Hepatitis B testing among Vietnamese American men

The incidence of hepatitis B virus (HBV) infection in dialysis populations has declined over recent decades, largely because of improvements in infection control and widespread implementation of HBV vaccination. Regardless, outbreaks of infection continue to occur in dialysis units, and prevalence rates remain unacceptably high. For a variety of reasons, dialysis patients are at increased risk of acquiring HBV. They also demonstrate different disease manifestations compared with healthy individuals and are more likely to progress to chronic carriage. This paper will review the epidemiology, modes of transmission and diagnosis of HBV in this population. Prevention and treatment will be discussed, with a specific focus on strategies to improve vaccination response, new therapeutic options and selection of patients for therapy.

The impact of the COVID-19 pandemic on hepatitis B virus vaccination and transmission among men who have sex with men: A mathematical modelling study

Asian communities in North America include large numbers of immigrants with limited English proficiency. Hepatitis B virus (HBV) infection is endemic in most Asian countries and, therefore, Asian immigrant groups have high rates of chronic HBV infection. We conducted a group-randomized trial to evaluate the effectiveness of a hepatitis B English as a second language (ESL) educational curriculum for Asian immigrants. Eighty ESL classes were randomized to experimental (hepatitis B education) or control (physical activity education) status. Students who reported they had not received a HBV test (at baseline) completed a follow-up survey 6 months after randomization. The follow-up survey assessed recent HBV testing and HBV-related knowledge. Provider reports were used to verify self-reported HBV tests. The study group included 218 students who reported they had not been tested for HBV. Follow-up surveys were completed by 180 (83%) of these students. Provider records verified HBV testing for 6% of the experimental group students and 0% of the control group students (P = 0.02). Experimental group students were significantly (P < 0.05) more likely than control group students to know that immigrants have high HBV infection rates, HBV can be spread during sexual intercourse and by sharing razors, and HBV infection can cause liver cancer. Our ESL curriculum had a meaningful impact on HBV-related knowledge and a limited impact on HBV testing levels. Future research should evaluate the effectiveness of ESL curricula for other immigrant groups and other health topics, as well as other intervention approaches to increasing levels of HBV testing in Asian immigrant communities.

Over the last 2 decades, successful public health interventions have altered the epidemiology of viral hepatitis in the United States. Vaccination of children and adolescents has reduced the incidence of hepatitis A virus (HAV) and hepatitis B virus (HBV) infections to historic lows. American Indians/Alaskan Natives, a population whose HBV rate was once 5 times that of other racial/ethnic populations, now has the lowest (0.5 cases per 100 000).1–3 Since the adoption in 1991 of a strategy to eliminate HBV transmission, HBV vaccination of infants, children, and adolescents has largely contributed to an 81% decline in new cases of HBV, and infant HBV vaccination is now on par with that of other vaccines in the childhood schedule. (1,2,4,5) With more than 90% of pregnant women screened for HBV infection and postexposure prophylaxis 85% to 95% effective in preventing mother-to-child HBV transmission at delivery, substantial progress has been made in the prevention of perinatal HBV infections.4 In the absence of a vaccine to prevent HCV, the advent of laboratory testing in 1992 to protect the nation’s blood supply and prevention efforts to reduce risk behaviors among injection drug users (IDUs) have led to a 78% decline in new HCV infections.1,2,6 Health care–related transmission of HBV and HCV is now rare thanks to widespread vaccination of health care workers and the adoption of universal infection control procedures.7 Although these prevention successes are remarkable, challenges remain. Despite the existence of risk-based vaccination recommendations, HAV and HBV infections remain common.3,5 In 2006, an estimated 32000 persons were infected with HAV, with risks highest among international travelers, individuals in close contact with infected persons, men who have sex with men, and IDUs; food-borne outbreaks also continue to be reported.2 Of an estimated 46000 new HBV infections in 2006, more than 80% were attributable to injection drug use and high-risk sexual activity.2,5 Children continue to be infected at birth. Of approximately 24000 infants born to HBV-infected women annually, only about one quarter complete case management and are tested for infection or susceptibility (CDC, unpublished data, 2007). In 2006, a total of 86 perinatal HBV cases were reported to the CDC, but testing and reporting are incomplete; thus, the true number of perinatal HBV cases per year is likely 10 to 20 times higher. Approximately half of persons with chronic HBV in the United States are Asian Americans (CDC, unpublished data, 2006). HBV-related liver cancer is a leading cause of cancer deaths in this population.8 Although the incidence of HBV infection in the United States is declining, the prevalence of chronic HBV is sustained by immigration from HBV-endemic countries in Asia, Africa, and Eastern Europe; each year, an estimated 40000 persons with chronic HBV immigrate to the United States from these countries.5 In 2006, approximately 20000 persons were infected with HCV.2 Injection drug use was responsible for most of these new cases, and at least one third of IDUs are HCV infected.9 Despite the decline in the number of new infections, the number of persons with chronic viral hepatitis is over 4 million, including 3.2 million chronic HCV infections and 800 000 to 1.4 million chronic HBV infections (CDC, unpublished data, 2006).10 Chronic viral hepatitis is a major cause of morbidity responsible for approximately two thirds of chronic liver disease and conservatively 9000 deaths per year. 11,12 Mortality from HCV is expected to rise as the HCV-infected population ages, extending their years of living with the infection and increasing their risk of liver cirrhosis and cancer.13 Cofactors such as HIV infection and alcohol use accelerate the progression of HCV; approximately 25% of the 1 million persons infected with HIV are co-infected with HCV.6 Finally, cases of health care–associated HBV and HCV transmission continue to occur. The changing epidemiology of viral hepatitis reveals both gaps in the delivery of proven interventions and new opportunities to reduce the health consequences of chronic disease. The Centers for Disease Control and Prevention (CDC) has identified new priorities to improve current programs and develop new prevention goals.

