subjects aged 10-14 years compared to those aged less than 10 years (50.0% vs. 31.0%). In subjects aged 20-29 years, a rapid increase in the hepatitis A virus prevalence was noted; it reached 97.0%. The seroprevalence of anti-hepatitis A virus differed by zone of residence (81.1% in rural area vs. 72.4% in urban area, p = .005) and increased significantly with lower level of education (p = .019). There was no statistical significant seroprevalence difference between male and female: 84.2% versus 85.2%, respectively. Our study confirm the transition pattern of the hepatitis A virus endemicity in Tunisia from high to intermediate and provide an evaluation of the hepatitis A virus epidemiological situation before vaccine implementation.

Hepatitis A susceptibility in newly attending men who have sex with men to an urban sexual health centre.

Within the UK, the majority of hepatitis A occurs in high risk groups such as men who have sex with men (MSM). It has been estimated that 70% of MSM need immunity to provide adequate herd immunity. We aimed to estimate the proportion of hepatitis A susceptibility in MSM throughout a 10-year period (2010-2019), and explore associated demographic factors. Using our Electronic Patient Record system, we extracted anonymous clinical data between for MSM at their first attendance; including hepatitis A IgG result, age, country of birth and diagnosis of an STI. Overall, 1401/6884(20%) were tested for hepatitis A IgG at their first attendance, with 626/1401 (45%, 95% CI = 42%-47%) showing susceptibility. Testing rates increased between 2010-2019 (OR = 67.79, 95%CI = 39.09-117.60, p = <0.0001); however, susceptibility remained similar (OR = 0.98, 95%CI = 0.33-2.89, p = 0.98). MSM aged 35 and under had significantly higher susceptibility vs MSM aged over 35 (OR 3.4176, 95%CI = 2.71-4.31, p = <0.0001). UK-born had significantly higher susceptibility vs non-UK born (OR 1.5, 95%CI = 1.2147-1.8618, p = 0.0002). Susceptibility of hepatitis A in MSM may be higher than necessary to control future outbreaks. It is important that effective targeting of MSM, particularly young MSM, occur at all levels of healthcare and not solely rely on opportunistic presentation at a sexual health clinic.

Hepatitis A seroprevalence in Erzurum, Turkey.

INTRODUCTION AND OBJECTIVE: Hepatitis A Virus (HAV), reportedly the most common cause of acute viral hepatitis in developing countries, infects millions of people worldwide each year. The aim of the study is to investigate the seropositivity of anti-hepatitis A virus (HAV) IgG and IgM in all age groups in Erzurum, and to determine the effect of various factors such as age, gender, climatic conditions and HAV vaccination (included in 2012 in the National Immunization Schedule on seroprevalence) on the seropositivity. MATERIAL AND METHODS: The serological results of 25,007 individuals referred to Erzurum Public Health Microbiology Laboratory between January 2015 - December 2018 were retrospectively reviewed to test for the presence of anti-HAV IgG and IgM. The patient ages were 0-93 years. Serum samples were analyzed by ELISA. S/CO values of ≥1.00 and >1.21 were considered positive for anti-HAV IgG and IgM, respectively; results below this value were considered negative. RESULTS: Anti-HAV IgG and IgM seropositivities were 87.3% and 0.2%, respectively. Anti-HAV IgG prevalence - 88.5% and 86.4%, anti-HAV IgM positivity - 0.1% and 0.3% in men and women. Anti-HAV IgG seroprevalence - 87%, 73.2%, 58.7%, 75.2%, 86.1%, 89.8%, 96.1%, 99.1%, 99.1% and 99.3%, respectively, at 0-4, 5-9 10-14, 15-19, 20-24, 25-29, 30-39, 40-49, 50-59 and >60 age groups. Anti-HAV IgM seropositivity - 0, 0.1%, 0.7%, 0.7%, 0.3%, 0, 0.1%, 0.2%, 0.1%, and 0.2%, respectively, in the same age groups. Anti-HAV IgM positivity was the highest in November - 36(0.97%. CONCLUSIONS: In Erzurum, anti-HAV IgG prevalence is tremendously high, whereas prevalence of anti-HAV IgM is exceptionally low, especially in the paediatric age group. Therefore, HAV vaccine is provided free of charge in Turkey, including Erzurum, since 2012.

