[Vaccination against hepatitis B. Impact of vaccination programmes after 20 years of use in Spain. Is it time for a change?]. / Vacunación frente a la hepatitisB. Impacto de los programas de vacunación tras 20años de su utilización en España. ¿Es tiempo de cambios?

The highest incidence rate of hepatitis B (HB) in Spain is detected in adults between 20 and 54 years old, whereas the incidence in children under 1 year old is almost nil. The low prevalence of HB in children under 1 year is mainly due to the success of gestational screening strategies for the detection of HBsAg(+) in pregnant women, and vaccination campaigns during childhood. Currently, in Spain, the last dose of the HB included in the national childhood immunization program is administered at 6 months of age, although some studies show that delaying the age of the administration of the last dose of HB vaccine and increasing the time between doses, may improve immune memory by offering greater protection against this virus in the adulthood. In this article, the impact of HB vaccination in Spain is reviewed, and other potential vaccination strategies in our environment are discussed, such as extending the interval between doses, and administering the last dose in the second year of life, adapting the valid strategy in Spain to the current epidemiological context in order to reduce the prevalence of HB in adulthood.

Post-Vaccination and Post-Infection Immunity to the Hepatitis B Virus and Circulation of Immune-Escape Variants in the Russian Federation 20 Years after the Start of Mass Vaccination.

A neonatal vaccination against the Hepatitis B virus (HBV) infection was initiated in Russia 20 years ago, with catch-up immunization for adolescents and adults under the age of 60 years launched in 2006. Here, we have assessed the humoral immunity to HBV in different regions of Russia, as well as the infection frequency following 20 years of a nationwide vaccination campaign. We have also evaluated the role of immune-escape variants in continuing HBV circulation. A total of 36,149 healthy volunteers from nine regions spanning the Russian Federation from west to east were tested for HBV surface antigen (HBsAg), antibodies to HBV capsid protein (anti-HBc), and antibodies to HBsAg (anti-HBs). HBV sequences from 481 chronic Hepatitis B patients collected from 2018-2022 were analyzed for HBsAg immune-escape variants, compared with 205 sequences obtained prior to 2010. Overall, the HBsAg detection rate was 0.8%, with this level significantly exceeded only in one study region, the Republic of Dagestan (2.4%, p < 0.0001). Among the generation vaccinated at birth, the average HBsAg detection rate was below 0.3%, ranging from 0% to 0.7% depending on the region. The anti-HBc detection rate in subjects under 20 years was 7.4%, indicating ongoing HBV circulation. The overall proportion of participants under 20 years with vaccine-induced HBV immunity (anti-HBs positive, anti-HBc negative) was 41.7% but below 10% in the Tuva Republic and below 25% in the Sverdlovsk and Kaliningrad regions. The overall prevalence of immune-escape HBsAg variants was 25.2% in sequences obtained from 2018-2022, similar to the prevalence of 25.8% in sequences collected prior to 2010 (p > 0.05). The population dynamics of immune-escape variants predicted by Bayesian analysis have remained stable over the last 20 years, indicating the absence of vaccine-driven positive selection. In contrast, the wild-type HBV population size experienced a rapid decrease starting in the mid-1990s, following the introduction of mass immunization, but it subsequently began to recover, reaching pre-vaccination levels by 2020. Taken together, these data indicate that it is gaps in vaccination, and not virus evolution, that may be responsible for the continued virus circulation despite 20 years of mass vaccination.

Seroprevalence of Hepatitis B, C and D in Vietnam: A systematic review and meta-analysis.