Biotinidase activity is closely related to liver function. To evaluate whether maternal chronic hepatitis B virus (HBV) infection affects neonatal biotinidase activity. Twenty-three asymptomatic pregnant women with HBV (group A) and 28 healthy pregnant women (controls) in the delivery room and their newborns (cord blood) underwent laboratory examinations. Serological HBV and liver function tests were performed with standard techniques, while biotinidase activity was measured with an HPLC method. Serological HBV tests and HBV DNA showed chronic HBV (precore mutant G1896A) in group A, whereas anti-HBc and anti-HBe were detected in their neonates. Liver function chemistry was found normal in controls and both groups of newborns. Moderately increased transaminases were found in the infected mothers. Interestingly, albumin levels did not differ among the studied groups. Biotinidase activity in HBV mothers (5.76+/-0.6 nmol/min/mL) was significantly decreased (p<0.001) as compared to controls (8.43+/-0.65 nmol/min/mL). The enzyme activity did not differ among the neonates. Biotinidase activity inversely correlated with transaminases but not with albumin or with HBV-DNA levels. Decreased biotinidase activities were evaluated in mothers with HBV and normal in their neonates. Biotin supplementation in the diseased mothers may prevent possible symptoms due to biotin recycling impairment.

BackgroundIn Australia, Chinese migrants are among the populations most affected by hepatitis B virus (HBV) infection but often experience late diagnosis or access to clinical care. This study aims to explore approaches to increase HBV testing in Australia’s Chinese community and inform evaluation planning, specifically to i) assess the feasibility and acceptability of HBV educational programs, and ii) compare HBV testing uptake in people receiving a tailored education resource focussing on liver cancer prevention compared with a standard HBV education package.MethodsThis is a pre-post mixed-methods pilot and feasibility study. People of Chinese ethnicity and unsure of their HBV infection or immunity status were recruited from ten community sites in Melbourne, Australia in 2019–2020. Participants were randomised to receive an education package (comprised of a leaflet and in-person one-on-one educational session) with a focus on either 1) standard HBV-related information, or 2) liver cancer prevention. Participants completed a baseline questionnaire prior to receiving the intervention and were followed up at 6 months’ time for a questionnaire and an opt-in semi-structured interview. Primary study outcomes included feasibility of study procedures, measured by recruitment, participation, and retention rates; acceptability of the education program assessed by acceptability scores; and HBV testing uptake rate in each arm. Secondary outcomes include HBV-related knowledge change, assessed by pre-post comparison; and factors affecting participants’ testing behaviour analysed using qualitative data.ResultsFifty-four participants received an education package; baseline and follow-up data from 33 (61%) were available. The study procedures of recruitment and retention were feasible; the acceptability of the education program was moderate with improved HBV-related knowledge observed. Four participants self-reported being tested: one (1/15, 7%) in the standard HBV information group and three (3/18, 17%) in the liver cancer prevention information group. Factors identified as affecting testing included perceived relevance and seriousness of HBV, healthcare access and costs of testing, and perceptions of the role of primary care providers in HBV-related care.ConclusionA tailored education program targeting ethnic Chinese in Australia was feasible with moderate acceptability. A larger study is required to determine if a liver cancer prevention message would improve HBV testing uptake in Chinese community than standard HBV education message. Supports from healthcare providers, community-based testing programs, and public health education programs are likely needed to motivate diagnostic testing among Chinese people at risk of HBV infection.