Hepatitis a virus infection in Central-West Tunisia: an age structured model of transmission and vaccination impact.

BACKGROUND: The epidemiological pattern of hepatitis A infection has shown dynamic changes in many parts of the world due to improved socio-economic conditions and the accumulation of seronegative subjects, which leads to possible outbreaks and increased morbidity rate. In Tunisia, the epidemiological status of hepatits A virus is currently unknown. However, over the past years higher numbers of symptomatic hepatitis A virus infection in school attendants and several outbreaks were reported to the Ministry of Health, especially from regions with the lowest socio-economic levels in the country. The aim of this study was to investigate the current seroprevalence of hepatitis A virus antibodies in central-west Tunisia and assess the impact of hepatitis A virus vaccination on hepatitis A epidemiology. METHODS: Serum samples from 1379 individuals, aged 5-75 years, were screened for hepatitis A virus antibodies. Adjusted seroprevalence, incidence and force of infection parameters were estimated by a linear age structured SEIR (Susceptible-Exposed-Infectious-Recovered) compartmental model. A vaccine model was then constructed to assess the impact on hepatitis A virus epidemiology of 3 scenarios of vaccination strategies: one dose at 12-months of age, one dose at 6-years and one dose at 12-months and another at 6-years of age during 6 years. RESULTS: A rapid increase in anti-hepatitis A virus seroprevalence was noted during infancy and adolescence: 47% of subjects under 10-years-old are infected; the prevalence increases to 77% at 15-years and reaches 97% in subjects aged 30-years. The force of infection is highest between 10 and 30-years of age and the incidence declines with increasing age. The vaccine model showed that the 3-scenarios lead to a significant reduction of the fraction of susceptibles. The two doses scenario gives the best results. Single-dose vaccination at 6-years of age provides more rapid decrease of disease burden in school-aged children, as compared to single-dose vaccination at 12-months, but keeps with a non-negligible fraction of susceptibles among children < 6-years. CONCLUSIONS: Our study confirms the epidemiological switch from high to intermediate endemicity of hepatitis A virus in Tunisia and provides models that may help undertake best decisions in terms of vaccinations strategies.

Modeling the Long-term Antibody Response and Duration of Immune Protection Induced by an Inactivated, Preservative-free Hepatitis A Vaccine (Healive) in Children.

OBJECTIVE: Long-term seroprotection via the hepatitis A vaccine is essential for the prevention of disease from the hepatitis A virus (HAV). Due to documented difficulties during decade-long follow-ups after receiving vaccines, statistical-modeling approaches have been applied to predict the duration of immune protection. METHODS: Based on five-year follow-up data from a randomized positive-controlled trial among Chinese children (1-8 years old) following a 0, 6 months vaccination schedule, a power-law model accounting for the kinetics of B-cell turnover, as well as a modified power-law model considering a memory-B-cell subpopulation, were fitted to predict the long-term immune responses induced by HAV vaccination (Healive or Havrix). Anti-HAV levels of each individual and seroconversion rates up to 30 years after vaccination were predicted. RESULTS: A total of 375 participants who completed the two-dose vaccination were included in the analysis. Both models predicted that, over a life-long period, participants vaccinated with Healive would have close but slightly higher antibody titers than those of participants vaccinated with Havrix. Additionally, consistent with previous studies, more than 90% of participants were predicted to maintain seroconversion for at least 30 years. Moreover, the modified power-law model predicted that the antibody titers would reach a plateau level after nearly 15 years post-vaccination. CONCLUSIONS: Based on the results of our modeling, Healive may adequately induce long-term immune responses following a 0, 6 months vaccination schedule in children via induction of memory B cells to provide stable and durable immune protection.

Factors associated with anti-hepatitis A virus immunoglobulin G seropositivity among Korean workers: a cross-sectional study.

