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CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management

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Abstract

This report contains CDC guidance that augments the 2011 recommendations of the Advisory Committee on Immunization Practices (ACIP) for evaluating hepatitis B protection among health-care personnel (HCP) and administering post-exposure prophylaxis. Explicit guidance is provided for persons working, training, or volunteering in health-care settings who have documented hepatitis B (HepB) vaccination years before hire or matriculation (e.g., when HepB vaccination was received as part of routine infant [recommended since 1991] or catch-up adolescent [recommended since 1995] vaccination). In the United States, 2,890 cases of acute hepatitis B were reported to CDC in 2011, and an estimated 18,800 new cases of hepatitis B occurred after accounting for underreporting of cases and asymptomatic infection. Although the rate of acute hepatitis B virus (HBV) infections have declined approximately 89% during 1990-2011, from 8.5 to 0.9 cases per 100,000 population in the United States, the risk for occupationally acquired HBV among HCP persists, largely from exposures to patients with chronic HBV infection. ACIP recommends HepB vaccination for unvaccinated or incompletely vaccinated HCP with reasonably anticipated risk for blood or body fluid exposure. ACIP also recommends that vaccinated HCP receive postvaccination serologic testing (antibody to hepatitis B surface antigen [anti-HBs]) 1-2 months after the final dose of vaccine is administered (CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2011;60 [No. RR-7]). Increasing numbers of HCP have received routine HepB vaccination either as infants (recommended since 1991) or as catch-up vaccination (recommended since 1995) in adolescence. HepB vaccination results in protective anti-HBs responses among approximately 95% of healthy-term infants. Certain institutions test vaccinated HCP by measuring anti-HBs upon hire or matriculation, even when anti-HBs testing occurs greater than 2 months after vaccination. This guidance can assist clinicians, occupational health and student health providers, infection-control specialists, hospital and health-care training program administrators, and others in selection of an approach for assessing HBV protection for vaccinated HCP. This report emphasizes the importance of administering HepB vaccination for all HCP, provides explicit guidance for evaluating hepatitis B protection among previously vaccinated HCP (particularly those who were vaccinated in infancy or adolescence), and clarifies recommendations for postexposure management of HCP exposed to blood or body fluids.

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... During the six months, the exposed (HCP) can resume normal health care duties but should not donate blood, plasma, organs, tissue or semen. For the exposed (HCP) who received the complete hepatitis B vaccine course, anti-HBs testing should be performed 1-2 months after the last dose to determine immunity [6,22]. ...
... It should ideally be administered within 24 hrs of exposure, but is still effective up to 7 days if not immediately available or there are delays in source testing results. It is estimated that HBIG is 75% effective in preventing HBV infection if the first dose is initiated within one week of exposure [22]. ...
... Health-care professionals who test positive for HCV RNA should be referred to a specialist for appropriate follow-up and management. During the follow-up testing period, the HCP can resume normal health care duties but should not donate blood, plasma, organs, tissue or semen [9,22]. ...
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Viral infections, such as human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV), are transmitted either sexually or through blood-borne contamination. The later causes enormous concern within health establishments and health care-workers. Post-exposure management of HIV rests on the use of triple Anti-Retroviral Therapy (ART), but special care must be taken to choose the right combination for particular circumstances, especially when the subject is pregnant or likely to get pregnant from the event. New-borns of mothers living with HIV require special attention, as maternal viral load plays a central role in their management. When viral load is not detectable, there is a good argument to avoid ART in these infants. Continued maternal ART is encouraged more so in women who intend to breastfeed. The management of exposure to Hepatitis B requires a detailed risk assessment of the source. In high-risk cases, Hep B immunoglobulin will be necessary otherwise passive immunisation with HBV vaccine will suffice. The use of anti-viral treatment for exposure to Hepatitis C remains controversial. New and potent drugs have been introduced but are quite expensive, and the cost-effectiveness of post-exposure therapy should be considered. Curative treatment now exists for HCV, and an option might be to follow exposed subjects up and give them definitive treatment if seroconversion occurs. This review discusses in details the practical steps in the management of sexual and occupational exposure to HIV and other blood-borne viruses with emphasis on preventing infections. Healthcare facilities should have tightly managed protocols for the management of exposure and the ability to start medication as early as possible when indicated.
... Thus a relatively large proportion of SAns are unvaccinated and at high risk of contracting HB [2]. HBV is a blood-borne virus, thus healthcare workers (HCWs) performing invasive or other exposure-prone procedures, and staff cleaning contaminated surfaces or handling patients' blood and body fluids, are at high risk of occupational exposure (OE) [4,5]. Since human immunodeficiency virus (HIV) co-infection is a wellestablished risk factor for increased HBV replication and transmission, the high prevalence of HIV/HBV co-infection in SA [6] places HCWs at a particularly high risk of OE to HBV. ...
... The SAn National Department of Health (NDoH) guidelines for viral hepatitis management [15], recommend vaccination of student HCWs and in-service at-risk HCWs with three HepB doses, followed by post-vaccination anti-HBs testing to establish response, with anti-HBs 10 mIU/mL being protective. These recommendations follow international guidelines, which add that student HCWs must be protected before being exposed to patients or their specimens [4,5,16]. However, while free HepB has been included for HCWs and health facility cleaning staff in the SAn Standard Treatment Guidelines and Essential Medicines List for >10 years, student HCWs are not included [17]. ...
... In the European Union, member countries need to comply with European Council Directives (2000/54/EC and 2010/32EU) mandating employers of HCWs to offer HepB to all HCWs at risk of OE to HBV. Importantly, the definition of HCWs includes student HCWs [24 ,25] In the United States of America (USA), where student HCWs are included in the HCW definition, employers are legally mandated to provide HepB free to at-risk HCWs [4,5]. Despite the similarity in legislation, the 63% HepB coverage of USA HCWs lags behind the 70-100% in 5 EU countries surveyed in 2019 [24 ]. ...
Article
Healthcare workers (HCWs) are at high risk of contracting hepatitis B (HB), a severe blood-borne vaccine-preventable disease, caused by HB virus (HBV) infection. Low HB vaccine (HepB) coverage has resulted in suboptimal protection and high HBV infection rates in South African HCWs. Studies from Africa have identified cost; unavailability/lack of access to HepB; and lack of awareness/knowledge of HB and HepB, as barriers to HCW uptake. Studies from Europe show little difference in HepB coverage between countries mandating versus recommending HepB. Providing easy and sustained access to free HepB to student HCWs, together with education about HB and HepB, are recommended to create demand for HepB. Only if this fails should mandatory vaccination be considered.
... 2,5 In 2013, the CDC Advisory Committee on Immunization Practices (ACIP) issued updated guidance about the assessment of immunity to HBV in HCP, including postexposure management strategies. 6 More recently, the Communicable Disease Network of Australia (CDNA) published updated guidelines for managing HCP living with bloodborne pathogens, 7 the Public Health Agency of Canada (PHAC) published an exhaustive guideline for the prevention of transmission of bloodborne viruses from HCP to their patients. 8 The United Kingdom published guidance in July 2019 on the health clearance and management of HCP living with a bloodborne pathogen, 9 and CDC issued testing and follow-up information for HCP potentially exposed to HCV. 10 The following section summarizes the changes involved in the management and treatment of these pathogens since 2010. ...
... 1. Assure that HCP living with HBV, HCV, and/or HIV who do not perform category III/exposure-prone procedures are not prohibited from participating in patient-care activities solely on the basis of their infection(s) 2. Ensure that all HCP follow all recommended and applicable infection prevention precautions 3. Ensure that all HCP have the necessary training, personal protective equipment and safer devices and equipment to be able to avoid transfers of blood or other potentially infectious materials 4. Ensure that all HCP who perform or participate in category III/exposure-prone procedures are aware of the ethical obligation to know their HBV, HCV, and HIV serologic/infection statuses 5. Provide all HCP who have potential for exposure to blood in the healthcare workplace with an HBV vaccine series and assure that vaccination has been successful, as measured by an anti-HBs response 6. Provide HCP who either refuse to be vaccinated or fail to develop an anti-HBs response after a second immunization series with access to additional testing to assess the HCP's HBV status (eg, HBsAg or anti-HBc) 6 7. Ensure that HCP who perform category III/exposure-prone procedures and who have not been, or cannot be, immunized with the HBV vaccine are aware that they should undergo annual testing for HBV to assure they are not infected. The Canadian guidelines 8 and the UK guidelines 9 recommend annual and postexposure testing 8. Create postexposure management protocols for follow-up testing for potential or known exposures to HBV, HCV, and HIV that occur during the provision of healthcare 9. Confirm suspected HCV or HIV infection among HCP with virus-specific RNA testing; confirm suspected HBV infection with HBsAg and/or HBV DNA testing 10. ...
... Healthcare workers (HCWs) are at risk of infection due to needle-stick injuries (NSIs) worldwide [1,2]. Among the three major blood-borne pathogens transmitted through NSIs, i.e., hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV), immunization is available for only HBV (4). Moreover, postexposure management has been well established for HIV and HBV [3,4]. ...
... Among the three major blood-borne pathogens transmitted through NSIs, i.e., hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV), immunization is available for only HBV (4). Moreover, postexposure management has been well established for HIV and HBV [3,4]. In contrast, no vaccine is available for HCV [5]. ...
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Background As a blood-borne pathogen, hepatitis C virus (HCV) has long been a major threat associated with needle-stick injuries (NSIs) mainly because no vaccine is available for HCV. Following an NSI, we usually test the source patient for HCV antibody (HCV-Ab). Since HCV-Ab positivity does not necessarily indicate current infection, HCV RNA is further examined in patients positive for HCV-Ab. Direct-acting antivirals (DAAs) have enabled us to treat most HCV-infected patients; therefore, we speculate that the rate of HCV RNA positivity among HCV-Ab-positive patients decreased after the emergence of DAAs. This cross-sectional study was performed to investigate the change in the actual HCV RNA positivity rate in source patients before and after the interferon (IFN)-free DAA era. Methods This was a cross-sectional study of NSI source patients at a tertiary academic hospital in Japan from 2009 to 2019. IFN-free DAA regimens were first introduced in Japan in 2014. Accordingly, we compared HCV status of NSI source patients that occurred between 2009 and 2014 (the era before IFN-free DAAs) with those that occurred between 2015 and 2019 (the era of IFN-free DAAs) in a tertiary care hospital in Japan. Results In total, 1435 NSIs occurred, and 150 HCV-Ab-positive patients were analyzed. The proportion of HCV RNA-positive patients significantly changed from 2009 through 2019 ( p = 0.005, Cochran–Armitage test). Between 2009 and 2014, 102 source patients were HCV-Ab-positive, 78 of whom were also positive for HCV RNA (76.5%; 95%CI, 67.4–83.6%). Between 2015 and 2019, 48 patients were HCV-Ab-positive, 23 of whom were also positive for HCV RNA (47.9%; 95%CI, 34.5–61.7%; p = 0.0007 compared with 2009–2014). In the era of IFN-free DAAs, 9 of 23 HCV RNA-negative patients (39.1%) and 2 of 22 HCV RNA-positive patients (9.1%) were treated with an IFN-free combination of DAAs ( p = 0.0351). Regarding the departments where NSIs occurred, HCV RNA-negative patients were predominant in departments not related to liver diseases in the era of IFN-free DAAs ( p = 0.0078, compared with 2009–2014). Conclusions Actual HCV RNA positivity in source patients of NSIs decreased after the emergence of IFN-free DAAs. IFN-free DAAs might have contributed to this reduction, and HCV RNA-negative patients were predominant in departments not related to liver diseases in the era of IFN-free DAAs.
... Before hepatitis B vaccination was widely implemented, hepatitis B virus (HBV) infection was recognized as a common occupational risk among HCP (82,83). Routine hepatitis B vaccination of HCP and the use of standard precautions have resulted in a 98% decline in HBV infections among HCP from 1983 through 2010 (84). The Occupational Safety and Health Administration mandates that employers offer hepatitis B vaccination to all personnel who have occupational risk and that postexposure prophylaxis be available following an exposure (74,84,85). ...
... Routine hepatitis B vaccination of HCP and the use of standard precautions have resulted in a 98% decline in HBV infections among HCP from 1983 through 2010 (84). The Occupational Safety and Health Administration mandates that employers offer hepatitis B vaccination to all personnel who have occupational risk and that postexposure prophylaxis be available following an exposure (74,84,85). Continued efforts are needed to increase hepatitis B vaccination coverage among unvaccinated HCP to protect workers and patients (86). ...