The management of hepatitis B virus (HBV) during pregnancy remains a challenge and involves various aspects of maternal-fetal care. Our objective is to provide a comprehensive review of the current knowledge regarding pregnancy and HBV infection, as well as recent efforts to reduce the rate of mother-to-child transmission (MTCT). We also present the 2016 clinical experience with HBV positive patients. We analysed data from 43 HBV positive pregnancies, resulting in 44 live childbirths, in “Panait Sîrbu” Hospital during 2016. A literature review was also conducted examining recent studies devoted to the clinical, therapeutic, and prognostic aspects of HBV infection during pregnancy in order to extrapolate and interpret data that can help physicians in the management of HBV infection in this setting. In our study group, the mean maternal age was 30 (± 7) and the majority were primiparous. Caesarean section was the birth method in 39 (93%) of the cases, with 36 (83.7%) being born at term. In 7 cases (16.2%) spontaneous membrane rupture occurred. All the newborns received active immunoprophylaxis (HBV vaccine) and 38 (88.3%) also received passive immunoprophylaxis consisting in the administration of hepatitis B immune globulin (HBIG). Testing for HBV is recommended in every pregnancy, regardless of previous testing or vaccination. The identification of HBV-positive pregnant women remains the most effective way to prevent HBV transmission to new-borns, combined with passive and active prophylaxis at birth. Breastfeeding is not contraindicated for HBV patients, but it is not recommended for women taking antiviral drugs. Finally, there is no clear evidence that elective caesarean section reduces the risk of mother-to-child transmission compared to vaginal delivery.

Introduction: Screening high risk patients for chronic hepatitis B virus (HBV) infection is important for early diagnosis, treatment, hepatocellular carcinoma screening. Linkage of care among newly diagnosed HBV patients is not well reported, especially among underserved safety-net populations. We aim to evaluate the outcomes of a pilot model of integrated HBV testing and linkage of care among the outpatient endoscopy unit of a large ethnically diverse safety-net hospital. Methods: From July 2015-March 2016, all consecutive adults presenting for outpatient endoscopy were evaluated for risk-based HBV screening using U.S. Preventative Services Task Force guidelines. Primary outcomes included HBsAg prevalence among high risk patients offered screening, HBV DNA testing among HBsAg positive patients, and linkage of care to HBV clinic. Completion of testing was stratified by sex, ethnicity, language (English vs. non-English), and place of birth (U.S. vs foreign born) and evaluated with multivariate logistic regression. Results: Among 446 high risk patients who accepted HBV testing, 69.7% (n=311) completed testing, with higher rates of completion among women (76.0% vs. 63.1% in men, p < 0.01), foreign born patients (73.1% vs. 44.2% in US born, p < 0.001), and non-English speakers (72.9% vs. 63.9% in English speakers, p < 0.05). Hispanics (72.0%) and Asians (77.6%) also had higher rates of test completion compared to whites (33.3%), p < 0.001. On multivariate regression, men were significantly less likely to complete testing (OR 0.55, 95% CI 0.34-0.87, p < 0.001), and compared to whites, Hispanics were more likely to complete testing (OR 5.21, 95% CI 0.96-28.2, p=0.055). Among those completing testing, 82.3% completed testing on the same day, 95.8% completed testing within 1 week. Overall prevalence of HBsAg positive among those tested was 2.25%. Among newly diagnosed HBsAg positive patients, 71.4% completed HBV DNA testing (3 with detectable DNA and 2 with undetectable DNA). Among HBsAg patients that needed HBV clinic evaluation, only 60% were successfully linked to HBV care.Table 1: HBV Screening OutcomesConclusion: Among a pilot model of integrated HBV testing at an outpatient endoscopy unit of underserved safety-net populations, the prevalence of HBsAg positivity among high risk patients was 2.25%. However, sub-optimal linkage of care was observed despite this integrated approach: 30% of patients did not complete HBV DNA testing and 40% of HBsAg positive patients were not linked to HBV clinic.