OBJECTIVES: Hepatitis A incidence in Korea has dramatically increased in recent years. Individuals in their twenties and thirties, who account for majority of the workforce in Korea, are particularly susceptible to infection owing to a low seroprevalence of anti-hepatitis A virus (anti-HAV) immunoglobulin G (IgG). This study aimed to identify behavioural and occupational factors related to anti-HAV IgG seropositivity. DESIGN: Cross-sectional study. SETTING: A large university hospital in Seoul, Korea. PARTICIPANTS: Workers in formal employment having an annual routine health screening. PRIMARY OUTCOME MEASURE: Anti-HAV IgG seropositivity. RESULTS: Of 131 711 individuals who had an annual health screening at the study hospital in 2018, 68 612 met the inclusion criteria and were included in the analysis. Study participants were predominantly men (64.3%) and in their thirties (55.3%). The overall seroprevalence of anti-HAV IgG was 36.2%. In multivariate analyses, anti-HAV IgG seropositivity was independently associated with working in a workplace with ≥2 health managers (vs no health manager, adjusted OR 1.32, 95% CI 1.22 to 1.43); age 40-49 years (vs 20-29 years, OR 2.51, 95% CI 2.36 to 2.68); female sex (OR 1.54, 95% CI 1.48 to 1.59); experience of any general disease (vs no general disease history, OR 1.19, 95% CI 1.14 to 1.25), obesity (vs normal weight, OR 0.91, 95% CI 0.86 to 0.97); and hepatitis B antibody seropositivity (OR 2.39, 95% CI 2.31 to 2.49). CONCLUSIONS: The low prevalence of anti-HAV IgG seropositivity points to a need for implementation of workplace-based hepatitis A vaccine programmes. To promote workers' health and prevent hepatitis A outbreaks, occupational health managers, healthcare providers and policy-makers should focus on individuals who are susceptible to HAV, such as young men.

Immunity to hepatitis A among men who have sex with men attending a large sexual health clinic in Melbourne, Australia, 2012-2018.

BACKGROUND: Outbreaks of hepatitis A are being reported more commonly among men who have sex with men (MSM) globally. Australia has also reported a sharp increase in the number of cases of hepatitis A in 2017. This study aimed to determine the level of immunity to hepatitis A among MSM attending a large urban sexual health clinic in Victoria in the lead up to recent outbreak. METHODS: This was a retrospective audit of serological testing data from first-time MSM attendees at Melbourne Sexual Health Centre (MSHC) in Australia from 1 January 2012 to 31 December 2018. We determined the proportion of MSM who were tested and who had serological detection of hepatitis A IgG, stratified by age and calendar year. We used univariable and multivariable logistic regression to investigate factors associated with testing for and detection of hepatitis A IgG. RESULTS: There were 16 609 first-time MSM attendees at MSHC over the 7-year period, of which 9718 (59%, 95% CI 58% to 60%) were tested for hepatitis A IgG. There was a 2% annual increase in the proportion of men tested (from 60% in 2012 to 69% in 2018; OR=1.02, 95% CI 1.00 to 1.03, p=0.025). Men born outside of Australia/New Zealand, and younger men <30 years had higher odds of being tested. Of those tested, 44% (n=4304, 95% CI 43% to 45%) had hepatitis A IgG detected at their first visit, with no change over time (OR=1.01, 95% CI 0.99 to 1.03, p=0.210). Detection of hepatitis A IgG was associated with being aged 30 years or older (adjusted OR=2.06, 95% CI 1.89 to 2.24, p<0.001) or being born overseas versus Australia/New Zealand (AOR=1.21, 95% CI 1.11 to 1.31, p<0.001). CONCLUSION: Hepatitis A immunity among MSM remains below the estimated 70% required to prevent outbreaks. Measures including increased testing and higher vaccination coverage are needed to prevent outbreaks and to limit the number of cases and deaths.

Prevalence of clinically significant antibodies in patients undergoing elective surgery in a Nigerian teaching hospital: A case for the type and screen method.