Article
Problem/condition: Adults are at risk for illness, hospitalization, disability and, in some cases, death from vaccine-preventable diseases, particularly influenza and pneumococcal disease. CDC recommends vaccinations for adults on the basis of age, health conditions, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults remains low. Reporting period: August 2017-June 2018 (for influenza vaccination) and January-December 2018 (for pneumococcal, herpes zoster, tetanus and diphtheria [Td]/tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap], hepatitis A, hepatitis B, and human papillomavirus [HPV] vaccination). Description of system: The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. NHIS's objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors. Adult receipt of influenza, pneumococcal, herpes zoster, Td/Tdap, hepatitis A, hepatitis B, and at least 1 dose of HPV vaccines was assessed. Estimates were derived for a new composite adult vaccination quality measure and by selected demographic and access-to-care characteristics (e.g., age, race/ethnicity, indication for vaccination, travel history [travel to countries where hepatitis infections are endemic], health insurance status, contacts with physicians, nativity, and citizenship). Trends in adult vaccination were assessed during 2010-2018. Results: Coverage for the adult age-appropriate composite measure was low in all age groups. Racial and ethnic differences in coverage persisted for all vaccinations, with lower coverage for most vaccinations among non-White compared with non-Hispanic White adults. Linear trend tests indicated coverage increased from 2010 to 2018 for most vaccines in this report. Few adults aged ≥19 years had received all age-appropriate vaccines, including influenza vaccination, regardless of whether inclusion of Tdap (13.5%) or inclusion of any tetanus toxoid-containing vaccine (20.2%) receipt was measured. Coverage among adults for influenza vaccination during the 2017-18 season (46.1%) was similar to the estimate for the 2016-17 season (45.4%), and coverage for pneumococcal (adults aged ≥65 years [69.0%]), herpes zoster (adults aged ≥50 years and aged ≥60 years [24.1% and 34.5%, respectively]), tetanus (adults aged ≥19 years [62.9%]), Tdap (adults aged ≥19 years [31.2%]), hepatitis A (adults aged ≥19 years [11.9%]), and HPV (females aged 19-26 years [52.8%]) vaccination in 2018 were similar to the estimates for 2017. Hepatitis B vaccination coverage among adults aged ≥19 years and health care personnel (HCP) aged ≥19 years increased 4.2 and 6.7 percentage points to 30.0% and 67.2%, respectively, from 2017. HPV vaccination coverage among males aged 19-26 years increased 5.2 percentage points to 26.3% from the 2017 estimate. Overall, HPV vaccination coverage among females aged 19-26 years did not increase, but coverage among Hispanic females aged 19-26 years increased 10.8 percentage points to 49.6% from the 2017 estimate. Coverage for the following vaccines was lower among adults without health insurance compared with those with health insurance: influenza vaccine (among adults aged ≥19 years, 19-49 years, and 50-64 years), pneumococcal vaccine (among adults aged 19-64 years at increased risk), Td vaccine (among all age groups), Tdap vaccine (among adults aged ≥19 years and 19-64 years), hepatitis A vaccine (among adults aged ≥19 years overall and among travelers aged ≥19 years), hepatitis B vaccine (among adults aged ≥19 years and 19-49 years and among travelers aged ≥19 years), herpes zoster vaccine (among adults aged ≥60 years), and HPV vaccine (among males and females aged 19-26 years). Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance. Vaccination coverage was higher among adults reporting ≥1 physician contact during the preceding year compared with those who had not visited a physician during the preceding year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts during the preceding year, depending on the vaccine, 20.1%-87.5% reported not having received vaccinations that were recommended either for all persons or for those with specific indications. Overall, vaccination coverage among U.S.-born adults was significantly higher than that of foreign-born adults, including influenza vaccination (aged ≥19 years), pneumococcal vaccination (all ages), tetanus vaccination (all ages), Tdap vaccination (all ages), hepatitis B vaccination (aged ≥19 years and 19-49 years and travelers aged ≥19 years), herpes zoster vaccination (all ages), and HPV vaccination among females aged 19-26 years. Vaccination coverage also varied by citizenship status and years living in the United States. Interpretation: NHIS data indicate that many adults remain unprotected against vaccine-preventable diseases. Coverage for the adult age-appropriate composite measures was low in all age groups. Individual adult vaccination coverage remained low as well, but modest gains occurred in vaccination coverage for hepatitis B (among adults aged ≥19 years and HCP aged ≥19 years), and HPV (among males aged 19-26 years and Hispanic females aged 19-26 years). Coverage for other vaccines and groups with Advisory Committee on Immunization Practices vaccination indications did not improve from 2017. Although HPV vaccination coverage among males aged 19-26 years and Hispanic females aged 19-26 years increased, approximately 50% of females aged 19-26 years and 70% of males aged 19-26 years remained unvaccinated. Racial/ethnic vaccination differences persisted for routinely recommended adult vaccines. Having health insurance coverage, having a usual place for health care, and having ≥1 physician contacts during the preceding 12 months were associated with higher vaccination coverage; however, these factors alone were not associated with optimal adult vaccination coverage, and findings indicate missed opportunities to vaccinate remained. Public health actions: Substantial improvement in adult vaccination uptake is needed to reduce the burden of vaccine-preventable diseases. Following the Standards for Adult Immunization Practice (https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html), all providers should routinely assess adults' vaccination status at every clinical encounter, strongly recommend appropriate vaccines, either offer needed vaccines or refer their patients to another provider who can administer the needed vaccines, and document vaccinations received by their patients in an immunization information system.
... To achieve this, the vaccine must trigger an immune response which would produce anti-HBs at a concentration of >10 IU/mL at least 1 month and at most 2 months after the 3 rd dose [13] [14]. About 5% -15% of vaccines may not develop the expected immune response following the complete dose administration of the vaccine [15]. Usually, about 30% -50% of people who do not respond to a primary 3-dose vaccine series with anti-HBs concentrations of >10 IU/mL, may respond to an additional vaccine dose or to a 3-dose revaccination series [15] [16]. ...
... About 5% -15% of vaccines may not develop the expected immune response following the complete dose administration of the vaccine [15]. Usually, about 30% -50% of people who do not respond to a primary 3-dose vaccine series with anti-HBs concentrations of >10 IU/mL, may respond to an additional vaccine dose or to a 3-dose revaccination series [15] [16]. Vaccination coverage of healthcare personnel (HCP) against this virus remains low especially in some developing countries. ...
... [16][17][18][19][20][21][22][23] Sufficient anti-HBs-specific post-vaccination titers are broadly considered as the marker of vaccination efficiency and a correlate of HBV-specific protection. [24][25][26] However, the role of HBs-reactive T cells in vaccination cannot be simplified to B cell helper function alone. The high frequency of HBs-reactive T cells in resolving acute hepatitis B, as well as the lack of these cells in chronic HBV infections, provide evidence for the antiviral protection of these cells. ...
... 6 The post-vaccination anti-HBs titers are broadly accepted as protection correlates and, thus, reflect vaccination efficacy. [24][25][26] As compared to healthy populations, ESRD patients, as well as kidney transplant recipients, show lower vaccination efficacy against HBV. [7][8][9][10] In posttransplant settings this is mostly due to, though not limited to, the immunosuppressive therapy. ...
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While virus-specific antibodies are broadly recognized as correlates of protection, virus-specific T cells are important for direct clearance of infected cells. Failure to generate Hepatitis B-specific antibodies is well-known in patients with end-stage renal disease. However, whether and to what extent HBV-specific cellular immunity is altered in this population and how it influences humoral immunity is not clear. To address it, we analyzed HBV-reactive T cells and antibodies in hemodialysis patients post vaccination. 29 hemodialysis patients and 10 healthy controls were enrolled in a cross-sectional study. Using multiparameter flow cytometry, HBV-reactive T cells were analyzed and functionally dissected based on Granzyme B, IFNγ, TNFα, IL2 and IL4 expression. Importantly, HBV-reactive CD4⁺ T cells were detected not only in all patients with sufficient titers but also in 70% of non-responders. Furthermore, a correlation between the magnitude of HBV-reactive CD4⁺ T cells and post-vaccination titers was observed. In summary, our data showed that HBV-reactive polyfunctional T cells were present in the majority of hemodialysis patients even if humoral immunity failed. Further studies are required to confirm their in vivo antiviral capacity. The ability to induce vaccine-reactive T cells paves new ways for improved vaccination and therapy protocols.
... Interventions like vaccination, protective equipment, post-exposure follow up, and training can be effective in reducing the transmission of BBP among HCWs. Evidence shows that pre-exposure anti-HBs testing and post-exposure evaluation decrease the rate of HBV infection among healthcare personnel trainee (Schillie et al., 2013). While the greatest risk of transmission is through percutaneous exposure, transmission of HBV, HCV, and HIV after mucous membrane or non-intact skin exposure to blood or contaminated body fluids have also been reported (Schillie et al., 2013). ...
... Evidence shows that pre-exposure anti-HBs testing and post-exposure evaluation decrease the rate of HBV infection among healthcare personnel trainee (Schillie et al., 2013). While the greatest risk of transmission is through percutaneous exposure, transmission of HBV, HCV, and HIV after mucous membrane or non-intact skin exposure to blood or contaminated body fluids have also been reported (Schillie et al., 2013). Percutaneous exposures occur when HCWs are injured with sharps or needles during medical interventions. ...
Article
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Objectives: Despite numerous initiatives, occupational exposure to blood-borne pathogens (BBP) caused by percutaneous injuries or mucosal contamination remain common among healthcare workers (HCWs). These exposures were decreasing at the American University of Beirut Medical Center (AUBMC) in the previous decades. Recently, the medical center activity has been increasing with higher number of interventions performed and shorter hospital stay. Our aim was to determine the trend of incidents resulting from BBP exposures at AUBMC from 2014 till 2018 and identify whether the increase in hospital activity affected the rate of these exposures. We also aimed to assess the risk factors associated with needle stick injuries (NSIs). Methods: A retrospective observational descriptive study of all exposures to BBPs among HCWs reported to the Environmental Health, Safety, and Risk Management department at the AUBMC between 2014 and 2018 was performed. Results: There were 967 exposures reported among which 84% were due to needlesticks. Residents (40%), followed by nurses (30%), and then by attending physicians (16%) were the top three most exposed occupational groups. Half of the participants injured themselves using either a syringe or a suture needle; and mostly during or after use. Occupation and incident location were associated with NSIs. The mean BBP exposure incidence rate was 5.4 per 100 full-time employees, 65.6 per 100 bed-years, and 0.48 admission-years. The BBP exposure rate per 100 occupied beds per year decreased between 2014 and 2017 then increased in 2018 (P < 0.001). The number of BBP exposures showed a strong, though non-significant negative correlation with the average length of hospital stay (Spearman correlation coefficient = −0.9, P = 0.083). Conclusions: BBP exposure remains a serious occupational hazard. Our study shows that the BBP exposure rate per 100 occupied beds per year started decreasing during the study period before increasing again in 2018. Only the nursing department showed a consistent decrease of exposures. The occupation and incident location were found to be risk factors associated with NSIs. In addition to providing education and training, additional steps such as providing safety equipment and future interventions directed towards adjusting to higher workload should be all considered.
... [12][13][14] Thus, anti-HBV vaccination is recommended for all HCWs independently of job duty. 4,15 Furthermore, the healthcare profession and postgraduate medical students have a high occupational risk for HBV infection, also in countries with a low incidence of the disease. [16][17][18] Particularly, in Italy several studies have demonstrated that healthcare workers and students could have a risk that is low but not negligible. ...
... In fact, even the CDC recommends pre-exposure assessment of current or past anti-HBs results upon matriculation, followed by one or more additional doses of HBV vaccine for subjects with anti-HBs <10 mIU/mL, if necessary, helps to ensure HBV protection after contacts with blood or body fluids. 4 This research has some limitations: it was a retrospective, observational study, and we had no data available on the formulation, and sociodemographic characteristics. Despite these limitations, this study enriches the literature on HBV vaccination and offers additional knowledge and reflections on the persistence of anti-HBV immunity approximately two decades after vaccination from early childhood. ...
Article
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In Italy, vaccination against hepatitis B became compulsory for all the newborns and 12-years-old adolescents in 1991. The main purpose of this study was to evaluate the persistence of long-term protection against HBV in medical students of the University of L’Aquila and in postgraduates Medical Doctors (HCWs) working in San Salvatore Hospital. The second aim was to study the variables associated with a protective anti-HBs antibody level, such as age at vaccination, gender, time elapsed from the last dose of vaccination. Three hundred and forty-two subjects were enrolled from January 2017 to January 2019 and a blood sample was collected to evaluate the levels of serum HBsAg, anti-HBs and anti-HBc. Statistical analysis calculated a multivariable logistic regression model to examine predictors of a protective anti-HBs titer. The larger part (239, 70%) of the students had an anti-HBs titer >10 mIU/mL, those were statistically significant older (26.7 vs 24.5 years, p < .001), vaccinated at age 12 years (83.5% vs 59.9% among vaccinate at infancy, p < .001) and more frequently attending postgraduate medical school (80.8% vs 57.5% among healthcare profession school, p < .001). The multivariable logistic regression model showed that HBV vaccination at age of 12 was significantly and independently associated with protective titers (OR = 10.27, p = .019). The results agreed with literature on HBV vaccination, confirming the efficacy of vaccination after 20 years. In particular, our results suggest that adolescent administration is the main predictor of a protective title, regardless of gender, course and years since vaccinations.
... HBV, being a blood-borne pathogen, represents a significant occupational risk among healthcare workers (HCWs). The frequencies of infection in HCWs are up to 4-times greater than in individuals who do not work in hospitals [8][9][10]. Among the 35 million HCWs working globally, approximately 3 million each year have occupational exposure to HBV infection, leading to up to 66 thousand HBV infections (261 deaths) [9,11]. ...
... The frequencies of infection in HCWs are up to 4-times greater than in individuals who do not work in hospitals [8][9][10]. Among the 35 million HCWs working globally, approximately 3 million each year have occupational exposure to HBV infection, leading to up to 66 thousand HBV infections (261 deaths) [9,11]. The chain of transmission of HBV is thus maintained from patients to HCWs and vice versa as well as to HCW relatives [12]. ...