The problem of transfusion safety preventing parenteral viral hepatitis transmission remains relevant. Viral hepatitis B (HB) is the most common viral infection transmitted through transfusion procedures. One of the natural phases of a chronic viral hepatitis B (CHB) course is occult hepatitis B infection (OBI) characterized by undetectable HBsAg level (regardless of other serological marker levels) along with detected hepatic HBV DNA as well as blood viral load ranging from extremely low to undetectable. In Vietnam, prevention of transfusion-based HBV transmission is focused on donor screening; it is still based solely on HBsAg serology. As such, OBI remains a potential threat to blood transfusion safety. Assessing hepatitis B virus (HBV) DNA is a reliable preventive measure against HBV transmission from HBsAg– donors, especially in highly endemic regions. The aim of our work was HBV identification and molecular genetic characterization in blood donors from South Vietnam. The study material was presented by 500 donor serum samples. Subjects were examined for HBV markers with qualitative detection of HBsAg, HBs IgG, and HBcore IgG. Amplification and subsequent HBV sequencing were performed using nested PCR with overlapping primer pairs jointly flanking the complete HBV genome (S, P, C, X genes). Full-size HBV genome nucleotide sequences were obtained for 58 samples. Among blood donors, taking into account HBsAg+ and HBsAg– samples, HBV DNA was detected in 11.6%, including 8.6% OBI. HBV phylogenetic analysis showed genotypes B and C. Vaccine escape mutations and mutations that contribute to disease progression were identified. Current screening in Vietnam is insufficient for eliminating the risk of transfusion-transmitted HBV infection. The major risk factor is OBI. PCR testing for HBV should be considered for blood donor screening.

Hepatocellular carcinoma (HCC) is one of the five leading causes of cancer death in human. Hepatitis B virus (HBV) is the most common etiologic agent of HCC in the world, particularly in areas prevalent for HBV infection such as Asia, Africa, southern part of Eastern and Central Europe, and the Middle East. Risk factors of HBV-related HCC include (1) viral factors-persistent high viral replication, HBV genotype C or D, pre-S2 or core promoter mutants; (2) host factors-older age (>40years old) at HBeAg seroconversion, male gender; (3) mother-to-infant transmission; and (4) other carcinogenic factors-smoking, habitual use of alcohol, etc. Prevention is the best way to control cancer. There are three levels of liver cancer prevention, i.e., primary prevention by HBV vaccination targeting the general population, secondary prevention by antiviral agent for high-risk subjects with chronic HBV infection, and tertiary prevention by antiviral agent to prevent recurrence for patients who have been successfully treated for liver cancer. Primary prevention by hepatitis B vaccination is most cost effective. Its cancer preventive efficacy supports it as the first successful example of cancer preventive vaccine in human. This experience can be extended to the development of other cancer preventive vaccine. Careful basic and clinical research is needed to develop ideal vaccines to induce adequate protection. Understanding the main transmission route and age at primary infection may help to set the optimal target age to start a new cancer preventive vaccination program. Besides timely HBV vaccination, the earlier administration of hepatitis B immunoglobulin immediately after birth, and even antiviral agent during the third trimester of pregnancy to block mother-to-infant transmission of HBV are possible strategies to enhance the prevention efficacy of HBV infection and its related liver cancer.

Hepatitis B transmitted via urine?

Since October 2005, a total of 2,921,561 blood donations have been screened by the South African National Blood Service for hepatitis B virus (HBV) by individual-donation nucleic acid testing (ID-NAT). Over 4 years, 149 hepatitis B surface antigen-negative acute-phase HBV NAT-positive donations were identified (1:19,608). The lookback program identified one probable HBV transmission. The complete genomes of HBV isolated from the donor and recipient were sequenced, cloned, and analyzed phylogenetically. The HBV window period (WP) transmission risk was estimated assuming a minimum infectious dose of 3.7 HBV virions and an incidence rate correction factor of 1.34 for transient detectability of HBV DNA. Of 149 acute-phase HBV NAT yields, 114 (1:25,627) were classified as pre-antibody to hepatitis B core antigen (anti-HBc) WP and 35 (1:83,473) as post-anti-HBc WP. The acute-phase transmission risk in the HBV DNA-negative pre- and post-anti-HBc WPs (of 15.3 and 1.3 days, respectively) was estimated at 1:40,000 and 1:480,000, respectively. One HBV transmission (1:2,900,000) was identified in a patient who received a transfusion from an ID-NAT-nonreactive donor in the pre-anti-HBc WP. Sequence analysis confirmed transmission of HBV Subgenotype A1 with 99.7% nucleotide homology between donor and recipient strains. The viral burden in the infectious red blood cell unit was estimated at 32 (22-43) HBV DNA copies/20 mL of plasma. We report the first known case of transfusion-transmitted HBV infection by blood screened using ID-NAT giving an observed HBV transmission rate of 0.34 per million. The estimated pre-acute-phase transmission risk in the ID-NAT screened donor population was 73-fold higher than the observed WP transmission rate.

