Occult hepatitis B: the Egyptian situation

Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
Tropical gastroenterology: official journal of the Digestive Diseases Foundation 12/2012; DOI: 10.7869/tg.2012.65


Occult hepatitis B infection is defined as the presence of HBV DNA in serum and/or the liver
tissue without detectable HBsAg with or without anti-HBc or anti-HBs antibodies. In Egypt
many studies on occult hepatitis B have been conducted and this infection is well established
in various patients groups. This short review sheds light on the occurrence of occult hepatitis
B infection among different disease states in Egypt. The coexistence of occult hepatitis B with
hepatitis C infection is of particular importance because of its added co-morbidity of liver
enzymes elevation, increased severity of liver disease and increased risk of hepatocellular
carcinoma. Patients on regular hemodialysis and those exposed to blood transfusion are at
high risk of acquiring this form of infection. The highest prevalence of occult hepatitis B virus
in Egypt was reported among patients with hepatocellular carcinoma and similar to the scenario
for classic hepatitis B infection, genotype D is the most prevalent genotype.

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Available from: Mohamed Hassan Emara
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    ABSTRACT: Introduction: Spread of hepatitis B virus (HBV) continues to be at an alarming rate worldwide, and this created an impact on many countries. Even with the presence of effective vaccines, hepatitis B remains a stubborn, unrelenting health problem, especially in Africa and other developing areas. Studies in the Middle East showed that the prevalence of HBsAg ranged from 3 to 11% in Egypt. Patients on repeated blood transfusion are at high risk for acquiring HBV infection. The aim of the work was evaluation of hepatitis B vaccination protection in both healthy and polytransfused Egyptian children with β-thalassemia major. Methods: Cross-sectional study was conducted on 200 Egyptian children; 100 of them were known to have β-thalassemia major, receiving packed transfusion more than 10 times and documented to be vaccinated by the recombinant hepatitis B vaccine applied by the Ministry of Health at 2, 4, and 6 months of age, and 100 healthy children with matched age and sex also documented to be vaccinated according to the same schedule served as the control group. Samples were collected from all children for HBsAb titer level by enzyme-linked immunosorbent assay test, and questionnaire was designed to collect the risk factors data. Results: (a) The mean anti-HBs titer was significantly higher among healthy children than in thalassemic cases. (b) Thalassemic children with age range from 7 to 12 years had the lowest mean serum anti-HBs levels. (c) There was significant negative correlation between postvaccination intervals in healthy as well as thalassemic children and the mean level of anti-HBs titer. (d) There was significant negative correlation between number of blood transfusions in thalassemic children and the mean level of anti-HBs titer. Conclusion: Anti-HBs titer wanes with time lapse and became not enough to be immunogenic in a high percentage of thalassemic children especially after the age of 7 years. Recommendations: Booster dose to all multitransfused thalassemic children beyond 2 years of vaccination is recommended. Healthy children aged 7 years or more need booster dose of HBV vaccine to achieve complete immune response.
    No preview · Article · Mar 2015 · Egyptian Liver Journal
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    ABSTRACT: The prevalence of end-stage renal disease has increased dramatically in developing countries. Hepatitis B virus (HBV) infection is a global health problem that represents a significant co-morbidity event that has led to outbreaks of hepatitis B. There are inadequate data concerning occult HBV infection among Egyptian chronic hemodialysis patients. This study aimed to detect occult HBV infection among chronic hemodialysis patients in Alexandria, Egypt. A cross-sectional study was performed on 100 patients with end-stage renal disease that received maintenance hemodialysis and had tested negative for HBV surface antigen. Blood samples were collected before the initiation of hemodialysis. Sera were tested for hepatitis C virus (HCV) and hepatitis B core (HBc) antibodies using ELISA, and HBV DNA was detected by SYBR Green real-time PCR using specific primers for the s and c genes and by nested PCR using pol gene-specific primers. The serum activity of alanine and aspartate aminotransferase (ALT and AST) were also measured. Anti-HCV and anti-HBc antibodies were detected in 34% and 48% of patients, respectively, and 70.6% of anti-HCV positive patients were also positive for anti-HBc antibodies. This association was statistically significant (p = 0.001). HBV DNA was detected in 32% of the hemodialysis patients. A significant association was determined between the presence of HBV DNA and anti-HCV positivity (p = 0.021). Aminotransferases were elevated in 21% of the studied patients, more often in patients with positive anti-HCV profiles than in patients negative for anti-HCV (p < 0.05). In conclusion, the serological markers of HBV infection should be verified with molecular tests to investigate possible occult infections, especially among anti-HBc-positive hemodialysis patients, to improve our understanding of their clinical, laboratory, and epidemiological characteristics.
    No preview · Article · May 2015 · Journal of Infection and Public Health
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    ABSTRACT: The emerging evidence of the potentially clinical importance of occult hepatitis B virus (HBV) infection (OBI) increases the interest in this topic. OBI may impact in several clinical contexts, which include the possible transmission of the infection, the contribution to liver disease progression, the development of hepatocellular carcinoma, and the risk of reactivation. There are several articles that have published on OBI in Egyptian populations. A review of MEDLINE database was undertaken for relevant articles to clarify the epidemiology of OBI in Egypt. HBV genotype D is the only detectable genotype among Egyptian OBI patients. Higher rates of OBI reported among Egyptian chronic HCV, hemodialysis, children with malignant disorders, and cryptogenic liver disease patients. There is an evidence of OBI reactivation after treatment with chemotherapy. The available data suggested that screening for OBI must be a routine practice in these groups of patients. Further studies needed for better understand of the epidemiology of OBI among Egyptian young generations after the era of hepatitis B vaccination.
    Full-text · Article · Jun 2015 · World Journal of Hepatology

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