Article
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BACKGROUND The hepatitis B virus (HBV) infection is a global public health concern that affects about 2 billion people and causes 1 million people deaths yearly. HBV is a blood-borne disease and healthcare workers (HCWs) are a high-risk group because of occupational hazard to patients’ blood. Different regions of the world show a highly variable proportion of HCWs infected and/or immunized against HBV. Global data on serologic markers of HBV infection and immunization in HCWs are very important to improve strategies for HBV control. AIM To determine the worldwide prevalence of HBV serological markers among HCWs. METHODS In this systematic review and meta–analyses, we searched PubMed and Excerpta Medica Database (Embase) to identify studies published between 1970 and 2019 on the prevalence of HBV serological markers in HCWs worldwide. We also manually searched for references of relevant articles. Four independent investigators selected studies and included those on the prevalence of each of the HBV serological markers including hepatitis B surface antigen (HBsAg), hepatitis e antigen (HBeAg), immunoglobulin M anti-HBc, and anti-HBs. Methodological quality of eligible studies was assessed and random-effect model meta-analysis resulted in the pooled prevalence of HBV serological markers HBV infection in HCWs. Heterogeneity (I²) was assessed using the χ² test on Cochran’s Q statistic and H parameters. Heterogeneity’ sources were explored through subgroup and metaregression analyses. This study is registered with PROSPERO, number CRD42019137144. RESULTS We reviewed 14059 references, out of which 227 studies corresponding to 448 prevalence data among HCWs (224936 HCWs recruited from 1964 to 2019 in 71 countries) were included in this meta-analysis. The pooled seroprevalences of current HBsAg, current HBeAg, and acute HBV infection among HCWs were 2.3% [95% confidence interval (CI): 1.9-2.7], 0.2% (95%CI: 0.0-1.7), and 5.3% (95%CI: 1.4-11.2), respectively. The pooled seroprevalences of total immunity against HBV and immunity acquired by natural HBV infection in HCWs were 56.6% (95%CI: 48.7-63.4) and 9.2% (95%CI: 6.8-11.8), respectively. HBV infection was more prevalent in HCWs in low-income countries, particularly in Africa. The highest immunization rates against HBV in HCWs were recorded in urban areas and in high-income countries including Europe, the Eastern Mediterranean and the Western Pacific. CONCLUSION New strategies are needed to improve awareness, training, screening, vaccination, post-exposure management and treatment of HBV infection in HCWs, and particularly in low-income regions.
... Asimismo, y continuando esta misma línea, nuestros resultados corroborarían los datos de menor protección obtenidos en los trabajadores sanitarios con fecha de nacimiento igual o posterior a la inclusión de la vacuna anti-HBs en el calendario de inmunización sistemático, siendo estos más elevados en el Departamento de Salud de Elche-Crevillente, unos datos que concordarían con publicaciones que identifican la perdida de niveles de Anti-HBs con el paso de los años desde el momento de la vacunación infantil incluida en el calendario vacunal (31) . No obstante, estudios realizados para evaluar los niveles de anticuerpos 30 después de la vacunación frente a la hepatitis B (32) , al igual que las guías de recomendaciones dirigidas al personal sanitario, elaboradas por el Grupo de trabajo de la Ponencia de Programa y Registro de Vacunaciones, mantienen que la protección contra el VHB dispone de una duración superior a 30 años en el 90% de los vacunados, y considera protegidos de por vida, debido a la memoria inmunológica, una serología con títulos anti-HBs >10mlU/ml (10) . ...
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Objetivo: Estimar la prevalencia de inmunización frente al virus de la Hepatitis B del personal sanitario, vinculado a los Departamentos de Salud de Torrevieja y Elche-Crevillente, de la Comunidad Valenciana Métodos: Estudio descriptivo transversal en todos los trabajadores sanitarios de dos departamentos de Salud. Obtenida la muestra se identificó los niveles de anticuerpos de superficie del virus de la Hepatitis B a través de los resultados serológicos ubicados en las historias clínicas. Se consideró inmunizado a títulos de anti-HBs ≥10mlU/ml. Las variables analizadas fueron categorizadas según: Departamento; Género; Edad (18-34; 35-49; >50años); categoría profesional (facultativos/Enfermería/Otro personal sanitario/Personal no sanitario); Servicio riesgo contagio (Si/No); Inmunidad (≥10mlU/ml / <10mlU/ml / No Dato) y Vacunacion sistemática anti-HBs según fecha nacimiento (Si/No). Resultados: El personal estudiado ascendió a 2674. Predominó el género femenino 68,8%, el grupo de edad 35-49 años, 52,8%, y la categoría profesional de Enfermería, 32,2%. Un 74,9% de los resultados serológicos identificaron niveles de protección anti-HBs, frente al 11,3% no inmune, y un 13,8% que no disponían de información. Del personal con información serológica (2306), obtuvieron porcentajes de no protección más elevadas la categoría masculina, 17,8%. Los niveles de protección fueron inversamente proporcionales según la variable edad, menor inmunidad a mayor edad. El personal no sanitario y los facultativos arrojaron niveles de protección más bajos, 36,9% y 11,1% respectivamente. Conclusiones: A pesar de identificarse una inmunidad elevada, el porcentaje de no inmunizados y de ausencia de información inmunológica plantea la necesidad de implementar nuevas estrategias de comunicación dirigidas a este colectivo.
... Though hepatitis B and HPV are the causes of these conditions, the hepatitis B and HPV mass vaccination programs have not, at this point, shown empirical impacts on the prevalence of liver cirrhosis and cancer. In spite of the significant reduction in acute cases of hepatitis B, the prevalence of chronic hepatitis B has remained practically unchanged since 1976 [49]. As for the HPV vaccine, although the prevention of HPV infections that are necessary for the potential development of cancer has been observed [45], cancer protection has not yet been empirically documented and uncertainties remain. ...
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Since the late 1940s, mass vaccination programs in the USA have contributed to the significantly reduced morbidity and mortality of infectious diseases. To assist the evaluation of the benefits of mass vaccination programs, the number of individuals who would have suffered death or permanent disability in the USA in 2014, had mass vaccination never been implemented, was estimated for measles, mumps, rubella, tetanus, diphtheria, pertussis, polio, Haemophilus influenzae type b (Hib), hepatitis B, varicella, and human papillomavirus (HPV). The estimates accounted for mortality and morbidity trends observed for these infections prior to mass vaccination and the impact of advances in standard of living and health care. The estimates also considered populations with and without known factors leading to an elevated risk of permanent injury from infection. Mass vaccination prevented an estimated 20 million infections and 12,000 deaths and permanent disabilities in 2014, including 10,800 deaths and permanent disabilities in persons at elevated risk. Though 9000 of the estimated prevented deaths were from liver cirrhosis and cancer, mass vaccination programs have not, at this point, shown empirical impacts on the prevalence of those conditions. Future studies can refine these estimates, assess the impact of adjusting estimation assumptions, and consider additional risk factors that lead to heightened risk of permanent harm from infection.
... Since some studies have shown a high risk of needlestick injuries in nurses because of low compliance with standard precautions in countries such as Iran [3], Indonesia [7], Brazilian [8], South Korea [9], Italy [10], and Saudi Arabia [11], it is necessary to pay more attention to increase adherence level following WHO (The World Health Organization) and CDC (Centers for Disease Control and Prevention) protocols [5,[12][13][14]. According to Zandiyeh et al.'s study, 3.6% of infections occur in Iran's healthcare centers. ...
Article
Introduction: Nurses' compliance with standard precautions is a viable tool for decreasing health hazards in health centers. Objective: This study aimed to identify factors affecting compliance with standard precautions (SPs) of infection control based on the health belief model (HBM) among emergency department nurses employed in the educational-therapeutic centers affiliated with Guilan University Medical Sciences in Rasht City, Iran. Materials and Methods: This cross-sectional study included 252 nurses working in the emergency departments of hospitals in Rasht City. The study samples were recruited using the convenience sampling method from September to October 2020. Nurses completed questionnaires, including demographics data, HBM constructs, knowledge, and compliance with standard precautions. A hierarchical multiple linear regression analysis was used to identify factors related to compliance with SPs. Results: The mean ±SD age of the nurses was 32.77±7.05 years, and the majority of them were females (88.9%). Their mean ±SD score for compliance with SPs was 63.2 ±16.0 (out of 100). The multivariable analysis results showed that the knowledge (β=0.47, 95%CI; 0.30-0.64, P=0.001), perceived benefits (β =0.19, 95%CI; 0.03-0.36, P=0.022) and perceived susceptibility (β =0.25, 95%CI; 0.13-0.36, P=0.001) constructs of HBM were positively correlated with the compliance with SPs. Furthermore, the level of education was significantly related to the compliance with SPs (β =9.51, 95%CI; 0.02-18.99, P=0.049). The final model accounted for 39.8% of the variance in compliance with SPs. Conclusion: Results indicated improvement in activity and safety level of the healthcare workers and also an increase in the overall level of compliance among nurses through education, regular training, and use of encouragement and punishment policies. It is suggested to follow the World Health Organization protocols. Also, the support management could have a better effect on perceived benefits and cues to action.
... HBV remains a key challenge despite being prevented by vaccine (Wang et al., 2016). In several trails HB vaccine has been proven to be safe for dispensing among infants, children, adolescents and adults (Advisory Committee on Immunization Practices and Centers for Disease Control and Prevention (CDC), 2011; Azami et al., 2016;Schillie et al., 2013) Still only 30% of HCWs intended to be vaccinated and others didn't want to get vaccinated as they had apprehension regarding efficacy and safety of vaccines. This reflects the low willingness for vaccination and shows the low knowledge level of HB vaccination (Wang et al., 2016). ...
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Objective: Elimination of viral hepatitis by 2030 as one of the international Sustainable Development Goals puts the hepatitis B vaccination on the forefront. However, barriers to vaccination reported in various studies are of concern. This study explores the global barriers for effective uptake of Hepatitis-B vaccination. Methods: A scoping review of studies reporting hepatitis B vaccination barriers was done using PMC data base and Google scholar search engine. About 803 journal articles and reports on hepatitis B barriers were retrieved but only 36 most relevant items during last 10 years were identified, pile sorted, grouped and analyze. Results: Overall 74 barriers have been identified for effective uptake of hepatitis-B vaccines. Most studies focused on non-zero dose of hepatitis B vaccine, One-third of the barriers are related to system issues, one-fourth of the barriers were related to caregiver education or awareness, fear of side effect, migration etc., one-fifth barriers were related to service provider issues like poor out-reach, home visits, poor communication and/relation with the caregivers, failure to identify unimmunized children etc., and other barriers were social-cultural issues. The review reveals limited availability and accessibility to health-facility based immunization, lack of awareness among caregivers, poor communication by the healthcare workers and negative relationships with the beneficiaries, cost of vaccine in private sector, inconvenience time and place of vaccination etc. as the major barriers for hepatitis B vaccination. Barriers varied from country to country. Conclusion: Myriad barriers for reduced hepatitis-B vaccine uptake need to be addressed contextually as countries are at different stages of hepatitis-B vaccination implementation.
... When the results of the study were evaluated, the questions that the participants can answer correctly only at rates below 40% were Table 2 questions 7, 8 and Table 3 question 3. Regarding these questions, 42.10% of the students in Table 2 immune globulin will provide increased protection 14,15) . ...
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Background: Hepatitis B is an important public health problem as one of the leading causes of morbidity and mortality. The aim of this study was to compare the theoretical and practical knowledge levels of dental assistant students about Hepatitis B Virus. Methods: The 1st and 2nd grade students of the Oral and Dental Health program were invited to participate in the survey. Out of the 68 invited students, 61 completed the questionnaire. The average ages of the male and female students surveyed were 20.27±1.45 and 19.56±1.16, respectively. A total of 34 questions were asked, of which 15 measured basic theoretical knowledge and 19 assessed basic practical knowledge. Results: There was no statistically significant difference between the students’ knowledge for each question according to their sex and grade. When the questionnaire was grouped into basic theoretical and basic practical knowledge levels, both were observed to be high. While the lowest correct answer rate was 35.00% for the questions about practical applications, it was 31.14% for the questions measuring the level of theoretical knowledge. There was no statistically significant difference when the levels of knowledge of 1st and 2nd grade students were compared. Students answered the majority of the questions correctly, and ranged between 71% and 100%. Conclusion: Students’ high level of basic theoretical knowledge can be a result of their in-class education on the fundamentals. However, their knowledge about the correct approaches in practical applications indicates the beneficial role of having well-defined criteria and prevention protocols that are required in hospitals and the effectiveness of their environmental orientations. Keywords : Dental hygienists, Hepatitis B virus, Infections
... To evaluate seroconversion in this study, an anti-HBs titer level of >10 IU/ml, which is a universal indicator of protective immunity, was used. 18,19 While over 98% of the study population received the recommended standard 3-dose vaccination, only 64.6% of participants demonstrated evidence of post-vaccination seroconversion. This is the first study demonstrating a low HBV Health screening for new entry medical students at Newcastle University Medicine (NUMed) Malaysia: a 4-year... ...
... Inadequate IR to HBV vaccination was considered if quantitative anti-HBs level was <10.0 mIU/ml, based on the Center for Disease Control and Prevention guidelines. 17 ...
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Background Hepatitis B (HepB) is an important vaccine preventable infection among healthcare workers (HCWs). Vaccination against Hep B virus, remains the foremost preventive approach. This study aims to measure the antibody titres to Hep B surface antigen (anti-HBs) in a mixed cohort of HCWs. It also aims to study the association between time since vaccination and the anti-HBs titres thus evaluating the duration of seroprotection Methods A total of 200 HCWs, including nursing students (n = 112), nursing staff (n = 49), laboratory technicians (n = 30) and doctors (n = 9) who had received all three doses of the Hep B vaccine and met the inclusion criteria of having taken all three doses of vaccine were included in this study. Anti-HBs titres were estimated by bioMérieux mini VIDAS® automated immunoassay based on the principle of enzyme-linked fluorescence assay. Results Two hundred subjects aged 19 to 52 years were included in the study; mean age was 27.29 ± 0.568 years. Duration since vaccination in the study cohort was ≤ 5 years in 149 (74.5.0%), 6–10 years in 20 (10.0%) and >10 years in 31 (15.5%) subjects. Postvaccination antibody titres were > 100 mIU/ml in 85.0%, 10-100 mIU/ml in 11.0% and ≤ 10 mIU/ml in 3.5%. There was a decline noted in antibody titres as duration after vaccination increased. Increasing age was associated with falling protective titres. Conclusion The study revealed that majority of the HCWs had adequate anti-HBs titres and were protected after vaccination.
... Majority preferred applying antiseptic together with testing for Hepatitis surface antigen post exposure. The positive value is that both these measures are recommended by CDC [16]. However, CDC recommends some of the other measures as well for which the respondents did not have adequate knowledge. ...
... Hepatitis-B virus (HBV) infection is a worldwide healthcare problem. 1 About 10% of the patients develop chronic hepatitis and about 15%-25% develop cirrhosis after infection with HBV. 2,3 National study on HBV has shown upto 2.7% prevalence among high risk group with injecting drugs in Western Nepal. ...