This study aimed to assess hepatitis B virus (HBV) vaccination rates among healthcare professionals and understand their knowledge about HBV transmission. Conducted in a healthcare setting, the research employed survey methods to collect data on vaccination status and awareness levels. Alarmingly, only 25% of healthcare workers were found to be vaccinated against HBV, highlighting a significant gap in protection. Additionally, a considerable lack of awareness regarding HBV transmission was observed among the participants. These findings underscore the urgent need for targeted vaccination campaigns and educational initiatives within primary healthcare environments. The study advocates for mandatory HBV vaccination as a condition of employment for healthcare workers, coupled with ongoing infection prevention and control training. Further research is recommended to explore the prevalence of HBV infection among healthcare professionals in primary care settings and to assess the broader implications for public health. This study serves as a critical call to action for healthcare systems to prioritize HBV vaccination and education, thereby safeguarding both healthcare providers and patients from HBV infection risks. Highlights : Low Vaccination Rates: Only 25% of healthcare workers are vaccinated against HBV, indicating a critical need for improved vaccination coverage in healthcare settings. Knowledge Deficit: There is a significant lack of awareness among healthcare professionals about HBV transmission, necessitating educational programs. Policy Implications: The study advocates for mandatory HBV vaccination for healthcare workers, emphasizing the importance of infection control measures for public health safety. Keywords : Hepatitis B Vaccination, Healthcare Workers, Infection Prevention, Public Health, Vaccination Awareness

Hepatitis B virus (HBV) DNA-positive yield since nucleic acid testing (NAT) implementation (minipools of 16 [MP16]) was reported for the first year. We have updated those figures, evaluated the current value of all HBV tests, calculated the HBV residual risk before and after the introduction of MP-NAT, and estimated residual risks with further improvements in HBV screening for US blood donations. All donations were screened by US-required serologic HBV tests and for HBV DNA by MP-NAT (Novartis/Gen-Probe). Further testing by individual-donation polymerase chain reaction (ID-PCR) confirmed various classes of MP-NAT-reactive or -nonreactive donations. The hepatitis B surface antigen (HBsAg)-yield method was used to calculate incidence and the incidence-window-period model used to define residual risk. Of approximately 12.8 million donations screened during 2009 to 2011, a total of 1368 HBV confirmed positives including 941 by MP-NAT were observed (combined 4.32% positive predictive value) of which five were seronegative NAT-yield donations (1:2.6 million) and 25 HBsAg-yield (anti-HBc-nonreactive) donations from which an incidence of 1.62/100,000 person-years (vs. 3.43 during 2006-2008) and residual risk of 1:592,000 to 1:754,000 were calculated. With the addition of MP-NAT, and resulting 8.8-day window-period reduction, residual risks decreased to 1:765,000 to 1:1,006,000. Of the 1368 positives, 99.6% were detected by serology and 68.8% by MP-NAT; ID-PCR detected 427 more infected donors than MP-NAT. HBV MP-NAT and decreases in HBV incidence (likely vaccine-related) in the United States have reduced residual risks to levels comparable to those of human immunodeficiency virus and hepatitis C virus and raise the question of the continued need for all three HBV markers for blood donation screening. Further reductions in residual risk will require the implementation of more sensitive HBV-NAT methods including ID-NAT.

3 For Life aims to increase hepatitis B virus (HBV) awareness and reduce the high prevalence of undiagnosed chronic HBV infection and susceptibility among Asian/Pacific Islander (API) adults. This pilot program offered low-cost HBV vaccination with free HBV testing targeted primarily at foreign-born Chinese adults. Semimonthly screening and vaccination clinics were held in San Francisco, California, for 1 year. A total of 1206 adults accessed the program. Participants paid a discounted fee for a full vaccine series against HBV, hepatitis A virus (HAV), or both. Participants also provided blood samples for HBV serologic testing. Test results, recommendations, and appointment reminders were provided by mail. We compared the probability of completing a recommended vaccine series by HBV serologic status and sociodemographic characteristics. Proportions were compared using multivariate logistic regression models. Nine percent of adults were chronically infected with HBV, and 53% were unprotected. In the latter group, 85% completed the HBV vaccine series. The probability of completing a recommended hepatitis vaccine series was similar across most sociodemographic groups, with slightly higher completion rates among middle-aged and Chinese participants. Lessons learned from this pilot program have been used toward successful replication in other cities, demonstrating that 3 For Life is an accessible, affordable, reproducible, and sustainable model to increase HBV awareness, testing, and prevention among API adults.