RESUMEN
BACKGROUND: This study aimed to determine the prevalence and factors associated with susceptibility to hepatitis B virus (HBV) among cisgender men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP) in Northeastern Brazil. METHODS: This was a cross-sectional, analytical study conducted between September 2021 and June 2023. Participants underwent structured interviews to collect sociodemographic and clinical information, including hepatitis B vaccination history, HIV PrEP use and sexual health history. Blood samples were collected for hepatitis B serologic testing: HBV surface antigen (HBsAg), HBV surface antibody (anti-HBs), total and IgM HBV core antibody (anti-HBc). HBV susceptibility was defined as nonreactive results for all these serological markers. RESULTS: A total of 287 participants were enrolled into the study. The median age of the individuals was 31 years (interquartile range: 27; 36). HBV susceptibility was found in 58 out 286 individuals (20.3%; 95% CI: 15.9-25.2). Seventy-six percent of the participants reported completing the three-dose hepatitis B vaccine schedule. Susceptibility was significantly associated with a monthly income ≤ 5 minimum wages (PR: 2.02; 95% CI: 1.01-4.05), lack of complete hepatitis B vaccination schedule (PR: 4.52; 95% CI: 2.89-7.06), initiation of HIV PrEP (PR: 2.18; 95% CI: 1.21-3.94), duration of six months of HIV PrEP (PR: 2.16; 95% CI: 1.19-3.91), absence of tattoos (PR: 1.55; 95% CI: 1.00-2.40) and no history of sexually transmitted infections (PR: 1.65; 95% CI: 1.07-2.54). CONCLUSION: Our findings highlight the significant burden of HBV susceptibility among MSM on HIV PrEP in Northeastern Brazil. Socioeconomic factors, vaccination status, PrEP use and sexual health behaviors play critical roles in determining susceptibility to HBV. Integrating hepatitis B screening and vaccination into PrEP services is critical for identifying and addressing HBV susceptibility among MSM. Interventions aimed at increasing vaccination coverage and promoting safer sexual practices are essential for mitigating the burden of HBV infection in this population.
Asunto(s)
Infecciones por VIH , Hepatitis B , Homosexualidad Masculina , Profilaxis Pre-Exposición , Humanos , Masculino , Estudios Transversales , Brasil/epidemiología , Adulto , Profilaxis Pre-Exposición/estadística & datos numéricos , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Hepatitis B/prevención & control , Hepatitis B/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Prevalencia , Virus de la Hepatitis B/inmunología , Susceptibilidad a Enfermedades , Adulto Joven , Factores de Riesgo , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/inmunología , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/inmunologíaRESUMEN
OBJECTIVE: To investigate the association between the dimensions of the Health Belief Model (HBM) and complete vaccination for hepatitis B among healthcare workers (HCW). METHODS: Cross-sectional epidemiological study with HCW in Primary Health and Medium Complexity Care. Univariate and bivariate analyses were performed to test the association between the outcome variable (complete vaccination for hepatitis B based on self-report) and the variables of the HBM dimensions. Prevalence ratio (PR) and its respective 95% confidence intervals (95%CI) were calculated. RESULTS: 453 HCW participated. The prevalence of complete vaccination for hepatitis B was 56.9%. In the final analysis model, the following variables were associated with complete vaccination for hepatitis B: chances of having hepatitis B (PR=1.73) - related to the susceptibility dimension; disease severity (PR=0.74) - related to severity; reduced risk of absenteeism (PR=1.29) - related to benefits; not spending time to get vaccinated (PR=1.41) and not worrying about Events Supposedly Attributable to Vaccination or Immunization (PR=1.43) - related to barriers. CONCLUSIONS: The completeness of the hepatitis B vaccination schedule, reported by the investigated HCW, reveals the prevalence is below the target established by the Ministry of Health, which follows the national scenario of low coverage presented for other age groups. Understanding the risk perception and severity of hepatitis B can contribute to increasing the prevalence of vaccination for this infection.