Article
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Background: Hepatitis B vaccine is the single most effective and safest strategy for the prevention of the disease among health care workers (HCW), trainees and medical students. There is scanty information on knowledge, attitude and practice (KAP) regarding Hepatitis B vaccination among medical students who are likely to get exposed in the future as they start practicing. This study was undertaken to understand the knowledge, attitude and practice of hepatitis B vaccination among clinical medical students of Manipal College of Medical sciences at Pokhara, Nepal.
... Individuals with certification that they received a complete HB vaccine series and who have never experienced post-vaccination serologic testing should receive a single vaccine booster dose. These individuals should be treated in relation to the guidelines for the management of individuals with occupational exposure to blood or body fluids that contain HBV [78]. ...
Article
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Hepatitis B (HB) vaccination is the most effective method for preventing HB virus (HBV) infection. Universal HB vaccination containing recombinant HB surface antigens (HBsAg) is recommended. Our data revealed that human monoclonal HB surface antibody (anti-HBs) from individuals inoculated with genotype C-based HB vaccine induced cross-protection against HBV genotype A infection. An in vitro infection model demonstrated anti-HBs-positive sera from individuals inoculated with genotype A- or C-based HB vaccine harbored polyclonal anti-HBs that could bind to non-vaccinated genotype HBV. However, because there were low titers of anti-HBs specific for HBsAg of non-vaccinated genotype, high anti-HBs titers would be required to prevent non-vaccinated genotype HBV infection. Clinically, the 2015 Centers for Disease Control and Prevention guidelines state that periodic monitoring of anti-HBs levels after routine HB vaccination is not needed and that booster doses of HB vaccine are not recommended. However, the American Red Cross suggests that HB-vaccine-induced immune memory might be limited; although HB vaccination can prevent clinical liver injury (hepatitis), subclinical HBV infections of non-vaccinated genotypes resulting in detectable HB core antibody could not be completely prevented. Therefore, monitoring anti-HBs levels after routine vaccination might be necessary for certain subjects in high-risk groups.
... Hepatitis B virus (HBV) infection is a worldwide healthcare problem. 1 After infection with HBV, 10% of the patients develop chronic hepatitis and about 15-25% develop cirrhosis. Half of these individuals later develop hepatic decompensation or hepatocellular carcinoma. ...
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Background Hepatitis B vaccine is the single most effective and safest strategy for the prevention of the disease among health care workers. Despite the knowledge, higher occupational risk among themselves and increasing prevalence of hepatitis B virus worldwide, there is scanty information on knowledge, attitude and practice (KAP) concerning HBV vaccination among health care workers in our country. Objective To understand the knowledge, attitude and practice of hepatitis B vaccination among health care workers at Manipal Teaching Hospital at Pokhara, Gandaki Province in Nepal. Method Four hundred and eight health care workers were enrolled for an observational, cross-sectional study at Manipal Teaching Hospital, Gandaki Province, Nepal after obtaining ethical clearance from Institutional Review Committee. Pre-tested questionnaire including knowledge, attitude and practice regarding hepatitis B vaccination were studied. Result All participants demonstrated good knowledge and positive attitude towards Hepatitis B infection and vaccination. However many had risky practice towards it. Only about half (51.7%) of these participants were completely vaccinated. The most common reason for non vaccination was negligence. Conclusion Despite good knowledge and positive attitude towards hepatitis B infection and vaccination, low rates of vaccination and risky practice was observed among HCW. Various occupational, behavioural, economical and psychological factors associated with it must be explored. Easy availability of vaccine, regular hepatitis B campaigns must be conducted and policy guidelines need to be formulated by the government to manage all aspects of knowledge, attitude and practice of HCWs regarding hepatitis B vaccination.
... The antibody titer was measured by the chemiluminescent enzyme-linked immunosorbent assay (CLEIA) We defined antibody negative as anti-HBs titer at less than 10mIU/ml according to the CDC guidelines. 16 ...
Article
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Hepatitis B virus (HBV) vaccination is recommended for health-care professionals because of their frequent contact with blood. At one medical school, new students undergo HBV antibody tests upon admission, and antibody-negative individuals receive the HBV vaccine. We aimed to characterize individuals who remained antibody negative after HBV vaccination. Between 2009 and 2017, we enrolled 1064 first-year students from a medical school where their HBV antibody test and vaccination records remained. We analyzed data regarding the hepatitis B surface antibody (anti-HBs) test record during admission, vaccination record for antibody-negative participants, anti-HBs test result after completing the three vaccination doses, drug name of the vaccine used, sex, body mass index (BMI), and age. We calculated the yearly percentage of antibody-negative individuals and analyzed the characteristics of vaccine-refractory cases by logistic regression analysis. Of the 1064 participants, 999 were initially antibody negative. They were vaccinated with HBV thrice and tested for antibodies after vaccination. The average age of participants was 20.1 y, with 677 males. Although the type of vaccine has been changed since 2016, the average rate of refractoriness from 2009 to 2015 was 6.9% per year and 18.6% after 2016. Logistic regression analyses showed that sex (male vs. female; OR, 1.787), BMI (OR. 1.171), and vaccine type (genotype A vs. genotype C: OR, 3.144) were significant factors associated with antibody-negative individuals. Vaccine type differences altered the proportion of antibody-refractory individuals, with no association with age. The data on vaccine refractoriness will be continuously analyzed in the future while considering other factors.
... Not only does this accommodation protect HBV-infected students, but it also protects nonresponders to the hepatitis B vaccine; this nonresponse to the hepatitis B vaccine affects 5%-16% of health care providers who are unable to develop an immune response to the vaccine. 27 The 2013 DOJ settlement requires schools and health care facilities to adopt a disability rights policy that outlines their nondiscriminatory approach to students with HBV infection, and CDC recommends that these policies include procedures for the "identification and management of hepatitis Binfected health care providers, students, and school applicants." 14,17 School policies can define HBV vaccination and testing requirements for students and should describe accommodations that will be made for any student whose test results fail to prove HBV immunity or any student who tests positive for HBV infection. ...
... T FH are paramount to the elicitation of BNAbs. Whether induced by vaccination or natural infection, BNAbs targeting invading pathogens have been shown in a variety of contexts to mitigate, eliminate, and even prevent disease (63,64). Some viruses, however, can escape from or disrupt this response, often leading to uncontrolled viral replication and chronic infection. ...
Article
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Follicular-helper T cells (TFH) are an essential arm of the adaptive immune system. Although TFH were first discovered through their ability to contribute to antibody affinity maturation through co-stimulatory interactions with B cells, new light has been shed on their ability to remain a complex and functionally plastic cell type. Due to a lack sample availability, however, many studies have been limited to characterizing TFH in mice or non-canonical tissue types, such as peripheral blood. Such constraints have resulted in a limited, and sometimes contradictory, understanding of this fundamental cell type. One subset of TFH receiving attention in chronic infection are CXCR3-expressing TFH cells (CXCR3+TFH) due to their abnormal accumulation in secondary lymphoid tissues. Their function and clonal relationship with other TFH subsets in lymphoid tissues during infection, however, remains largely unclear. We thus systematically investigated this and other subsets of TFH within untreated HIV-infected human lymph nodes using Mass CyTOF and a combination of RNA and TCR repertoire sequencing. We show an inflation of the CXCR3+TFH compartment during HIV infection that correlates with a lower HIV burden. Deeper analysis into this population revealed a functional shift of CXCR3+TFH away from germinal center TFH (GC-TFH), including the altered expression of several important transcription factors and cytokines. CXCR3+TFH also upregulated cell migration transcriptional programs and were clonally related to peripheral TFH populations. In combination, these data suggest that CXCR3+TFH have a greater tendency to enter circulation than their CXCR3- counterparts, potentially functioning through distinct modalities that may lead to enhanced defense.
... PHCPs include all paid and unpaid individuals providing healthcare, working, or training in healthcare settings. Such individuals have a reasonably high risk of exposure to infectious materials, including blood or other body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces (Ray, 2017;Schillie et al., 2013). The nature of PHCPs' work increases their risk of HBV infection, making it one of their major occupational risks (Auta et al., 2017;Kisic-Tepavcevic et al., 2017;Konlan, Aarah-Bapuah, Kombat, & & Wuffele, 2017). ...
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Background: Hepatitis B Virus (HBV) infection is an important occupational health risk among primary healthcare providers (PHCPs). However, there is limited evidence on whether PHCPs’ level of knowledge and attitude can predict better HBV infection prevention practices. This study established the relationship between knowledge, attitude, and HBV infection prevention practices among PHCPs in Wakiso district, Central Uganda. Methods: A cross-sectional study design was used. Data were collected from 306 PHCPs, using a structured questionnaire. PHCPs were randomly selected from 55 healthcare facilities. STATA version 14.0 was used to analyse data. A ‘modified Poisson’ regression model was used for inferential statistics. Results: About 42.2% of PHCPs exhibited poor knowledge of HBV infection transmission and prevention, 41.8% had a negative attitude, and 41.5% exhibited poor prevention practices. Age (PR 1.82, 95% CI: 1.24–2.66) was positively associated with the level of knowledge. Healthcare facility level (PR 0.53, 95% CI: 0.34–0.84), main department of work (PR 0.69, 95% CI: 0.51–0.95), years in service (PR 0.66, 95% CI: 0.44–0.99), working in private not-for-profit healthcare facilities (PR 0.59, 95% CI: 0.34–0.99), and public healthcare facilities (PR 0.58, 95% CI: 0.42–0.80) were negatively associated with the level of knowledge. There was a negative association between the location of healthcare facility (PR 0.76, 95% CI: 0.62–0.93) and attitude, and a positive association between level of knowledge (PR 1.36, 95% 1.12–1.65) and attitude. Working in a public healthcare facility (PR 0.80, 95% CI: 0.64–0.99) was negatively associated with practices while having a positive attitude (PR 1.60, 95% CI: 1.28–1.99) predicted better HBV infection prevention practices. Conclusion: PHCPs who were more knowledgeable about HBV infection were more likely to have a positive attitude. In turn, having a positive attitude was associated with better HBV infection prevention practices. There is a need to sensitise PHCPs on HBV infection, and provision of screening and vaccination services in order to address the KAP gaps.
... İlk aşı serisinden sonra anti-HBs seviyesi mL başına 10 mIU'dan azsa, yeniden aşılama uygulanmalıdır (22). Yanıt vermeyen kişi ise altı doz veya daha fazla HBA'dan sonra anti-HBs düzeyi mL başına 10 mIU'dan az olan kişi olarak tanımlanır (23). Biz de anti-HBs negatif saptanan ve HBV ile enfekte olmamış çocuklara hepatit B aşılarını 3 doz şeklinde tekrar yaptırmaları gerektiğini bildirdik. ...
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Amaç: Hepatit B virüsü (HBV), akut ve kronik karaciğer hastalığının ve bunlara bağlı morbidite ve mortalitenin başlıca nedenidir. Ülkemizde 1998 yılında Hepatit B aşısı rutin aşı takvimine alındı. Bu çalışmada, ülkemizde Hepatit B aşısı uygulanmaya başlandıktan sonra doğan çocuklardaki Hepatit B belirteçlerinin değerlendirilmesini amaçladık. Gereç ve Yöntemler: Düzce Üniversitesi Tıp Fakültesi Çocuk Polikliniklerine başvurup HBV seroloji testleri yapılan, rutin aşı takviminde aksama olmayan ve yaşları 10-19 arasında olan 310 çocuğun Hepatit B belirteçleri değerlendirildi. Çocukların tam aşılı sayılabilmeleri için 1999 ve sonrası doğumlu olanlar çalışmaya dahil edildi. Aynı hastanın farklı zamanlarda yapılan değerlendirmeleri çalışma dışı bırakıldı. Bulgular: Çalışmaya 166 (%53,5) erkek ve 144 (%46,5) kız toplam 310 çocuk alındı. Çocukların 192’sinde anti-HBs pozitif (%61,9), 118’inde (%38,1) negatif saptandı. Cinsiyetler açısından anti-HBs ve HBsAg pozitifliği karşılaştırıldığında anlamlı fark bulunmadı. Sonuç: Hepatit B aşısı sonrası bireylerin seropozitiflik durumları üzerine günümüzde fazla araştırma yapılmıyor olsa da çalışmamızda saptanan anti-HBs pozitiflik oranları; geniş bir popülasyonda yeni bir çalışma planlanarak aşılama sonrası anti-HBs düzeyinin değerlendirilmesinin tekrar gündeme gelmesini, belki de kişiden kaynaklanan sigara içme, fazla kilo problemi veya aşıların uygulanması yönünden kaynaklanan aşı transportu, saklama ve uygulama problemleri gibi sorunların ortaya çıkmasını sağlayarak, toplumda saptanan pozitif anti-HBs yüzdesinin istenilen düzeye gelmesini sağlayacaktır.
... In addition, US Centre for Disease Control and Prevention recommends checking antibody titers after 1-2 months of full dose of vaccination and booster doses to the HCWs whose anti-HBs is <10mIU/ml or those working in high-risk exposure situations. 12,16 Therefore, screening of the antibodies against hepatitis B is needed to identify and encourage the HCW for vaccine booster dose. ...