Background: Vietnam has one of the greatest disease burdens from chronic viral hepatitis. Comprehensive prevalence data are essential to support its elimination as a public health threat. Methods: We searched Medline and Embase from 1990 to 2021 for seroprevalence data relating to Hepatitis B (HBV), C (HCV) and D (HDV) in Vietnam. We estimated pooled prevalence with a DerSimonian-Laird random-effects model and stratified study populations into i) low-risk ii) high-risk exposure and iii) liver disease. We further estimated prevalence by decade and region and rates of HIV-coinfection. Findings: We analysed 72 studies, including 120 HBV, 114 HCV and 23 HDV study populations. Pooled HBV prevalence was low in blood donors (1.86% [1.82-1.90]) but high in antenatal populations (10.8% [10.1-11.6]) and adults in the general population (10.5% [10.0-11.0]). It was similar or modestly increased in groups at highest risk of exposure, suggesting the epidemic is largely driven by chronic infections acquired in childhood. HCV pooled prevalence in the general population was lower than historical estimates: 0.26% (0.09-0.51) have active infection defined by detectable antigen or HCV RNA. In contrast, there is an extremely high prevalence of active HCV infection in people who inject drugs (PWID) (57.8% [56.5-59.1]), which has persisted through the decades despite harm-reduction interventions. HDV appears mainly confined to high-risk groups. Interpretation: Blood safety has improved, but renewed focus on HBV vaccination at birth and targeted HCV screening and treatment of PWID are urgently required to meet elimination targets. Large cross-sectional studies are needed to better characterize HDV prevalence, but mass screening may not be warranted. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Coverage with Timely Administered Vaccination against Hepatitis B Virus and Its Influence on the Prevalence of HBV Infection in the Regions of Different Endemicity.

Universal hepatitis B vaccination of newborns was implemented in Russia starting from 1998. From 1998 to 2019, the incidence of acute hepatitis B reduced from 43.8 to 0.57 cases per 100,000 population. Here, we assessed the timely coverage of newborns with the birth dose (HepB-BD), second dose (HepB-2nd), and three vaccine doses (HepB3) in two remote regions of Russia with low (Belgorod Oblast) and high (Yakutia) levels of hepatitis B virus (HBV) endemicity. Vaccination data were obtained from the medical records of 1000 children in Yakutia and 2182 children in Belgorod Oblast. Sera of healthy volunteers from Belgorod Oblast (n = 1754) and Yakutia (n = 1072) across all age groups were tested for serological markers of HBV to assess the infection prevalence and herd immunity. Average HepB-BD coverage was 99.2% in Yakutia and 89.4% in Belgorod Oblast (p < 0.0001) and in both regions varied significantly, from 66% to 100%, between medical centers. The principal reason for the absence of HepB-BD was parent refusal, which accounted for 63.5% of cases of non-vaccination (83/123). While timely HepB-2nd coverage was only 55.4%-64.7%: HepB3 coverage by the age of one year exceeded 90% in both study regions. HBV surface antigen (HBsAg) prevalence in the 1998-2019 birth cohort was 0.2% (95% CI: 0.01-1.3%) in Belgorod Oblast and 3.2% (95% CI: 1.9-5.2%) in Yakutia. The proportion of persons testing negative for both antibodies to HBsAg (anti-HBs) and antibodies to HBV core antigen (anti-HBc) in the 1998-2019 birth cohort was 26.2% (125/481) in Belgorod Oblast and 32.3% (162/501) in Yakutia. We also assessed the knowledge of and attitude towards vaccination among 782 students and teachers of both medical and non-medical specialties from Belgorod State University. Only 60% of medical students knew that hepatitis B is a vaccine-preventable disease. Both medical and nonmedical students, 37.8% and 31.3%, respectively, expressed concerns about safety and actual necessity of vaccination. These data indicate the need to introduce a vaccine delivery audit system, improve medical education with respect to vaccination strategies and policies, and reinforce public knowledge on the benefits of vaccination.

Chronic Hepatitis B in US Veterans.

PURPOSE OF REVIEW: This review summarizes recent data on chronic Hepatitis B virus (HBV) epidemiology, issues in special populations undergoing immunosuppressive and hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy, and describes care delivery, adherence to guideline-recommended care, and barriers to access to care and high-quality care for chronic HBV. RECENT FINDINGS: Chronic HBV is present in up to 1% of veterans and is more than in the general US population. HBV associated with more advanced liver disease in HCV, HIV, and delta hepatitis co-infection. Recent data on HBV reactivation show a substantial risk of reactivation with anti-CD20 antibodies, no documented cases of reactivation with anti-tumor necrosis factor (anti-TNF) therapy, and a low risk of reactivation with HCV DAA therapy. Adherence to guideline-recommended care for HBV is suboptimal for many quality indicators. SUMMARY: Important studies in HBV epidemiology, long-term outcomes and care delivery practices have been conducted in the VA. Future studies should prospectively investigate how to improve guideline-recommended care for HBV.