Asunto(s)
Modelo de Creencias sobre la Salud , Personal de Salud , Vacunas contra Hepatitis B , Hepatitis B , Humanos , Estudios Transversales , Vacunas contra Hepatitis B/administración & dosificación , Masculino , Femenino , Adulto , Personal de Salud/estadística & datos numéricos , Personal de Salud/psicología , Hepatitis B/prevención & control , Hepatitis B/epidemiología , Persona de Mediana Edad , Vacunación/estadística & datos numéricos , Vacunación/psicología , Adulto Joven , Conocimientos, Actitudes y Práctica en SaludRESUMEN
The serological markers for the diagnosis of COVID-19 plays an important role in the epidemiological investigation of the pandemic. This study aims to assess the prevalence of anti-SARS-CoV-2 in hepatitis B and C patients in a pre-vaccination of COVID-19 period. Between March 2020 and January 2021, 199 serum samples from individuals with HBsAg/HBV DNA or anti-HCV/HCV RNA positivity were tested for antibodies (IgM and IgG) against SARS-CoV-2 using Electrochemiluminescent Immunoassay (ECLIA). Among these, 50.3 % (100/199) tested positive for hepatitis C virus infection and 49.7 % (99/199) for hepatitis B virus, confirmed through molecular and serological diagnosis. The anti-SARS-CoV-2 seroprevalence was 24.1 % (48/199) in this population, with 23.23 % (23/99) hepatitis B and 25 % (25/100) hepatitis C patients tested positive for anti-SARS-CoV-2. The higher seroprevalence of anti-SARS-CoV-2 (16.58 %, 33/199) was detected among those over-40 years of age and the month of November 2020 had the highest number of detections 9 % (18/199) with the majority living in impoverished and neglected neighborhoods in the city of Rio de Janeiro. We found a high prevalence of anti-SARS-CoV-2 in patients with viral hepatitis before COVID-19 vaccination. This demonstrates the high exposure of this population during the period of social isolation.
Asunto(s)
Anticuerpos Antivirales , COVID-19 , Hepatitis B , Hepatitis C , SARS-CoV-2 , Humanos , Estudios Seroepidemiológicos , COVID-19/epidemiología , COVID-19/inmunología , COVID-19/prevención & control , Femenino , Masculino , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Hepatitis B/inmunología , Adulto , SARS-CoV-2/inmunología , Persona de Mediana Edad , Hepatitis C/epidemiología , Anticuerpos Antivirales/sangre , Brasil/epidemiología , Adulto Joven , Anciano , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , AdolescenteRESUMEN
The hepatitis B elimination is a goal proposed by the WHO to be achieved by 2030 through the adoption of synergistic measures for the prevention and chronic HBV infection treatment. Complete cure is characterized by the HBV elimination from the body and is the goal of the chronic hepatitis B treatment, which once achieved, will enable the hepatitis B elimination. This, today, has been a scientific challenge. The difficulty in achieving a complete cure is due to the indefinite maintenance of a covalently closed episomal circular DNA (cccDNA) reservoir and the maintenance and persistence of an insufficient and dysfunctional immune response in chronically infected patients. Among the measures adopted to eliminate hepatitis B, two have the potential to directly interfere with the virus cycle, but with limited effect on HBV control. These are conventional vaccines-blocking transmission and antiviral therapy-inhibiting replication. Vaccines, despite their effectiveness in protecting against horizontal transmission and preventing mother-to-child vertical transmission, have no effect on chronic infection or potential to eliminate the virus. Treatment with antivirals suppresses viral replication, but has no curative effect, as it has no action against cccDNA. Therapeutic vaccines comprise an additional approach in the chronic infection treatment, however, they have only a modest effect on the immune system, enhancing it temporarily. This manuscript aims to address (1) the cccDNA persistence in the hepatocyte nucleus and the immune response dysfunction in chronically infected individuals as two primary factors that have hampered the treatment and HBV elimination from the human body; (2) the limitations of antiviral therapy and therapeutic vaccines, as strategies to control hepatitis B; and (3) the possibly promising therapeutic approaches for the complete cure and elimination of hepatitis B.