Article
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Background: Hepatitis B is a serious public health problem and dental healthcare workers (HCW) are at a greater risk of acquiring the infection. The main aim of this study was to as­sess the knowledge, attitude, and hepatitis B vaccination status of dental HCW at a tertiary dental hospital. Methods: A cross-sectional study was carried out among all dental HCW and their knowledge lev­el, attitude, and vaccine uptake were measured. Factors associated with the receipt of full hepatitis B vaccination was assessed using Pearson’s chi-square test. The data was analyzed using Statistical Package for the Social Sciences version 23. Results: Out of the total 254 dental HCW, 207 responded to the survey signifying a response rate of 81.5%. The mean age of the participants was 25.6±5.4 years. A majority of the participants were female (156; 75.4%), unmarried (169; 81.6%), and dental students (117; 56.5%). Most participants had a fair knowledge (117; 56.5%) and a positive attitude regarding Hepatitis B virus (189; 91.3%). However, the uptake of full dose of hepatitis B vaccine was only 41.5%. Dental HCW’s age, marital status, educational attainment, and type of dental HCW were associated with receipt of full vac­cination (all p-value <0.05). Conclusions: Despite fair knowledge and positive attitude, the uptake of full vaccination was low among the dental HCW. Further strategies are needed to improve the hepatitis B vaccine uptake. Specifically, increasing the access
... However, across several countries, HBV vaccination coverage among all healthcare workforce who directly or indirectly participate in the healthcare service delivery including health extension workers, medical waste handlers, janitors remained low (< 20%) 10 . In Ethiopia, the minimal (14%) 11,12 coverage of HepB vaccination among healthcare professionals was also reported. ...
Preprint
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Objective Ethiopia is one of the countries with high endemicity of hepatitis B infection. In Ethiopia, the current vaccine coverage among health care workers accounts for around 14%. Most health workforce (241,250) of Ethiopia was first considered as susceptible with a probability of getting Hepatitis B Virus acutely and 5–10% chance of progressing to chronic Hepatitis B. Hence, examining cost-utility analysis of hepatitis B vaccination coverage among healthcare workers in Ethiopia was found the most essential work. Method Markov model for expanding vaccination coverage (3 doses of hepatitis B vaccine) was simulated based on the data obtained both primary and secondary data. A secondary data particularly cost and effectiveness data were obtained from published articles, World Health Organization (WHO) guidelines and Ethiopian Federal Ministry of Health (FMOH) documents. Moreover, cost related data for vaccination and chronic hepatitis B treatment were also gathered by interviewing expertise from Tikur Anbesa Specialized Hospital (TASH). This study was conducted from a healthcare payer perspective, with 3% discount rate of cost and health outcome as WHO recommendation. Primarily health outcome was measured by Quality Adjusted Life Year (QALY) gain and Incremental Cost-Effectiveness Ratio (ICER). Deterministic analysis and tornado diagrams were employed to manage parameter uncertainty and show a plausible range of cost and effectiveness of variables. Result Current vaccination program is more expensive (USD 29.99) with a positive incremental cost of USD 1.32 and less effective that have negative incremental effectiveness of -0.08 and total life year gains of 28.54 than Expanded Hepatitis B vaccination strategy which costs USD 28.67 and gives relatively high total life-year gain of 28.62. The resulting ICER was USD 16.23 per QALY gained. However, the ICER was a negative for the current vaccination strategy that could show, it was dominated by the Expanded Hepatitis B vaccination strategy. One-way sensitivity analysis also provided that the current vaccine coverage was dominated for an increase in the risk of infection among unvaccinated individuals. Conclusion Increasing current vaccine coverage from 14% to no less than 80% across Ethiopian healthcare workforces would be the most cost-effective strategy.
... 2 It ranges from acute presentation, mild or fulminant hepatitis to chronic infection with liver cirrhosis, liver failure, hepatocellular carcinoma and death. 3 HBV infection can be prevented by using protective barriers, sterilized medical equipment, and a suitable hospital waste management system. 4 HB immunization as part of childhood vaccination has decreased rate of infection, especially among adults under 20 years. ...
Article
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INTRODUCTION Hepatitis B is an inflammatory process of the liver caused by a viral infection that is found worldwide. The World Health Organization (WHO) estimated that in 2015 about 240 million people were chronic carriers of hepatitis B virus (HBV), 1 with more than 686,000 deaths annually. 2 It ranges from acute presentation, mild or fulminant hepatitis to chronic infection with liver cirrhosis, liver failure, hepatocellular carcinoma and death. 3 HBV infection can be prevented by using protective barriers, sterilized medical equipment, and a suitable hospital waste management system. 4 HB immunization as part of childhood vaccination has decreased rate of infection, especially among adults under 20 years. 5 INTRODUCTION: Hepatitis B virus (HBV) is one of the most common viruses in the modern world and ranked by the WHO as one of the top ten killers. The virus is responsible for approximately 1.5 million deaths worldwide each year, two thirds of which are attributable to primary hepatic carcinoma following HBV infection. OBJECTIVE: To assess the knowledge and attitudes towards hepatitis B and its transmission from mother to child among pregnant women attending the primary health center. METHODS: A cross sectional study was carried for the period from 1st of Sep. /2018-15th of Nov. /2018, at nine primary health centers at Baghdad. A convenient sampling technique was conducted to choose the primary health centers; pregnant women 15-49 years old were included, pregnant women who refuse to participate were excluded. A questionnaire was administered via face-to-face interviews. The questionnaire consisted of 26 items, divided into three parts: demographic information, knowledge of HBV, and attitudes about HBV. RESULTS: The proportion who agreed to participate was high (93%). The most common age groups were (25-29) years old and (20-24) years old, (27.5%) and (26.5%) respectively. More than half of the women were housewives 144 (72%). more than half of the pregnant did not know that hepatitis B is caused by a virus 161 (80.5%).105 (52.5%) did not know that HBV can be transmitted through the use of unsafe needles, sharps, doing tattoo or during dentist visit and nearly (81.0%) did not know that HBV can be transmitted from mother to infant. 123 (61.5%) of the respondent agreed that the person with HBV should always be isolated to prevent HB infection to others. CONCLUSION: Pregnant women had insufficient general knowledge regarding HBV infection and their conception regarding mode of transmission, vaccination and prevention of MTCT were poor. Despite more respondent being aware of the importance of antenatal screening, neonatal vaccination and postnatal follow up of HBV; their attitude towards infected person were poor.
... Passively acquired anti-HBs can be detected for 4-6 months after administration of HBIG. 17 Use of vaccine is recommended in victims with no history of prior vaccination. Yet, this approach is both impractical and ineffective for a traumatized victim of assault. ...
Article
More than 400,000 sexual assaults are reported annually in the United States in females and males above the age of 12. Victims are likely to include members of vulnerable populations such as the disabled, homeless persons, and immigrants. Victims of such assaults are at heightened risk of contracting the Hepatitis B virus (HBV) from their assailant. Unfortunately, approximately two-thirds of people with chronic HBV are unaware of their own status, exposing for victims the risk viral transmission, disease-related cirrhosis, and hepatocellular carcinoma. Victims are also at increased risk for posttraumatic stress disorder (PTSD). Although immediate vaccination of the assaulted victim is recommended, protective levels of antibody are not present for fourteen days post vaccination. Complementary treatment with a Hepatitis B immune globulin (HBIG), however, may provide immediate protective serum concentrations. Prompt prophylactic therapeutic intervention may not only protect patients from risk of infection but may also prevent the effects of PTSD by providing victims with psychological and emotional benefit. Yet, existing Centers for Disease Control and Preventions (CDC) recommendations for suspected HBV infection in sexual assault patients recommend initiating immunoprophylaxis only in cases where the perpetrator’s HBsAg status is known, a guideline that perpetuates inequities and injustice for those equally subject to the harms of sexual assault. This paper presents an ethical assessment of prophylactic treatment for sexual assault patients suspected of HBV exposure. In the absence of equitable guidelines, we argue for the clinician’s duty to rescue sexually assaulted patients from future harm and to protect the public through mitigation of transmission using currently available and evidence-based treatment modalities. The paper concludes with an ethical foundation to advocate for modification of current guidelines in view of existing prophylactic regimens.
... In our study, 87% of those who had received the HBV vaccines, received the 3 doses as recommended by the Center for Disease Control and Prevention (CDC) [38]. For those who have never receive the HBV vaccination, 40% of them said the vaccines were expensive. ...
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Purpose: Hepatitis B viral(HBV) infection is a global public health challenge. Mother to child transmission is the leading cause of HB Vinfection in high endemic countries. The objective of this study was to examine pregnant women's knowledge of HBV and their vaccination uptake in the North Gonja District of the Savanah Region of Ghana. Methods: A facility-based cross-sectional study was conducted in five Health centres and five Community-based Health Planning and Services(CHPS) compounds.Data was collected from April to June 2020 using a structured questionnaire. Data on socio-demographic characteristics,HBV Knowledge, testing and vaccination uptake among 310 pregnant women attending antenatal clinics (ANC) were collected using a simple random sampling method. The data was analyzed using Microsoft Excel version 2019 and IBM SPSS v25. Results were presented as frequencies, percentages, tables and figure. A chi-square test of associations was performed and a P-value of <0.05 was considered statistically significant. Results: In all, 43.25% of the respondents had excellent knowledge, 21.94% had good knowledge whilst 34.84% had poor knowledge. There was a statistical association between educational level (p=0.002), ANC visit (p<0.001), ethnicity (p<0.001), occupation(p<0.011) and knowledge of HBV. Original Research Article Abdul-Wahab et al.; AJPCB, 4(3): 27-39, 2021; Article no.AJPCB.71997 28 HBV testing and vaccination uptake were only 35.5% and close to 33% respectively. Educational level (p<0.001), previous HBV screening (p<0.001), occupation (p<0.001), knowledge of HBV(p<0.001), ANC visit(p=0.002) were significantly associated with Hepatitis B virus vaccination uptake. Conclusion: Pregnant women were knowledgeable of HBV. However, HBV testing and vaccination uptake were low. Pregnant women attending ANC should be screened for hepatitis B. Vaccination of pregnant women against HBV should be introduced into the EPI program.
... Appropriate HCWs should have follow-up serological testing (online supplemental table 2). 34 For HCV, testing of source patient and exposed HCWs should be done as soon as possible. HCV PEP is not recommended. ...
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Objectives: Vietnam is an endemic area for hepatitis B virus and hepatitis C virus infection (HBV-HCV), yet its largest city, Ho Chi Minh City (HCMC), has no comprehensive policy to educate, screen, treat and protect healthcare workers (HCWs) from viral hepatitis. We conducted a mixed-methods study to document HBV-HCV infection rates, risk factors, local barriers and opportunities for providing education, screening and medical care for HCWs. Design: This mixed-methods study involved an HBV and HCV serological evaluation, knowledge, attitude and practice survey about viral hepatitis and many in-depth interviews. Descriptive statistics and thematic content analysis using inductive and deductive approaches were used. Setting: HCMC, Vietnam. Participants: HCWs at risk of viral hepatitis exposure at three hospitals in HCMC. Results: Of the 210 invited HCWs, 203 were enrolled. Of the 203 HCWs enrolled, 20 were hepatitis B surface antigen-positive, 1 was anti-hepatitis C antibody (anti-HCV Ab)-positive, 57 were anti-hepatitis B core Ab-positive and 152 had adequate anti-hepatitis B surface Ab (anti-HBs Ab) titre (≥10IU/mL). Only 50% of the infected HCWs reported always using gloves during a clinical activity involving handling of blood or bodily fluid. Approximately 50% of HCWs were still not vaccinated against HBV following 1 year of employment. In-depth interviews revealed two major concerns for most interviewees: the need for financial support for HBV-HCV screening and treatment in HCWs and the need for specific HBV-HCV guidelines to be independently developed. Conclusions: The high HBV infection rate in HCWs coupled with inadequate preventive occupational practices among the population in HCMC highlight the urgent needs to establish formal policy and rigorous education, screening, vaccination and treatment programmes to protect HCWs from HBV acquisition or to manage those living with chronic HBV in Vietnam.
... This finding should not, however, indicate the absence of immunogenicity of these vaccines; it is well known that in vaccinated individuals, anti-HBs wanes rapidly over time, but the majority preserve vaccine-induced immunological memory that can be verified by an anamnestic response to a challenge dose of HBV vaccine. 27 Fifth, the vaccines used in this study might be less effective in preventing HBV genotypes circulating in this area. The efficacy of Engerix-B, originally developed from HBV genotype A2, against non-A2 subgenotypes has been questioned. ...
Article
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Background In sub-Saharan Africa, administration of hepatitis B virus (HBV) birth-dose vaccines remains suboptimal. Evidence is scarce on whether African countries should focus on increasing vaccine coverage or developing strategies incorporating additional measures, such as peripartum antiviral prophylaxis to pregnant women at high risk. To better inform decision makers, we estimated the residual risk of mother-to-child transmission despite HBV birth-dose vaccine in Cameroon. Methods We did a single-centre, longitudinal observational study. Pregnant women were systematically screened for HBV surface antigen (HBsAg) at Tokombéré District Hospital (Tokombéré district, Cameroon). Children born to HBsAg-positive mothers in 2009–16 who received the HBV birth-dose vaccine and three subsequent doses of pentavalent vaccine at 6, 10, and 14 weeks were followed up prospectively in 2015–17. In children, capillary blood was obtained for HBsAg rapid test and dried blood spots to quantify HBV DNA concentrations. Venous blood was also collected from HBsAg-positive children. Mother-to-child transmission was confirmed by whole-genome sequencing. Findings Between Jan 31, 2009, and Dec 31, 2016, 22 243 (66·8%) of 33 309 pregnant women accepted antenatal HBV screening, of whom 3901 (17·5%) were HBsAg positive. 2004 (51·4%) of 3901 children who were born to HBsAg-positive mothers received the HBV birth-dose vaccine, of whom 1800 (89·8%) also completed the three-dose pentavalent vaccine. In total, the current analysis included 607 children who had a follow-up serosurvey. The prevalence of HBsAg was 5·6% in children who received the birth-dose vaccine in less than 24 h, 7·0% in those who received it 24–47 h after birth, and 16·7% in those who received it 48–96 h after birth (ptrend=0·083). 35 (89·7%) of 39 infected children were born to mothers positive for HBV e antigen with high HBV DNA of 5·3 log10 IU/mL or more. Whole-genome sequencing of HBV in infected mother-child pairs confirmed high identity proportions of 99·97–100%. Interpretation We documented a substantial risk of mother-to-child transmission despite timely administration of the HBV birth-dose vaccine within 24 h after birth. To reach WHO's elimination targets, peripartum antiviral prophylaxis might be required in parts of Africa, in addition to increasing coverage of the HBV birth-dose vaccine. Funding Agence nationale de recherches sur le sida et les hépatites virales (ANRS).