Hepatitis B prevalence in Brazilian waste pickers: a systematic review with meta-analysis

ABSTRACT OBJECTIVE: To describe the hepatitis B prevalence in Brazilian waste pickers. METHODS: We performed a literature search in the SciELO, Biblioteca Virtual em Saúde (BVS), PubMed and Web of Science databases using the descriptors: "hepatitis B" AND ("informal recycling" OR "waste picker" OR "recyclable waste collectors" OR "solid waste segregator") AND ("recyclable waste" OR "solid waste") AND Brazil. Epidemiological studies on HBV in Brazilian waste pickers published prior to February 2020 were included and evaluated for quality and bias using a funnel plot. RESULTS: This meta-analysis consisted of five articles. Prevalence of HBV surface antigen seropositivity was 14% (95%CI: 6%-22%) in Brazilian waste pickers. CONCLUSION: HBV prevalence in Brazilian waste pickers remains high. There should be more campaigns showing the importance of vaccination and personal protective equipment use.

Editorial on "What is a potentially damaging vaccination delay in children younger than 2 years?"

Control of hepatitis B through routine infant immunization in more than 95% of countries has reduced the prevalence of chronic hepatitis carriers to less than 1%-2% in immunized cohorts of children even in high endemicity countries. In that context the authors of this editorial found the results of a paper by Gras et al in this issue concerning. They performed a Delphi survey of 37 French immunization experts and the results concluded that delayed hepatitis B immunization would cause "potential damage" only after 11 years. Large cohorts of French children and adolescents remain susceptible to hepatitis B infection. Given the high rates of immigration to France from areas of higher endemicity, the higher birth rate and degree of integration of these groups into the health system, plus the lower age of sexual debut and the use of injectable drugs in the general population, we cannot agree that a delay of 11 years is acceptable. Rates of adolescent immunization are quite low so relying on protection at this age will yield little in terms of population protection. Loss of confidence in Hepatitis B vaccine following disproved allegations that the vaccine caused Multiple Sclerosis persists in France, and we believe the results of this paper sends a damaging message to health workers and parents in France and beyond.

Viral hepatitis in female sex workers using the Respondent-Driven Sampling

ABSTRACT OBJECTIVE To estimate the prevalence of hepatitis B virus and C virus infections and their genotypes and analyze the risk factors for the markers of exposure to hepatitis B virus in female sex workers in a region of intense sex trade. METHODS This is a cross-sectional study performed with four hundred and two female sex workers in Goiânia, Brazil. Data have been collected using the Respondent-Driven Sampling. The women have been interviewed and tested for markers of hepatitis B and C viruses. Positive samples have been genotyped. The data have been analyzed using the Respondent-Driven Sampling Analysis Tool, version 5.3, and Stata 11.0. RESULTS The adjusted prevalence for hepatitis B virus and C virus were 17.1% (95%CI 11.6-23.4) and 0.7% (95%CI 0.1-1.5), respectively. Only 28% (95%CI 21.1-36.4) of the participants had serological evidence of vaccination against hepatitis B virus. Being older (> 40 years), being single, having a history of blood transfusion and use of cocaine, and ignoring the symptoms of sexually transmitted infections were associated with positivity for hepatitis B virus (p < 0.05). We have detected the subgenotype A1 of hepatitis B virus (n = 3) and the subtypes of hepatitis C virus 1a (n = 3) and 1b (n = 1). CONCLUSIONS We can observe a low prevalence of infection of hepatitis B and C viruses in the studied population. However, the findings of the analysis of the risk factors show the need for more investment in prevention programs for sexual and drug-related behavior, as well as more efforts to vaccinate this population against hepatitis B. The genotypes of the hepatitis B virus and C virus identified are consistent with those circulating in Brazil.

Epidemiology of hepatitis B virus infection in first-time blood donors in the southwestern region of Goiás, central Brazil.