Asunto(s)
Vacunas contra Hepatitis B , Virus de la Hepatitis B , Hepatitis B , Humanos , Virus de la Hepatitis B/efectos de los fármacos , Vacunas contra Hepatitis B/uso terapéutico , Hepatitis B/tratamiento farmacológico , Hepatitis B/prevención & control , Antivirales/uso terapéutico , Animales , ADN Circular , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/virologíaRESUMEN
BACKGROUND: Chronic hepatitis-B virus (HBV) infection due to mother-to-child transmission (MTCT) during the perinatal period is an important global health concern. Chile is a low-prevalence country with an increasing migratory inflow from Latin- American countries, with intermediate to high endemic rates of HBV infection, and until 2021, there is no universal maternal screening. This study aimed to evaluate infant outcomes using a risk-based strategy of maternal screening to prevent MTCT of hepatitis B virus (HBV) in a low-prevalence country. METHODS: This prospective study included infants born to HBsAg-positive women detected using a local risk-based strategy. The exposed infants received immunoprophylaxis (IP) and follow-up to evaluate their clinical outcomes and immune responses through post-serological vaccine testing (PSVT) after completing the three- dose schedule of the HBV vaccine. RESULTS: A total of 99 HBsAg-positive mothers were detected. Seventy-six (82%) infants completed the follow-up and had PSVT between 9 and 12 months of age. 55.2% female, the median gestational age was 39 weeks (25-41) and the median birth weight was 3,130g (816-4,400 g). All patients received IP with recombinant HBV vaccine plus hepatitis-B virus immunoglobulin (HBIG) and three doses of the HBV vaccine. There were no cases of HBV infection, and 96% (72) responded to immunization with HBsAg antibodies (anti-HBsAg) >10 UI/ml, with a median level of 799 IU/ml. CONCLUSIONS: A high-risk strategy can be implemented in countries with non-universal screening for VHB. Timely IP plus high-uptake VHB vaccination in infants born to HBsAg-positive mothers was associated with a high immunogenic response and absence of MTCT.
Asunto(s)
Hepatitis B Crónica , Hepatitis B , Complicaciones Infecciosas del Embarazo , Embarazo , Lactante , Femenino , Humanos , Masculino , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/epidemiología , Hepatitis B Crónica/prevención & control , Antígenos de Superficie de la Hepatitis B/uso terapéutico , Prevalencia , Estudios Prospectivos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Virus de la Hepatitis B , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Vacunas contra Hepatitis B/uso terapéutico , Complicaciones Infecciosas del Embarazo/prevención & controlRESUMEN
BACKGROUND: In the Americas, the Pan American Health Organization (PAHO) has promoted initiatives that aim at the elimination of mother-to-child transmitted diseases for over two decades. Although Guatemala has assumed the commitment to improve access and coverage of reproductive and perinatal services, the goals have not yet been reached. Often, the implementation of these efforts is hampered by complexities rooted in social, cultural, and environmental intersections. The objective of this work is to share our experience applying gender intersectionality as a methodological and analytical tool in a participatory research project that aims to improve access to maternal and child health screening services. The study shows the novel strategy that incorporates intersectionality contributing to evidence on how it can be applied to strengthen public health efforts around the implementation of the EMTCT Plus (Elimination of mother-to-child transmission of HIV, Syphilis, Hepatitis B, and Chagas disease) framework, in the mostly rural municipality of Comapa, in Guatemala. METHODS: We applied a participatory methodology, integrating theoretical and methodological frameworks to have an intersectional understanding of health services delivered by both, midwives, and the public health institution, for the prevention, diagnosis, treatment, and follow-up of HIV, Syphilis, Hepatitis B, and Chagas. The data was collected by conducting interviews, focus groups, workshops, and reviewing laboratory databases, guided by five strategies from a cultural appropriateness framework. RESULTS: The intersectional analysis shed light on the synergies and gaps of the current efforts and protocols implemented by both the midwives and the Ministry of Health. The services offered for the four diseases were often delivered independently from each other, and a comprehensive educational and communication material strategy was absent. However, our findings will be used to inform consistent, locally relevant, and culturally appropriate educational content for the local population, also following the national policy guidelines. CONCLUSIONS: Using intersectionality as a method and as an analytical tool allowed us to understand the (1) interrelation of diverse social, cultural, and environmental determinants which influence the delivery of health services, as well as (2) the dynamics between the traditional and institutional health systems. (3) Community engagement and the participation of different stakeholders in a consultative process have been fundamental for the conceptual and methodological tenets of this research. (4) Finally, giving a more prominent role to midwives can strengthen sustainability and cultural appropriateness, which is complementary to the delivery of institutional health services.