... This is adopted following bacterial infections in the case of tetanus, but is more common following exposure to viral infections. Although the post exposure approach is many times specific to the viral infection context, as for hepatitis B virus (7) or after a bite from a rabies infected dog, the concept is generally the same (8). Thus, active vaccination with the attenuated/killed pathogen or viral associated protein is a very effective mean to attenuate and almost eliminate any infection related symptoms. ...
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Background: During the COVID-19 pandemic, post-exposure-prophylaxis is not a practice. Following exposure, only patient isolation is imposed. Moreover, no therapeutic prevention approach is applied. We asked whether evidence exists for reduced mortality rate following post-exposure-prophylaxis. Methods: To estimate the effectiveness of post-exposure-prophylaxis, we obtained data from the Israeli Ministry of Health (MoH) registry. The study population consisted of Israeli residents aged 12 years and older, identified for the first time as PCR-positive for SARS-CoV-2, between December 20th, 2020 (the beginning of the vaccination campaign) and October 7th, 2021. We compared 'recently injected' patients - that proved PCR-positive on the same day or on one of the five consecutive days after first vaccination (representing an unintended post-exposure-prophylaxis), to unvaccinated control group. Results: Among Israeli residents identified PCR-positive for SARS-CoV-2, 11,690 were found positive on the day they received their first vaccine injection (BNT162b2) or on one of the 5 days thereafter. In patients over 65 years, 143 deaths occurred among 1413 recently injected (10.12%) compared to 280 deaths among the 1413 unvaccinated (19.82%), odd ratio (OR) 0.46 (95% confidence interval (CI), 0.36 to 0.57; P<0.001). The most significant reduction in the death toll was observed among the 55 to 64 age group, with 8 deaths occurring among the 1322 recently injected (0.61%) compared to 43 deaths among the 1322 unvaccinated control (3.25%), OR 0.18 (95% CI, 0.07 to 0.39; P<0.001). Conclusion: Post-exposure-prophylaxis is effective against death in COVID-19 infection. Israeli MoH Registry Number: HMO-0372-20
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Description of the spatial characteristics of viral dispersal is important in understanding the history of infections. Nine hepatitis B virus (HBV) genotypes (A-I), and a putative 10 th genotype (J), with distinct geographical distribution, are recognized. In sub-Saharan Africa (sub)-genotypes A1, D3 and E circulate, with E predominating in western Africa (WA), where HBV is hyperendemic. The low genetic diversity of genotype E (HBV/E) suggests its recent emergence. Our aim was to study the dispersal of HBV/E using full-length, non-redundant and non-recombinant sequences available in public databases. HBV/E was confirmed, and the phylogeny reconstruction performed using maximum likelihood (ML) with bootstrapping. Phylogeographic analysis was conducted by reconstruction of ancestral states using the criterion of parsimony on the estimated ML phylogeny. 46.5% of HBV/E sequences were found within monophyletic clusters. Country-wise analysis revealed the existence of 50 regional clusters. Sequences from WA were located close to the root of the tree, indicating this region as the most probable origin of the HBV/E epidemic and expanded to other geographical regions, within and outside of Africa. A localized dispersal was observed with sequences from Nigeria and Guinea as compared to other WA countries. Based on the sequences available in the databases, the phylogenetic results suggest that European strains originated primarily from WA whereas a majority of American strains originated in Western Central Africa. The differences in regional dispersal patterns of HBV/E suggest limited cross-border transmissions because of restricted population movements.
Article
Background: The duration of protection from hepatitis B vaccination in children and adults is not known. In 1981, we used three doses of plasma-derived hepatitis B vaccine to immunize a cohort of 1578 Alaska Native adults and children from 15 Alaska communities who were 6 months or older. Methods: We tested persons for anti-HBs levels 35 years after receiving the primary series. Those with levels <10 mIU/ml received 1 booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days post-booster. Results: Among the 320 recruited, 112 persons had not participated in the 22 nor 30-year follow-up study (Group 1) and 208 persons had participated but were not given an HBV booster dose (Group 2). Among the 112 persons in Group 1 who responded to the original primary series, 53 (47.3%) had an anti-HBs level ≥10 mIU/ml. Among group 1, 73.7% (28/38) of persons available for a booster dose responded to it with an anti-HBs level ≥10 mIU/ml at 30 days. Initial anti-HBs level after the primary series was correlated with higher anti-HBs levels at 35 years. Among 8 persons who tested positive for anti-HBc, none tested positive for HBsAg nor HBV DNA. Conclusions: Based on anti-HBs level ≥10 mIU/ml at 35 years and a 73.7% booster dose response, we estimate 86% of participants had evidence of protection 35 years later. Booster doses are not needed in the general population at this time.
Article
Background: Health care workers face a wide range of chemical, physical, and biological occupational hazards in their jobs. Objective: The present study aimed to investigate research trends on post-exposure prophylaxis (PEP) against blood-borne viral infections among health care workers. Method: Keywords related to health care workers, PEP, and blood-borne viruses were entered in the Scopus database for the period from 1950 to 27 January 2022. Results: The search query returned 271 papers. The earliest publication was in 1984. The Pan African Medical Journal ranked first (n = 8, 3.0%), followed by the Infection Control and Hospital Epidemiology and Journal of Hospital Infection with 6 (2.2%) papers for each. One hundred ninety-one journals took part in publishing the retrieved papers. Authors from 63 different countries took part in publishing the retrieved papers. The United States (US) ranked first (n = 53, 19.6%) followed by India (n = 26, 9.6%). The United States Centers for Disease Control and Prevention contributed the most (n = 9, 3.3%) and ranked first in the top active institutions. The mean number of authors per paper was 4.4 and the mean number of citations per paper was 17.0. The most frequent author keywords focused on PEP, health care workers, occupational exposure, HIV, hepatitis B, anti-retroviral and needle-stick injuries. Research themes in the retrieved papers focused on knowledge/attitude/practice and management and epidemiology of occupational exposure and PEP. There was a limited number of research publications in this field. Conclusion: Research activity in this field needs to be strengthened in low- and middle-income countries through reporting and training of HCWs.
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Infection caused by hepatitis B virus (HBV) can be prevented through a safe and effective vaccine. This study analysed the kinetics of serum antibodies against hepatitis B surface antigen (HBsAg) (anti-HBs) titers in relation to previous vaccine boosters in Italian nursing students who were followed up for two years. Serum anti-HBs titers were evaluated at the first visit, after vaccine booster (if required) and at visit after two years. Overall, 483 students (mean age = 21.7 years; SD = 3.7) with median anti-HBs IgG titer of 6 mUI/mL (interquartile range (IQR) = 0–34) were enrolled. A total of 254 (52.5%) students with a titer lower than 10 mIU/mL were offered an anti-HBV booster at the first visit. Among these students, an exponential relation between anti-HBs IgG titer, one month after HBV booster and anti-HBs IgG titer two years later was found (y = 3.32 exp (0.0045x); R2 = 0.48; p < 0.001). Students with anti-HBV titer higher than 10 mIU/mL (N = 229) were followed up, and anti-HBs IgG titers at follow-up visit linearly correlated with anti-HBV baseline titers (y = 0.86x + 26.2; R2 = 0.67; p < 0.001). A decrease in anti-HBs titers can be expected a few years after the anti-HBV booster dose. This reduction is more pronounced than that observed in students not administered the booster dose and is exponential with respect to basal titers assessed after the booster dose.
Article
BACKGROUND Dentists are at high risk for Hepatitis B infection. Vaccination provides effective immunity. Not all dentists are vaccinated despite awareness and availability. Hepatitis B vaccination for health care workers is mandatory as per Biomedical Waste Management Rules, 2018. The present study was planned to determine the vaccination status amongst dentists and their approach to Hepatitis B infected patients. METHODS After the institutional ethics committee permission, the study was initiated. A Google form along with an online consent was emailed to all dentists registered with Maharashtra dental council (MDC). Post survey, a short information sheet was mailed to all, about the need for Hepatitis B vaccination and certain aspects related to it. The responses were automatically transferred to a Microsoft excel sheet and analyzed. RESULTS 16,418 emails were sent out. 371 (2.3 %) participants responded, 352 (2.1 %) working dentists were included. 78.2 % (N = 273) were from urban area. 56 % (N =192) participants were in the age group 22-30 years. Male to female ratio was 0.8:1. 52.2 % (N = 184) had own clinic and 34.4 % (N = 121) were private practitioners. 56.4 % (N = 195) were dental graduates and 43.6 % (N = 151) were postgraduates. The vaccination status of dentists was found to be 74.7 % (N = 263). Only 22.1 % (N = 58) had tested for antibody titre against Hepatitis B, 55.7 % (N = 196) dentists routinely carried out hepatitis B testing of their patients. If patients tested positive, 53.1 % (N =187) provided dental care in their own clinic. CONCLUSIONS Improving the hepatitis B vaccination amongst dentists will improve their safety and reduce their fear of managing infected patients. KEY WORDS Hepatitis B, Vaccination, Dentists, Survey.
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Since the introduction of hepatitis B virus (HBV) vaccines, the numbers of HBV infections and complications have significantly decreased. However, the evidence on whether primary vaccination of infants confers lifelong immunity varies. We aimed to assess long-term immunity among healthcare workers and medical students, and the rate of decline of HBV surface antigen antibodies (anti-HBs). Hepatitis B status among participants born after 1 January 1992 was reviewed at Chulabhorn Royal Academy, Thailand. Participants were stratified by intervals since primary vaccination. HBV immunity was determined and analyzed as anti-HBs decline rate in participants with multiple follow-ups. A total of 464 participants were analyzed, with a median age of 23. Protective immunity against HBV (anti-HBs ≥ 10 mIU/mL) at 16–20, 21–25 and 26–28 years post-primary vaccination was 28%, 51.7% and 60%, respectively. The overall declining rate of anti-HBs was −42.39 mIU/mL per year. Participants with anti-HBs levels of >100–1000 mIU/mL at baseline had a faster decline rate than those with anti-HBs levels of 10–100 mIU/mL. Primary vaccination may not provide lifelong protection since HBV immunity deteriorates over time. Individuals with higher initial HBV immunity levels may experience a faster decline rate.
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Hepatitis B vaccine has contributed to the reduction in hepatitis B virus infections and chronic disease globally. Screening to establish extent of vaccine induced immune response and provision of booster dose are limited in most low-and-middle income countries (LMICs). Our study investigated the extent of protective immune response and breakthrough hepatitis B virus infections among adult vaccinated healthcare workers in selected health facilities in northern Uganda. A cross-sectional study was conducted among 300 randomly selected adult hepatitis B vaccinated healthcare workers in Lira and Gulu regional referral hospitals in northern Uganda. Blood samples were collected and qualitative analysis of Hepatitis B surface antigen (HBsAg), Hepatitis B surface antigen antibody (HBsAb), Hepatitis B envelop antigen (HBeAg), Hepatitis B envelop antibody (HBeAb) and Hepatitis B core antibody (HBcAb) conducted using ELISA method. Quantitative assessment of anti-hepatitis B antibody (anti-HBs) levels was done using COBAS immunoassay analyzer. Multiple logistic regression was done to establish factors associated with protective anti-HBs levels (≥ 10mIU/mL) among adult vaccinate healthcare workers at 95% level of significance. A high proportion, 81.3% (244/300) of the study participants completed all three hepatitis B vaccine dose schedules. Two (0.7%, 2/300) of the study participants had active hepatitis B virus infection. Of the 300 study participants, 2.3% (7/300) had positive HBsAg; 88.7% (266/300) had detectable HBsAb; 2.3% (7/300) had positive HBeAg; 4% (12/300) had positive HBeAb and 17.7% (53/300) had positive HBcAb. Majority, 83% (249/300) had a protective hepatitis B antibody levels (≥10mIU/mL). Hepatitis B vaccine provides protective immunity against hepatitis B virus infection regardless of whether one gets a booster dose or not. Protective immune response persisted for over ten years following hepatitis B vaccination among the healthcare workers.
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Background Occupational hazards like sharp injury and splash exposure (SISE) are frequently encountered in health-care settings. The adoption of standard precautions by healthcare workers (HCWs) has led to significant reduction in the incidence of such injuries, still SISE continues to pose a serious threat to certain groups of HCWs. Materials and Methods This was a retrospective study which examined the available records of all patients from January 2015 to August 2019 who self-reported to our emergency department with history of sharp injury and/or splash exposure. Details of the patients, mechanism of injury, the circumstances leading to the injury, status of the source (hepatitis B surface antigen, human immunodeficiency virus, and hepatitis C virus antibody status), and the postexposure prophylaxis given were recorded and analyzed. Data were represented in frequency and percentages. Results During the defined period, a total of 834 HCWs reported with SISE, out of which 44.6% were doctors. Majority of the patients have SISE while performing medical procedures on patients (49.5%), while 19.2% were exposed during segregation of waste. The frequency of needle stick injury during cannulation, sampling, and recapping of needle were higher in emergency department than in wards. More than 80% of HCWs received hepatitis B vaccine and immunoglobulin postexposure. Conclusion There is need for periodical briefings on practices of sharp handling as well as re-emphasizing the use of personal protective equipment while performing procedures.