BACKGROUND: Provision of safe and adequate blood is challenging in our environment due to paucity of voluntary donors as well as inappropriate blood ordering and utilization. The type and screen (TS) method (typing of blood group and screening for antibodies) reduces the demand for blood reservation in hospital blood banks. AIMS: The aim of this study is to determine the safety (detection clinically significant antibodies) and cost effectiveness of the TS method compared to the conventional antiglobulin crossmatch (ACM). SETTINGS AND DESIGN AND METHODS: This was a cross-sectional prospective study carried out at the University of Port Harcourt Teaching Hospital (UPTH). 124 participants booked for elective surgeries with no history of blood transfusion or pregnancy were investigated. ACM was performed on all participants' serum against 159 donor red cells. TS was also performed blindly on the same participants' sera, antibody screening was done with three-screen-cells using the gel method. An 11-cell panel was used for antibody identification. Blood utilization was calculated using the crossmatch: transfusion ratio (CTR), probability of transfusion (%T) and transfusion index (TI). RESULTS: Out of the 159 units crossmatched for 124 study participants, only 19 were actually transfused (88.1% not utilized). The prevalence of compatible ACM was 100%, however the TS detected one antibody (0.81%) in a male participant identified as anti-M. The overall CTR, %T and TI were 8.4, 15.6% and 0.16 respectively, with N384,750 ($963.1) wastage in terms of cost. The TS method would have saved N266,000{$665.9} (N1900{4.78} per un-transfused patient). CONCLUSIONS: There was improper utilization of blood in elective surgeries. The TS method identified an antibody not detected by ACM. This would have saved N266,000 {$665.9}, and reduced the demand for blood reservation in the bank. Although The TS method was found not to be significantly different in outcome compared to the ACM, it was found to be cost effective.

The impact of universal live attenuated hepatitis A vaccines in Henan, China, 2005-2018.

OBJECTIVES: To analyze the effects of one dose of live attenuated hepatitis A vaccine in a developing country. METHODS: The reported cases of hepatitis A virus (HAV) infection from 2005 to 2018 in Henan province, China, were analyzed. Data of vaccinated children were assessed on the childhood immunization information management system. Questionnaire survey and blood sample collection were randomly conducted in six counties and districts of Henan province to analyze the prevalence of HAV lgG among the population aged 0-70 years. RESULTS: In 2008, Henan province began to expand its program on immunization, and children aged 18 months were given one dose of live attenuated hepatitis A vaccine (HepA-L). From 2005 to 2007, the HAV incidence remained steady at above 5000 cases per year and increased to 7489 in 2007. Since 2008, the HAV incidence decreased cumulatively from 4576 to 237 in 2018, indicating a 94.8% decrease, which was particularly pronounced among adolescents (98.2%). The proportion of hepatitis A cases in patients younger than 10 years continually decreased from 41.6% in 2012 to 3.8% in 2018. The reduction of reported cases older than 40 years was slower than that of children. In 2012, the proportion of hepatitis A cases older than 40 years was 27.6%, and continually increased to 69.2% (164/237) in 2018. The results of serological investigation showed that the 0-1.5-year age group had the lowest anti-HAV IgG prevalence (38.6%), which increased to 75.0% in the 4-6-year age group, covered by this immunization program. CONCLUSIONS: The data indicated a large decrease in HAV infections in Henan province from 2008 onward in response to the introduction of a planned immunization program of HepA-L.

Population seroprotection against hepatitis a virus in Israel 18 years after introduction of inactivated vaccine into the routine childhood vaccination schedule.

Vaccine against Hepatitis A virus (HAV) is part of the routine vaccination schedule in Israel since 1999. As of 2016, new recruits to the Israel Defense Forces should have been vaccinated in their childhood. This sero-survey aimed to determine immunity against HAV 18 years after childhood vaccination, and to re-evaluate the need for HAV vaccination booster upon recruitment. Two populations were studied: soldiers who were recruited during 2011-2012, who belonged to birth cohorts before childhood vaccination (BCV) was introduced; and recruits from 2017, who belonged to birth cohorts after childhood vaccination (ACV) was introduced. Data on 339 BCV recruits and 295 ACV recruits were analyzed. Seropositivity was 35% in the BCV group and 68% in the ACV group (P < 0.0001). Seropositivity rates among ACV subjects enable evaluation of the vaccination program's impact on the population. Our findings do not support discontinuation of HAV vaccination of at risk groups until further evaluation.

Statistical modeling alongside observational data predicts long-term immunogenicity of one dose and two doses of pediatric hepatitis A vaccine in the Mendoza province of Argentina.