INTRODUCTION: Little is known about the epidemiology of hepatitis B virus (HBV) infection in populations from inner cities, especially in Central Brazil. Thus the objective of this study was to estimate the prevalence of HBV infection, and to analyze the factors associated with HBV infection, in a population of first-time blood donors in the southwestern region of Goiás, Central Brazil. METHODS: A total of 984 individuals were interviewed and gave blood samples to detect serological markers of HBV (HBsAg, anti-HBs, and anti-HBc) by enzyme linked immunosorbent assays. RESULTS: An overall prevalence of 6.9% was found for HBV, with constituent prevalence rates of 3.6% and 11.6%, in subjects classified as fit and unfit to donate blood according the epidemiological screening, respectively. Only three individuals were positive for anti-HBs alone, suggesting previous vaccination against HBV. The variables of prior blood transfusion (OR = 2.3), tattoo/piercing (OR = 2.1), illicit drug use (OR = 2.3), sex with a partner with hepatitis (OR = 14.7), and history of sexually transmitted diseases (OR = 2.9) were independently associated with HBV-positivity. These data suggested a low endemicity of hepatitis B in the studied population. CONCLUSION: The findings of low hepatitis B immunization coverage and the association of hepatitis B with risky behavior highlight that there is a need to intensify hepatitis B prevention programs in the southwest region of Goiás.

Comparação do perfil epidemiológico das hepatites B e C em um serviço público de São Paulo / Comparison between hepatitis B and C epidemiological profiles at a public institution in São Paulo, Brazil

CONTEXTO: As hepatites virais constituem doença de notificação compulsória e apresentam grande importância em nosso meio devido à elevada prevalência. OBJETIVO: Comparar o perfil epidemiológico dos casos confirmados de hepatites B e C notificados no Núcleo de Vigilância Epidemiológica do Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, no período entre janeiro de 2004 e abril de 2007. MATERIAL: Os resultados foram analisados através do teste do qui ao quadrado. RESULTADOS: Observou-se 112 casos confirmados de hepatite B e 651 de hepatite C. Houve predominância do sexo masculino dentre os casos de hepatite B e do sexo feminino entre os de hepatite C, com significância estatística. A faixa etária mais frequente foi de 30 a 39 anos, considerando-se hepatite B (P<0,01) e 40 a 49 anos para hepatite C (P = 0,49). A astenia foi o sintoma mais relatado. Os fatores de risco predominantes foram: doenças sexualmente transmissíveis (hepatite B; P<0,01), tratamento cirúrgico e transfusão de sangue (hepatite C; P<0,01). A confirmação por critério laboratorial foi predominante e quanto à forma clínica, observou-se evolução para hepatite crônica em 54,5 por cento e 81,7 por cento dos casos, respectivamente para hepatite B e C (P<0,01). A transmissão do vírus B ocorreu predominantemente por via sexual (P<0,01), enquanto o vírus C foi predominantemente transmitido por transfusão (P<0,01). CONCLUSÕES: Os dados referentes ao perfil epidemiológico dos pacientes foram semelhantes aos disponíveis na literatura nacional e internacional. Ressalta-se a importância da vigilância epidemiológica na determinação do perfil das hepatites virais, permitindo que se estabeleçam propostas adequadas de prevenção e rastreamento.

CONTEXT: Viral hepatitis is a disease of compulsory notification and is very important due to its high prevalence. OBJECTIVE: To analyze the epidemiological profiles of hepatitis B and C, reported through surveillance at the "Hospital do Servidor Público Estadual", São Paulo, SP, Brazil, from January 2004 to April 2007. METHODS AND RESULTS: The study revealed 112 confirmed cases of hepatitis B and 651 of hepatitis C. Male gender predominated among hepatitis B while female gender predominated among hepatitis C, statistically significant. Hepatitis B occurred mainly among patients from 30 to 39 years old (P<0.01), and hepatitis C was more frequent among patients from 40 to 49 years old (P = 0.49). Asthenia was the most frequent symptom. The main risk factors were: sexually transmitted diseases (hepatitis B; P<0.01), previous surgery and blood transfusion (hepatitis C; P<0,01). Cases were mostly confirmed through laboratory tests. Chronic hepatitis occurred in 54.5 percent and 81.7 percent cases of hepatitis B and C, respectively (P<0,01). Virus B was mostly transmitted by sexual contact (P<0,01); virus C was transmitted mainly by blood transfusion (P<0,01). CONCLUSIONS: The findings were similar to national and international data available. Epidemiologic surveillance plays an important role in determining the viral hepatitis profile in order to provide adequate screening and prevention.