Article
Background: The objective of this study was to define the relative impact of alcohol and/or hepatitis-related HCC etiology on the outcomes of patients who underwent resection or transplantation for HCC. Methods: The SEER-Medicare database was used to identify patients with HCC between 2004 and 2015. Patients with history of alcohol abuse or hepatitis were identified. Overall survival (OS) and cancer-specific survival (CSS) were calculated using the Kaplan-Meier method and multivariable Cox regression analysis. Results: Among 1140 patients, 11.9% (n = 136) of patients had alcohol-related HCC, 30.0% (n = 342) hepatitis-related HCC, and 58.1% (n = 662) had other cause-related HCC. On multivariable analysis, patients with alcohol-related HCC (HR:1.06, 95%CI:0.82-1.35) or hepatitis-related HCC (HR:1.05, 95%CI:0.88-1.26) had similar hazards of death compared with patients who had non-alcohol/non-hepatitis-related HCC. Patients who had tumor size ≤5 cm had lower hazards of death (HR:0.81, 95%CI:0.68-0.97), while individuals who underwent liver resection (vs. transplantation) had almost a two-fold higher hazards of death (HR:1.99, 95%CI:1.47-2.69). Conclusion: Tumor specific factors (i.e. tumor size and stage) and operative approach (i.e. resection vs. transplantation) -rather than HCC etiology- dictated both OS and CSS.
Article
Health care personnel (HCP) are at risk of exposure to infectious agents depending on their job duties and other factors. Risks include percutaneous exposure to blood-borne pathogens via sharp injuries (eg, human immunodeficiency virus, hepatitis B virus, hepatitis C virus); exposure by direct contact, droplet, or airborne transmission of pathogens through direct patient care (eg, pertussis, invasive meningococcus infections, tuberculosis); and through indirect contact transmission related to the contaminated health care environment (eg, Clostridioides difficile). Occupational health programs must effectively identify and respond to potential exposures and provide guidance to HCP on postexposure prophylaxis.
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ABSTRACT Objective: The global epidemic of hepatitis B is a significant public health problem. The endemicity of HBV infection used to be believed high in Yemen. Data for the prevalence of HBsAg among children in rural and urban areas in Yemen is scarce and incompetent. The study was made to determine prevalence of HB surface antigen among children in 2 selected areas in Yemen. Methods: Eight hundred forty and 212 children were randomly chosen from Sana'a city and Shabowah governorate, respectively. Sera were tested for HBs antigen by ELISA technique, and HB genome was tested for positive HB surface antigen specimens to confirm positivity using polymerase chain reaction (PCR)-based test. Each data collected in a pre-designed questionnaire including sex, age, and risk factors of HBV and prior vaccine of HBV. Results: The prevalence of HB surface antigen among children in Sana'a city was only 1.8%, and in Shabowah governorate was 3.8%. There was a significant association of non-vaccinated children, birth by cesarean, and with a history of parental exposure with contracting HBV infection. Conclusion: Evidence from these studies in Yemen suggests that there is a steady increase in exposure to HBV over a lifetime. Hospital-acquired HBV infection is common in Yemen, and high vaccination coverage rate should be achieved, particularly in rural areas, in parallel with health education.
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HEPATİT B REHBER GÜNCELLEME Editör Sıla AKHAN Kocaeli Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Kocaeli Yazarlar A. Atahan ÇAĞATAY İstanbul Üniversitesi İstanbul Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, İstanbul Ali ASAN Sağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Bursa Alper ŞENER Onsekiz Mart Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Çanakkale Aysel KOCAGÜL-ÇELİKBAŞ Hitit Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Çorum Ayşe BATIREL Sağlık Bilimleri Üniversitesi Kartal Dr. Lütfi Kırdar Şehir Hastanesi, İstanbul Bahar ÖRMEN Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi, İzmir Dilara İNAN Akdeniz Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Antalya Eda KÖKSAL Sağlık Bilimleri Üniversitesi Samsun Eğitim Araştırma Hastanesi, Samsun Ediz TÜTÜNCÜ Kafkas Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Kars Emel YILMAZ Uludağ Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Bursa Esma YÜKSEL Çiğli Eğitim ve Araştırma Hastanesi, İzmir Eyüp ARSLAN Diyarbakır Bismil Devlet Hastanesi, Diyarbakır Faruk KARAKEÇİLİ Erzincan Binali Yıldırım Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Erzincan Fatma YILMAZ-KARADAĞ Sağlık Bilimleri Üniversitesi Sancaktepe Şehit Prof. Dr. İlhan Varank Eğitim ve Araştırma Hastanesi, İstanbul Figen SARIGÜL YILDIRIM Sağlık Bilimleri Üniversitesi Antalya Eğitim ve Araştırma Hastanesi, Antalya Funda ŞİMŞEK Sağlık Bilimleri Üniversitesi SB Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, İstanbul Güle ÇINAR Ankara Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Ankara Günay TUNCER ERTEM Sağlık Bilimleri Üniversitesi Ankara Eğitim ve Araştırma Hastanesi, Ankara H. Kaya SÜER Yakın Doğu Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Lefkoşa H. Şener BARUT Gaziosmanpaşa Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Tokat Mehtap AYDIN Sağlık Bilimleri Üniversitesi Ümraniye Eğitim ve Araştırma Hastanesi, İstanbul Murat SAYAN Kocaeli Üniversitesi Tıp Fakültesi, PCR Ünitesi, Kocaeli Yakın Doğu Üniversitesi Deneysel Sağlık Bilimleri Araştırma Merkezi, Lefkoşa Nazlım AKTUĞ DEMİR Selçuk Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Konya Necla TÜLEK Atılım Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Ankara Neşe SALTOĞLU İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, İstanbul Onur URAL Selçuk Üniversitesi Tıp Fakültesi İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Konya Özgür GÜNAL Sağlık Bilimleri Üniversitesi Samsun Eğitim Araştırma Hastanesi, Samsun Süda TEKİN Koç Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, İstanbul Şükran KÖSE Sağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi, İzmir Yunus GÜRBÜZ Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, Ankara Ziya KURUÜZÜM Dokuz Eylül Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, İzmi
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To evaluate hepatitis B vaccination coverage and documentation of vaccine-induced immunity. Retrospective cohort analysis. Graduate school in the United States with programs in osteopathic medicine, dentistry, and allied health. Data collected included demographics, dates of hepatitis B vaccine doses, and postvaccination concentrations of antibody to hepatitis B surface antigen (anti-HBs), with dates. The proportions of students with anti-HBs of 10 IU/L or more by demographics, age at vaccination, interval since completion of the primary series, and response to additional vaccine doses were compared. Of 3,452 students who matriculated during 2004-2009, 2,643 had complete data; 2,481 (93.9%) received 3 primary doses. Most were women (64.6%), US-born (85.6%), and white (63.2%); median age at receipt of the primary series was 14.5 years (interquartile range, 11.6-20.2 years) and at postvaccination testing was 23.2 years (interquartile range, 22.1-24.8 years). Of those who received 3 primary doses, 2,306 (92.9%) had an anti-HBs postvaccination concentration of 10 IU/L or more. Younger age at vaccination and longer time interval from vaccination to anti-HBs testing were associated with a postvaccination concentration of less than 10 IU/L (P< .001 and P = .0185, respectively, Cochran-Armitage test for trend). Almost all students (98.2%) who initially had less than 10 IU/L of anti-HBs, but then received at least 1 additional dose, had a follow-up anti-HBs concentration of 10 IU/L or more. Almost all students had serologic evidence of protection against hepatitis B virus infection; most were vaccinated as adolescents and were tested more than 10 years after vaccination. Among students with anti-HBs concentrations of less than 10 IU/L, nearly all had 10 IU/L or more after at least 1 additional vaccine dose.
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We evaluated hepatitis B vaccination coverage and documentation of antibody to hepatitis B surface antigen (anti-HBs) concentration among a cohort of healthcare students. Of 4,075 students, 59.8% had documentation of vaccination and 83.8% had anti-HBs concentration greater than or equal to 10 mIU/mL. Documenting hepatitis B vaccination and anti-HBs concentration among healthcare students is needed to prevent transmission in healthcare settings. © 2011 by The Society for Healthcare Epidemiology of America. All rights reserved.
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After several decades of vaccination against hepatitis B virus in newborns, infants, adolescents, and adults, the question remains whether a booster dose is ever needed. Long-term protection is most commonly measured through 4 methods: the anamnestic response after administration of a booster dose, infection rate in vaccinated populations, in vitro B and T cell activity testing, and seroepidemiological studies. Long-term protection is present despite a decrease in anti-hepatitis B surface antibodies over time. The exact mechanism of long-term protection, however, is not yet fully understood. There is no need for boosters in immunologically potent persons as long as a full course was adequately administered that respected the recommended timelines, as evidenced by studies conducted up to 20 years after the original immunization course. However, a booster dose should be planned for immunocompromised patients, based on serological monitoring.
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To evaluate the efficacy and safety of using hepatitis B immunoglobulin (HBIG) during pregnancy to prevent hepatitis B virus (HBV) mother-to-child transmission (MTCT). We systematically reviewed the effect of HBIG in decreasing HBV MTCT from randomized controlled trials (RCTs) carried out between January 1990 and December 2008, in English and Chinese languages. Multiple databases were searched, and experts in this field were contacted. The methodological quality of each RCT was assessed by the Jadad score. We abstracted data on HBV intrauterine infection, MTCT, treatment methods, newborn immune prophylaxis methods, and adverse effects. A Mantel-Haenszel random-effects model was employed for all analyses using odds ratios (OR) and 95% confidence intervals (95% CI). Five thousand nine hundred newborns of asymptomatic hepatitis B surface antigen (HBsAg)-seropositive mothers from 37 qualified RCTs were included. Compared with the control group, newborns in the HBIG group had a lower intrauterine infection rate (indicated by HBsAg as OR 0.22, 95% CI [0.17, 0.29], from 32 RCTs; indicated by HBV DNA as OR 0.15, 95% CI [0.07, 0.30], from 13 RCTs; p<0.01 for both) and a higher protection rate (indicated by hepatitis B surface antibody (HBsAb) as OR 11.79, 95% CI [4.69, 29.61], from 15 RCTs; p<0.01). The same trend was found in MTCT by the time of 9-12 months after birth, indicated by HBsAg (OR 0.33, 95% CI [0.21, 0.51], from nine RCTs; p<0.01) and HBsAb (OR 2.49, 95% CI [1.55, 4.01], from 11 RCTs; p<0.01). HBIG appears to be safe, but a few RCTs have reported adverse events. Multiple injections of HBIG in HBV carrier mothers with a high degree of infectiousness in late pregnancy, effectively and safely prevent HBV intrauterine transmission.
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This study assessed the level of vaccine-induced hepatitis B surface antibody that is protective against hepatitis B infection and carriage in The Gambia. Sera from 700 of a cohort of 1041 children vaccinated against hepatitis B in infancy were serially tested for markers of hepatitis B until age 7 years. No absolute level of protection against infection was found, but all children who attained a peak antibody response to vaccination of ⩾10 IU/L were protected against carriage of hepatitis B surface antigen. Two-thirds of 45 infected children experienced brief infection (determined by loss of core antibody). This transient infection was likely related to surface antibody level. The data support the use of the peak antibody response as the best indicator of protection against carriage and suggest that most infections after vaccination are short-lived.
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A specific hepatitis B immune serum globulin preparation was effective for the prevention or modification of viral hepatitis, type B. All 11 children who had a parenteral exposure to MS-2 serum had evidence of hepatitis B infection after an average incubation period of 68 days. In contrast, of ten children who received hepatitis B immune serum globulin four hours after a parenteral exposure to MS-2 serum, (1) six were completely protected, five with evidence of passive-active immunity, (2) one had a transient infection for six days followed by the appearance of antibody, and (3) three had classical viral hepatitis, type B, after an average incubation period of 110 days. Under the conditions of this controlled study hepatitis B immune serum globulin was 70% effective.
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Objectives: To assess risk factors for decreased immunogenicity among adults vaccinated with hepatitis B vaccine and to determine the importance of differences in immunogenicity between vaccines among health care workers (HCWs).Design: Randomized clinical trial and decision analysis.Participants: HCWs.Main Outcome Measures: Development of seroprotective levels of antibody to hepatitis B surface antigen (anti-HBs) and the number of expected chronic hepatitis B virus (HBV) infections associated with lack of protection.Results: Overall, 88% of HCWs developed seroprotection. Risk factors associated with failure to develop seroprotection included increasing age, obesity, smoking, and male gender (P < .05). Presence of a chronic disease was associated with lack of seroprotection only among persons ≥40 years of age (P < .05). The two vaccines studied differed in their overall seroprotection rates (90% vs. 86%; P < .05), however, this difference was restricted to persons ≥40 years of age (87% vs. 81%; P < .01). Among HCWs ≥40 years of age, the decision analysis found 44 (0.34/100,000 person-years) excess chronic HBV infections over the working life of the cohort associated with use of the less immunogenic vaccine compared to the other.Conclusions: Hepatitis B vaccines are highly immunogenic, but have decreased immunogenicity associated with increasing age, obesity, smoking, and male gender; and among older adults, the presence of a chronic disease. One of the two available vaccines is more immunogenic among older adults; however, this finding has little clinical or public health importance. Hepatitis B vaccines should be administered to persons at occupational risk for HBV infection early in their career, preferably while they are still in their training.
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We compared self-reported hepatitis B (HepB) vaccine coverage among health-care personnel (HCP) with HepB vaccine coverage among the general population and determined trends in vaccination coverage among HCP. We used the 2010 National Health Interview Survey (NHIS) to determine the weighted proportion of self-reported ≥1- and ≥3-dose HepB vaccine coverage among HCP aged ≥18 years. We used logistic regression to determine independent predictors of vaccination and performed a trend analysis to determine changes in coverage from 2004 to 2010 using data from the 2004-2010 NHIS. Overall, 69.5% (95% confidence interval [CI] 67.2, 71.8) and 63.4% (95% CI 60.8, 65.9) of HCP reported receiving ≥1 and ≥3 doses of HepB vaccine, respectively, compared with 27.1% (95% CI 26.1, 28.1%) and 23.0% (95% CI 22.1, 24.0) among non-HCP. Among HCP with direct patient contact, 80.7% (95% CI 78.2, 83.1) and 74.0% (95% CI 71.2, 76.8) received ≥1 and ≥3 HepB vaccine doses, respectively. Independent predictors of vaccination included direct patient contact, having more than a high school education, influenza vaccination in the past year, and ever having been tested for HIV. There was no significant change in reported coverage from 2004 through 2010. The 2010 HepB vaccine coverage estimate among HCP remained well below the Healthy People 2010 goal of 90%. Efforts to target unvaccinated HCP for preexposure HepB protection should be encouraged.