RESUMEN: ANTECEDENTES: La Organización Panamericana de la Salud (OPS) ha impulsado iniciativas que buscan la eliminación de las enfermedades de transmisión materno infantil en las Américas desde hace más de dos décadas. Si bien Guatemala ha asumido el compromiso de mejorar el acceso y la cobertura de los servicios reproductivos y perinatales, las metas aún no se han alcanzado. Muchas veces, la implementación de estos esfuerzos se ve obstaculizada por complejidades arraigadas en intersecciones sociales, culturales y ambientales. Este estudio muestra una estrategia novedosa que incorpora la interseccionalidad como un componente metodológico y analítico. Esto contribuye a evidenciar la manera en que la interseccionalidad y la participación comunitaria pueden ser aplicadas para fortalecer los esfuerzos de salud pública en torno a la implementación de la estrategia ETMI Plus (Eliminación de la transmisión materno infantil del VIH, sífilis, hepatitis B y enfermedad de Chagas), en el municipio de Comapa, en Guatemala, el cual es mayoritariamente rural. MéTODOS: Implementamos una metodología participativa, integrando marcos teóricos y metodológicos para comprender la prestación de servicios de salud, tanto por parte de comadronas como de la institución de salud pública, desde una perspectiva interseccional para la prevención, diagnóstico, tratamiento y seguimiento de VIH, sífilis, hepatitis B y Chagas. Los datos fueron recolectados a través de entrevistas, grupos focales, talleres y tras la revisión de bases de datos de laboratorio, y nos guiamos por cinco estrategias propuestas en un marco para pertinencia cultural. RESULTADOS: El análisis interseccional permitió entender las sinergias y brechas de los esfuerzos y los protocolos que se implementan actualmente, tanto por parte de las comadronas como por el Ministerio de Salud. Encontramos que los servicios que actualmente se prestan para las cuatro enfermedades son en su mayoría independientes entre sí, y no se contaba con una estrategia integral de material educativo y de comunicación. Sin embargo, nuestros resultados se utilizarán como base para una estrategia de comunicación que sea coherente, localmente relevante y culturalmente apropiada para la población local, y también siga las regulaciones de las políticas nacionales. CONCLUSIONES: El uso de la interseccionalidad como método y como herramienta analítica nos permitió comprender (1) la interrelación de diversos determinantes sociales, culturales y ambientales que influyen en la prestación de servicios de salud, así como (2) la dinámica entre los sistemas de salud tradicional e institucional. (3) El compromiso de la comunidad y la participación de las diferentes partes interesadas en un proceso consultivo han sido fundamentales para los principios conceptuales y metodológicos de esta investigación. (4) Por último, otorgar un papel más destacado a las matronas puede reforzar la sostenibilidad y la adecuación cultural, que es complementaria a la prestación de servicios de salud institucionales.