BACKGROUND: Follow-up for anti-hepatitis A (HA) antibody persistence up to 10 years was conducted after implementation of universal vaccination against HA virus (HAV) in Mendoza, Argentina. Based on these data, statistical modeling was used to predict the antibody persistence to 30 years. METHODS: A non-interventional study evaluated long-term immunogenicity (geometric mean concentrations [GMCs] and seroprotection rate) following routine vaccination with 1 dose (Group 1: N = 436) or 2 doses (Group 2: N = 108) of HA vaccine. Associated statistical modeling based on a Bayesian approach of mixed effects models on log transformed titers evaluated three models (linear, piecewise linear, and exponential decay, with and without a natural boosting effect). RESULTS: From the initial cohort, 9 participants (Group 1) and 1 participant (Group 2) showed antibody titers below the seroprotective threshold and received a booster. At Year 10, 190 (Group 1) and 51 (Group 2) participants remained in the study without a booster dose and all were seroprotected. Regarding statistical modeling, the piecewise linear model showed the best fit and demonstrated high and similar seroprotection for each schedule up to 30 years (89% [1-dose schedule], 85% [2-dose schedule]). The 2-dose schedule showed higher GMC (95% CI) than the 1-dose schedule (Year 10: 352 [271-456] versus 78 [69.8-87.6] mIU/mL) and Year 30 (predicted) (37 [13-97] versus 19 [11-34] mIU/mL). Natural boosting had little impact on predicted seroprotection rates at 30 years for the 1-dose schedule (89% [0.8-0.96] and 84% [0.73-0.94] with and without a natural booster, respectively). CONCLUSIONS: Long-term persistence of anti-HAV antibodies was observed up to 10 years with 1-dose and 2-dose vaccine schedules, supporting booster flexibility. Statistical modeling predicted good persistence of seroprotection for each schedule up to 30 years. Natural boosting had a limited impact on seroprotection rate predictions, enabling extrapolation of these results to non-endemic settings for traveler vaccination.

RNA testing for the diagnosis of acute hepatitis A during the 2017 outbreak in France.

Diagnostic of acute hepatitis A virus (HAV) infection is based on the detection of anti-HAV IgM without testing for the pathogen itself. We evaluated the usefulness of HAV RNA testing for confirmation of acute hepatitis A and to provide indications about the level of HAV replication in HIV-positive and HIV-negative subjects during an unprecedented outbreak of HAV observed in France in 2017. HAV RNA was detected in 38 out of 41 (92.6%) subjects with a clinical diagnosis of acute hepatitis A, whereas nine cases tested positive for anti-HAV IgM in whom the diagnosis of acute hepatitis A was not retained were found negative for HAV RNA. All subjects in the control group were also tested negative for HAV RNA. HAV viremia was correlated to ALT peak (r = .64; P < .0001). HIV-infected patients have similar HAV RNA levels but were less likely to have prolonged international normalized ratio of prothrombin time when compared to the HIV-uninfected group (P = .016), suggesting a less severe course of acute hepatitis. HAV RNA was detected in the serum of most of the patients with acute hepatitis A, indicating that the direct detection of HAV can be used to confirm hepatitis A in patients tested positive for anti-HAV IgM antibodies. Nucleic acid tests should serve more broadly during the diagnosis workup of acute hepatitis A to improve the predictive values of HAV in vitro diagnostic tests and to confirm acute hepatitis A in patients tested positive with IgM with moderate or low S/CO values.

Serological and molecular study of Hepatitis E virus in pediatric patients in Mexico.

INTRODUCTION AND OBJECTIVES: Cases of viral hepatitis reported in Mexico are typically identified as hepatitis A, B and C. However, unspecified cases are reported annually. Hepatitis E virus (HEV) is an emergent agent that causes a self-limiting infection that can evolve to chronic in immunosuppressed individuals. In Mexico, HEV genotype 2 is considered endemic, though it's the prevalence is not well known. Therefore, the present study was designed to determine the prevalence of HEV among patients at the "Hospital Infantil de Mexico Federico Gomez". MATERIALS AND METHODS: The study included 99 patients, anti-HEV antibody (IgG and IgM) were detected by indirect ELISA and viral genome was identified using RT-PCR technique. Two PCR products of positive cases were sequenced. RESULTS: ELISA results were positive in 3% and 6%, for IgG and IgM respectively, 54.5% prevalence was found by PCR. Low lymphocyte count (p<0.05) and malnutrition (p<0.005) were significant factors for high PCR prevalence and could increase the possibility of infection. Two samples were sequenced and confirmed the presence of HEV genotype 3. CONCLUSIONS: This report reveals the incidence of HEV in pediatric patients in Mexico. Moreover, the identification of HEV genotype 3 in human samples suggests a potential zoonotic risk that requires further research.