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Introduction: Hepatitis B vaccination starting at birth provides a safety net for infants exposed to hepatitis B virus (HBV) during delivery or in early life. Hepatitis B vaccine is recommended in the United States for infants prior to birthing facility discharge, and within the first 12h of life for infants born to hepatitis B surface antigen (HBsAg)-positive mothers. We performed a literature review and summarized the response to recombinant hepatitis B vaccine among infants. Methods: Studies published between 1987 and 2011 assessing seroprotection from recombinant hepatitis B vaccine starting within the first 30 days of life were eligible. Seroprotection was defined using an antibody to hepatitis B surface antigen (anti-HBs) threshold of 10mIU/mL at series completion. Infant seroprotection was compared in trial arms varying by maternal hepatitis B antigen status (e antigen [HBeAg], HBsAg), hepatitis B immune globulin (HBIG) administration, birth weight, vaccine dosage, schedule, and age at first dose. Results: Forty-three studies were included. The median seroprotection proportion overall was 98% (range 52%, 100%). The final median seroprotection proportions did not vary appreciably by maternal HBsAg status, HBIG administration, or schedule. Higher compared to lower dosage resulted in earlier increases in anti-HBs but not in final seroprotection proportions. Infants with birth weights <2000g compared to ≥2000g had lower median seroprotection proportions (93% and 98%, respectively). Median seroprotection proportions were also lower when infants with birth weights <2000g were vaccinated at 0-3 days of age compared to 1 month of age or older (68% versus 95%, respectively). Conclusion: High levels of protection from recombinant hepatitis B vaccine are achieved in term infants vaccinated at birth, effectively preventing transmission of HBV and resultant morbidity and mortality. Implications, if any, for long-term protection are unknown for differences in responses among infants vaccinated at birth compared to ages older than 1 month.
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Background: During the evaluation of a needle-stick injury, an orthopedic surgeon was found to be unknowingly infected with hepatitis B virus (HBV) (viral load >17.9 million IU/mL). He had previously completed two 3-dose series of hepatitis B vaccine without achieving a protective level of surface antibody. We investigated whether any surgical patients had acquired HBV infection while under his care. Methods: A retrospective cohort study of all patients who underwent surgery by the surgeon was conducted. Patients were notified of their potential exposure and need for testing, and samples with positive HBV loads underwent DNA sequencing. Characteristics of the surgical procedures for the cohort were evaluated. Results: A total of 232 (70.7%) of potentially exposed patients consented to testing; 2 were found to have acute infection and 6 had possible transmission (evidence of past exposure without risk factors). Genome sequence analysis of HBV DNA from the infected surgeon and patients with acute infection revealed genetically related virus (>99.9% nucleotide identity). Only age was found to be statistically different between those with confirmed or possible HBV transmission and those who remained susceptible to HBV. Conclusions: We documented HBV transmission during orthopedic surgery to 2 patients from a surgeon with HBV. This investigation highlights the importance of evaluating individuals who do not respond to 2 series of HBV vaccination, the increased risk of HBV transmission from providers with high viral loads, and the need to evaluate the clinical practice of providers with HBV and implement appropriate procedure-based practice restrictions.
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Neonatal vaccination against hepatitis B virus (HBV) infection was launched in the 1980s in Qidong, China, where HBV and hepatocellular carcinoma were highly prevalent. Presence of immune memory and immunity against HBV in adults needs to be clarified. From a cohort of 806 who received plasma-derived Hep-B-Vax as neonates and were consecutively followed at ages 5, 10, and 20 years, 402 twenty-four-year-old adults were recruited for booster test. Among them 4 (1%) were found to be HBsAg(+), 27 (6.7%) were HBsAg(-)anti-HBc(+), 121 (30.2%) were HBsAg(-)anti-HBc(-)anti-HBs(+), and 252 (62.4%) were HBsAg(-)anti-HBc(-)anti-HBs(-). Of them, 141 subjects with HBsAg(-)anti-HBc(-) were boosted with 10-μg recombinant HBV vaccine on day-0 and 1-month. The conversion rates of anti-HBs ≥ 10 mIU/ml on D10-12 and 1-month post-booster were 71.4% and 87.3% respectively in the vaccinees who were anti-HBs(+) at age 5, higher than in those who were anti-HBs(-) at age 5, 57.5% and 80.0% respectively, but no statistically significant. After the second dose of booster, all subjects with anti-HBs(+) at age 5 had anti-HBs >500 mIU/ml. However, 6/40 subjects, with anti-HBs(-) at age 5, had anti-HBs <10 mIU/ml, geometric mean concentration was 3.6 (95% CI 2.0-7.7). Of the subjects received booster, 44 subjects were determined the presence of T cell immunity on D10-12, 41 had HBsAg-specific T cells detectable, including 7/10 subjects whose anti-HBs were <10 mIU/ml 10-12 days post-booster. Among 27 HBsAg(-)anti-HBc(+) subjects, 19 had detectable serum HBV-DNA, and an "a" epitope mutation was found in 1/5 HBV isolates. One subject who was anti-HBc(+) at age 20 converted into HBsAg(+) 4 years later. The adults received neonatal HBV vaccination had immune memory and immunity against HBV infection. However, 31.9% of neonatal HBV vaccinees who responded weakly at an early age might be susceptible to HBV infection after childhood.
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The duration of protection in children and adults (including health care workers) resulting from the hepatitis B vaccine primary series is unknown. To determine the protection afforded by hepatitis B vaccine, Alaska Native persons who had received plasma-derived hepatitis B vaccine when they were >6 months of age were tested for antibody to hepatitis B surface antigen (anti-HBs) 22 years later. Those with levels <10 mIU/mL received 1 dose of recombinant hepatitis B vaccine and were evaluated on the basis of anti-HBs measurements at 10-14 days, 30-60 days, and 1 year. Of 493 participants, 60% (298) had an anti-HBs level >or=10 mIU/mL. A booster dose was administered to 164 persons, and 77% responded with an anti-HBs level >or=10 mIU/mL at 10-14 days, reaching 81% by 60 days. Response to a booster dose was positively correlated with younger age, peak anti-HBs response after primary vaccination, and the presence of detectable anti-HBs before boosting. Considering persons with an anti-HBs level >or=10 mIU/mL at 22 years and those who responded to the booster dose, protection was demonstrated in 87% of the participants. No new acute or chronic hepatitis B virus infections were identified. The protection afforded by primary immunization with plasma-derived hepatitis B vaccine during childhood and adulthood lasts at least 22 years. Booster doses are not needed.
Article
Little is known about the risk of blood exposure among personnel providing care to individual patients residing at home. The objective of this study was to document and compare blood exposure risks among unlicensed home care personal care assistants (PCAs) and home care registered nurses (RNs). PCAs self-completed surveys regarding blood and body fluid (BBF) contact in group settings (n = 980), while RNs completed mailed surveys (n = 794). PCAs experience BBF contact in the course of providing care for home-based clients at a rate approximately 1/3 the rate experienced by RNs providing home care (8.1 and 26.7 per 100 full time equivalent (FTE), respectively), and the majority of PCA contact episodes did not involve direct sharps handling. However, for PCAs who performed work activities such as handling sharps and changing wound dressings, activities much more frequently performed by RNs, PCAs were at increased risk of injury when compared with RNs (OR = 7.4 vs. 1.4) and (OR = 6.3 vs. 2.5), respectively. Both PCAs and RNs reported exposures to sharps, blood, and body fluids in the home setting at rates that warrant additional training, prevention, and protection. PCAs appear to be at increased risk of injury when performing nursing-related activities for which they are inexperienced and/or lack training. Further efforts are needed to protect home care workers from blood exposure, namely by assuring coverage and enforcement of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard [Occupational Safety and Health Administration. 1993. Frequently Asked Questions Concerning the Bloodborne Pathogens Standard. Available at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS &p_id=21010#Scope. Accessed May 30, 2008].
Article
Patients continue to enter home health care (HHC) "sicker and quicker," often with complex health problems that require extensive intervention. This higher level of acuity may increase the risk of percutaneous injury (PI), yet information on the risk and risk factors for PI and other types of exposures in this setting is exceptionally sparse. To address this gap, a large cross-sectional study of self-reported exposures in HHC registered nurses (RNs) was conducted. A convenience sample of HHC RNs (N=738) completed a survey addressing 5 major constructs: (1) worker-centered characteristics, (2) patient-related characteristics, (3) household characteristics, (4) organizational factors, and (5) prevalence of PIs and other blood and body fluid exposures. Analyses were directed at determining significant risk factors for exposure. Fourteen percent of RNs reported one or more PIs in the past 3 years (7.6 per 100 person-years). Nearly half (45.8%) of all PIs were not formally reported. PIs were significantly correlated with a number of factors, including lack of compliance with Standard Precautions (odds ratio [OR], 1.72; P=.019; 95% confidence interval [CI]: 1.09-2.71); recapping of needles (OR, 1.78; P=.016; 95% CI: 1.11-2.86); exposure to household stressors (OR, 1.99; P=.005; 95% CI: 1.22-3.25); exposure to violence (OR, 3.47; P=.001; 95% CI: 1.67-7.20); mandatory overtime (OR, 2.44; P=.006; 95% CI: 1.27-4.67); and safety climate (OR, 1.88; P=.004; 95% CI: 1.21-2.91) among others. The prevalence of PI was substantial. Underreporting rates and risk factors for exposure were similar to those identified in other RN work populations, although factors uniquely associated with home care were also identified. Risk mitigation strategies tailored to home care are needed to reduce risk of exposure in this setting.
Article
A double blind, randomized, controlled trial has been conducted in 11 Veterans Administration hospitals during a 49-month period to compare the relative efficacies of immune serum globulin (ISG) and an albumin placebo for the prevention of post-transfusion hepatitis (PTH). A total of 2204 patients, of whom 1094 received ISG, participated in the study. The results indicate that ISG significantly reduced the incidence of icteric type non-B hepatitis only (inferred to be also type non-A hepatitis). Adverse reactions were rare, and the ISG did not significantly alter the incubation period or duration of the disease. The data suggest, however, that a similar reduction in type non-A, non-B hepatitis would have occurred had commercial blood been excluded from use. Analysis of the 241 patients who developed hepatitis indicates that type B hepatitis constituted less than 20% of the cases each year of the study. Furthermore, the efficacy of the ISG, manufactured in 1944, against apparent type non-A, non-B hepatitis suggests that this overlooked disease has existed from at least that time. Host- and transfusion-related factors that might have modified the development of PTH were examined. The use of commercial blood was observed to be the most important risk factor. It is concluded that the PTH incidence can be most effectively reduced by eliminating commercial donor blood, and continuing to screen volunteer donors for hepatitis B surface antigen (HBsAg) by sensitive procedures. Of prime importance is the need to define the agent(s) responsible for type non-A, non-B hepatitis.
Article
In a randomized, double-blind multicenter trial, 284 patients and 282 staff members of renal dialysis units who lacked detectable hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) were randomly assigned to receive two 3-ml injections of immune serum globulin with high, intermediate, or low titers of anti-HBs four months apart. The incidence of infection with hepatitis B and of development of HBsAg was significantly lower in both patients and staff who received the high-titer material than in subjects who received the low-titer preparation eight but not 12 months after randomization (P <0.01 for patients and P <0.04 for staff, low-titer vs. high-titer at eight months). The high-titer hepatitis B immune globulin preparation did not appear to affect the severity of the cases of hepatitis that did occur, the proportion of subjects who developed persistent antigenemia, or the magnitude or timing of primary anti-HBs responses.
Article
Hepatitis B immune globulin (HBIG) and immune serum globulin (ISG) were examined in a randomized, double-blind trial to assess their relative efficacies in preventing type B hepatitis after needle-stick exposure to hepatitis B surface antigen (HBsAG)-positive donors. Clinical hepatitis developed in 1.4% of HBIG and in 5.9% of ISG recipients (P = 0.016), and seroconversion (anti-HBs) occurred in 5.6% and 20.7% of them respectively (P less than 0.001). Mild and transient side-effects were noted in 3.0% of ISG and in 3.2% of HBIG recipients. Available donor sera were examined for DNA polymerase (DNAP) and e antigen and antibody (HBeAg; anti-HBE). Both DNAP and HBeAg showed a highly statistically significant correlation with the infectivity of HBsAg-positive donors. Hepatitis B immune globulin remained significantly superior to ISG in preventing type B hepatitis even when the analysis was confined to these two high-risk subgroups. The efficacy of ISG in preventing type B hepatitis cannot be ascertained because a true placebo group was not included.
Article
The value of hepatitis B immune serum globulin (HBIG) administration after exposure to hepatitis B surface antigen (HBsAg) has been questioned recently. The studies of Seeff et al. and Grady and Lee seemed to show that HBIG affords complete protection for a few months; the late onset of hepatitis observed in some cases was related to an inapparent second exposure, with a normal delay, in a population continuously at risk at a time when passively acquired antibody against HBsAg had fallen below a protective level. Krugman and Giles claimed that they had not observed a late case of hepatitis when HBIG had been administered less than 4 hr after exposure. The authors report 2 cases that give some additional information.
Article
A randomized, double-blind, multicenter study of hepatitis prevention by immune serum globulin with high anti-HBs titer ("hepatitis B immune globulin") was carried out among 318 new patients and 296 staff members of renal dialysis units. Three milliliters of high titer globulin, repeated at four months, was compared with equal doses of intermediate or normal titer globulin. Among staff members, the cumulative percentages developing hepatitis or HBs Ag, or both, within eight months were 6.9, 11.7, and 11.1 in the high, intermediate, and normal titer groups respectively. The lower incidence associated with high titer globulin was not significant (P greater than 0.05). However, among the patients the respective percentages were 7.9, 21.3, and 23.1 and the lower incidence in the high titer globulin group was significant.