Asunto(s)
Infecciones por VIH , Hepatitis B , Sífilis , Embarazo , Niño , Humanos , Femenino , Salud Infantil , Marco Interseccional , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Infecciones por VIH/epidemiología , Hepatitis B/prevención & controlRESUMEN
We present the case of a breakthrough infection by hepatitis B virus (HBV), intending to warn about the challenge that HBV represents for transfusion safety. Virological markers for HBV infection were assayed during a blood donor screening by detection of HBsAg, anti-HBc, and viral nucleic acid (HBV DNA) by a nucleic acid test (NAT). Additionally, samples were analyzed for detection of immunoglobulin M anti-HBc, HBeAg, anti-HBe, and anti-HBs. A first-time donor repeatedly tested positive for HBV DNA by NAT and nonreactive for HBV-serological markers of infection. He stated having completed the anti-HBV vaccination schedule; thus, study of anti-Hbs resulted in reactive at protective level (18 mIU/mL). The donor denied clinical symptoms of hepatitis and remained healthy during the follow-up period. 95 days postdonation, NAT was negative, seroconversion of anti-HBc ab was detected, and a significant increase in anti-HBs concentration was measured (>1000 mIU/mL). This is the first case of HBV-breakthrough infection reported in Argentina and to our knowledge, this potential threat to transfusion safety is novel in an HBV low-endemic region with high coverage of HBV vaccination. The occurrence of breakthrough infections challenges the current protocols for the identification of HBV-infected subjects, could be a source of silent HBV transmission.
Asunto(s)
Virus de la Hepatitis B , Hepatitis B , Masculino , Humanos , Virus de la Hepatitis B/genética , Infección Irruptiva , Donantes de Sangre , ADN Viral/genética , Antígenos de Superficie de la Hepatitis B , Antígenos del Núcleo de la Hepatitis B , Hepatitis B/diagnóstico , Hepatitis B/prevención & control , Hepatitis B/epidemiología , Anticuerpos contra la Hepatitis BRESUMEN
Persistent viruses are hard to be eradicated, even using effective medications, and can persist for a long time in humans, sometimes regardless of treatment. Hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and human T cell lymphotropic virus infections, the most common in our era, are still a challenge despite the increased knowledge about their biology. Most of them are highly pathogenic, some causing acute disease or, more often, leading to chronic persistent infections, and some of the occult, carrying a high risk of morbidity and mortality. However, if such infections were discovered early, they might be eradicated in the near future with effective medications and/or vaccines. This perspective review points out some specific characteristics of the most important chronic persistent viruses. It seems that in the next few years, these persistent viruses may have control by vaccination, epidemiological strategies, and/or treatment.
Asunto(s)
Infecciones por VIH , Infecciones por HTLV-I , Hepatitis B , Hepatitis C , Virus Linfotrópico T Tipo 1 Humano , Humanos , VIH , Virus de la Hepatitis B , Hepacivirus , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Infección Persistente , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiologíaRESUMEN
RESUMO Objetivo: Identificar o perfil dos doadores de tecidos oculares humanos na área de atuação do Banco de Olhos da Paraíba, destacando o impacto da sorologia positiva para hepatite B no descarte dos tecidos para transplante. Métodos: O estudo é transversal e utilizou dados do Banco de Olhos da Paraíba entre janeiro de 2013 e dezembro de 2022. Dados sobre procedência, idade, sexo, causa do óbito, tempo entre óbito e enucleação, resultados sorológicos e motivo de descarte das córneas dos doadores foram coletados. Resultados: O maior motivo de descarte foi por sorologia positiva (56,5%), sendo positivadas as sorologias positivas para hepatite B e HBsAg em 11,1% e 4,75% dos pacientes, respectivamente. Conclusão: A sorologia positiva para hepatite B como um critério de descarte absoluto é responsável por grande parcela de descartes, apesar da pouca informação sobre suas repercussões e representação de infectividade nos receptores do transplante.