Hepatitis A Seroprevalence Among Patients with Chronic Hepatitis B Infection: A Cross-Sectional Study in Iran During 2016-2017.

INTRODUCTION: The aim of this study was to determine the prevalence of exposure to hepatitis A by means of serologic markers in chronic hepatitis B patients, with the secondary aim of finding the best prevention method for hepatitis A infection in susceptible groups of our setting. METHODS: During the period between 2016 and 2017, we recruited 403 hepatitis B patients aged more than 14 years and regularly attending the infectious diseases clinic at a referral university hospital, Tehran, Iran. A blood sample was collected from all the patients and tested for hepatitis A IgG. The data was analyzed by SPSS v.19. RESULTS: Although none of the patients had previously received hepatitis A vaccine, the results for serologic level of hepatitis A IgG, demonstrated positive results in 379 (94%) cases. The mean age of patients with negative and positive IgG was 29.17 and 42.46 years, respectively; the difference was statistically significant (P≤0.001). The majority of seronegative patients were young adults aged < 25 years and 25 to 35 years (P <0.001). CONCLUSION: Seroprevalence of hepatitis A in chronic HBV patients in Iran is high. As HBV infected patients younger than 35 years could be seronagative for HAV infection, evaluation of these patients for HAV infection and vaccination of seronegative patients would be a reasonable approach.

Comparison of the Clinical Features of Hepatitis A in People Living with HIV between Pandemics in 1999-2000 and 2017-2018 in the Metropolitan Area of Japan.

Since 2017, hepatitis A virus (HAV) infection has been an epidemic among men who have sex with men (MSM) in Japan. We have come across 11 MSM patients with hepatitis A who were also infected with HIV. In 1999-2000, we came across 5 HIV-infected patients with hepatitis A. Since the conditions of current HIV-infected patients have changed owing to the recent progress in anti-HIV therapies, we compared clinical features of hepatitis A between patients in 2017-2018 and those in 1999-2000. By comparing the background characteristics of the patients, we found that the CD4/CD8 ratio was significantly higher in the 2017-2018 group. After the onset of hepatitis, peak levels of hepatic transaminases were found to be higher in the 2017-2018 group, suggesting severe hepatocellular damage. In contrast, neither the peak level of total bilirubin nor the nadir of prothrombin time was significantly different among the 2 groups. We also analyzed the HAV genome derived from some of the recently infected patients, and found that the HAV strains were almost the same among these patients; slight differences were observed from the previously identified strain. Thus, we concluded that the recovery of immunity by recent anti-HIV therapies may result in more severe hepatocellular damages and differences in clinical features.

Investigation and analysis of antibody levels of hepatitis A among children before and after implementing the Expanded National Immunization Program in China.

OBJECTIVE: To analyze changes of hepatitis A antibody levels and immunization coverage of HAV vaccine among children before and after implementing the Expanded National Immunization Program in five counties of China, and to provide evidence for developing hepatitis A vaccine immunization strategies. METHODS: 449 children born in 2001, 2005 and 2009 were selected from five counties for an immunization coverage and a sero-prevalence survey of hepatitis A. The chemiluminescence microparticle immunoassays (CMIA) were used to detect hepatitis A IgG antibody and analyzed the factors which influenced the immunization coverage and positive rates. RESULTS: Among 449 subjects of children born in 2001, 2005 and 2009, the immunization coverage were 53.02%, 78.52% and 99.34% (χ2 = 91.285, P < 0.001). The positivity rates of hepatitis A IgG antibody were 61.07%, 81.21%, 95.36% (χ2 = 54.198, P < 0.001), respectively. The immunization coverage and positivity rate significantly increased with the delay of birth year. Children accepting different doses of HA vaccines are significantly different in positive rates of HA antibody, while there are no significant differences of different genders, years of birth, residence types, or types of registered permanent residence in different regions. The positivity rate increased significantly with administration of hepatitis A vaccine and shorter intervals between sample collection and HAV immunization. CONCLUSIONS: After the Expanded National Immunization Program was implemented, hepatitis A antibody levels were significantly increased in five counties, which indicates a successful result of EPI.