ABSTRACT Objective: To identify the profile of human ocular tissue donors in the area covered by the Eye Bank of Paraíba (PB), highlighting the impact of positive serology for hepatitis B (anti-HBc) in the disposal of tissues for transplantation. Methods: This is a cross-sectional that uses data from the Eye Bank of Paraíba (PB) between January 2013 and December 2022. Data on origin, age, sex, cause of death, time between death and enucleation, serological results, and reason for discarded donor corneas were collected. Results: The main reason for discarding was due to positive serology (56.5%), with positive anti-HBc and HBsAg serology in 11.1% and 4.75% of patients, respectively. Conclusion: Anti-HBc positive serology as an absolute disposal criterion is responsible for great part of disposals, despite little information about its repercussions and representation of infectivity in transplant recipients.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Donantes de Tejidos/estadística & datos numéricos , Trasplante de Córnea/normas , Trasplante de Córnea/estadística & datos numéricos , Selección de Donante/normas , Bancos de Ojos/normas , Anticuerpos contra la Hepatitis B/análisis , Pruebas Serológicas/normas , Virus de la Hepatitis B , Estudios Transversales , Estudios Retrospectivos , Transmisión de Enfermedad Infecciosa/legislación & jurisprudencia , Transmisión de Enfermedad Infecciosa/prevención & control , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Bancos de Ojos/estadística & datos numéricos , Hepatitis B/prevención & control , Hepatitis B/transmisión , Antígenos del Núcleo de la Hepatitis B/análisisRESUMEN
Abstract Objective: to identify the vaccination and serological status against hepatitis B among community health workers; to vaccinate against hepatitis B virus and to evaluate the immune response of susceptible workers. Method: phase I, cross-sectional and descriptive study, among community health workers in a capital city of the Midwest region, through a self-administered questionnaire, checking of vaccination cards, and blood collection for testing of serological markers for hepatitis B. Phase II, cohort study carried out in vaccinated non-immune workers identified in phase I. They received one dose of vaccine (challenge dose) and serological testing. Results: a total of 109 workers participated in the study. Most had vaccination record (97; 89.0%) and vaccination completeness (75; 77.3%), while the isolated anti-HBs (Antibodies against hepatitis B virus) marker was detected in 78 (71.6%) workers. The prevalence of hepatitis B virus exposure was 8.2%. Of the ten non-immune vaccinated workers, after challenge dose, one remained susceptible. Conclusion: although most workers are vaccinated and show immunological response to hepatitis B, susceptibility after challenge dose was identified. Therefore, it is necessary to have a surveillance program of the vaccination situation and serological status for this virus, to promote these workers' safety.
Resumo Objetivo: identificar a situação vacinal e sorológica contra hepatite B entre agentes comunitários de saúde; vacinar contra o vírus da hepatite B e avaliar a resposta imunológica dos agentes susceptíveis. Método: fase I, estudo transversal e descritivo, entre agentes comunitários de saúde de uma capital da região Centro-oeste, por meio de questionário autoaplicável, conferência do cartão vacinal e coleta de sangue para testagem dos marcadores sorológicos para hepatite B. Fase II, estudo de coorte realizado em trabalhadores vacinados não imunes e identificados na fase I. Estes receberam uma dose da vacina (dose desafio) e teste sorológico. Resultados: participaram do estudo 109 agentes. A maioria tinha registro de vacinação (97; 89,0%) e completude vacinal (75; 77,3%), já o marcador anti-HBs (anticorpos contra o vírus da hepatite B) isolado foi detectado em 78 (71,6%) agentes. A prevalência de exposição ao vírus da hepatite B foi de 8,2%. Dos dez agentes vacinados não imunes, após a dose desafio, um permaneceu susceptível. Conclusão: apesar da maioria dos trabalhadores estarem vacinados e apresentarem resposta imunológica para hepatite B, a suscetibilidade após a dose desafio foi identificada. Portanto, é necessário que haja um programa de vigilância da situação vacinal e estado sorológico para este vírus, para promover a segurança destes trabalhadores.
Resumen Objetivo: identificar la situación de la vacunación y serología contra la hepatitis B entre agentes comunitarios de la salud, vacunar contra el virus de la hepatitis B y evaluar la respuesta inmunológica de los agentes susceptibles. Método: fase I, estudio transversal y descriptivo, entre agentes comunitarios de la salud de una capital de la región centro oeste, por medio de cuestionario autoadministrado, verificación del carné de vacunación y extracción de sangre para comprobar los marcadores serológicos para la hepatitis B. Fase II, estudio de cohorte realizado en trabajadores vacunados no inmunes e identificados en la Fase I; estos recibieron una dosis de la vacuna (dosis de desafío) y realizaron el test serológico. Resultados: participaron del estudio 109 agentes. La mayoría tenía registro de vacunación (97; 89,0%) y de cobertura de vacunación (75; 77,3%); el marcador anti-HBs (Anticuerpos contra el virus de la hepatitis B) aislado fue detectado en 78 (71,6%) de los agentes. La prevalencia de exposición al virus de la hepatitis B fue de 8,2%. De los diez agentes vacunados no inmunes, después de la dosis desafío, uno permaneció susceptible. Conclusión: a pesar de que la mayoría de los trabajadores estaban vacunados y presentaron respuesta inmunológica para la hepatitis B, la susceptibilidad, después de la dosis desafío, fue identificada. Por tanto, es necesario que exista un programa de vigilancia de la situación de vacunación y estado serológico para este virus, para promover la seguridad de estos trabajadores.
Asunto(s)
Humanos , Virus de la Hepatitis B , Exposición Profesional , Salud Laboral , Agentes Comunitarios de Salud , Hepatitis B/prevención & control , Anticuerpos contra la Hepatitis BRESUMEN
Hepatitis B Surface Antigen (HBsAg) seroclearance is the highest treatment goal recommended by the current guidelines for hepatitis B. Levels of antibodies to HBsAg (anti-HBs) are strongly associated with HBsAg recurrence, but hepatitis B vaccination may increase the anti-HBs seroconversion rate and reduce recurrence. We conducted a retrospective clinical study to ascertain the effect of this vaccination on the seroconversion rate and levels of protective anti-HBs after HBsAg. In this retrospective study, we distributed a questionnaire through an online survey platform to collect information related to hepatitis B vaccination in patients with functional cure of hepatitis B with Interferon-α (IFNα) therapy. We enrolled 320 patients who achieved functional cure from IFNα therapy. Of these, 219 patients had received hepatitis B vaccination according to their personal preference and drug accessibility after HBsAg seroclearance, whereas the remaining 101 patients did not receive hepatitis B vaccination. The anti-HBs seroconversion rate of 78.1% in the vaccinated group was significantly greater than that in the unvaccinated group (41.6%) (p < 0.001). Stratified comparisons with anti-HBs of ≥ 100 IU/L and ≥ 300 IU/L showed that both proportions in the vaccinated group were greater than those in the unvaccinated group (71.2% vs. 32.7% and 56.2% vs. 17.8%, respectively, all p-values < 0.001). Logistic regression analysis showed that the odds ratio of vaccination was 4.427, which was the strongest influencing factor for anti-HBs, reaching 100 IU/L or higher. Hepatitis B vaccination in patients after HBsAg seroclearance not only increased the anti-HBs seroconversion rate but also significantly increased antibody levels, with good safety, indicating the clinical value of vaccine therapy for patients with functional cure.
Asunto(s)
Hepatitis B Crónica , Hepatitis B , Humanos , Vacunas contra Hepatitis B , Antígenos de Superficie de la Hepatitis B , Estudios Retrospectivos , Seroconversión , Anticuerpos contra la Hepatitis B , Hepatitis B/prevención & controlRESUMEN
The hepatitis B virus (HBV), comprising of ten genotypes (A-J), has been a silent threat against humanity, constituting a public health problem worldwide. In 2016, the World Health Organization set forth an impressive initiative for the global elimination of viral hepatitis by 2030. As the target date approaches, many nations, particularly in the Latin American region, face challenges in designing and implementing their respective elimination plan. This review aimed to portray the state of knowledge about the epidemiological, molecular, and clinical characteristics of HBV genotype H (HBV/H), endemic to Mexico. PubMed, Scopus, Web of Science, and Google Scholar were searched to compile scientific literature over 50 years (1970-2022). A total of 91 articles were organized into thematic categories, addressing essential aspects such as epidemiological data, risk factors, HBV genotype distribution, HBV mixed infections, clinical characteristics, and vaccination. The prevalence and its associated 95% confidence interval (95% CI) were estimated using the Metafor package in R programming language (version 4.1.2). We provide insights into the strengths and weaknesses in diagnostics and prevention measures that explain the current epidemiological profile of HBV/H. Training, research, and awareness actions are required to control HBV infections in Mexico. These actions should contribute to creating more specific clinical practice guides according to the region's characteristics. Mexico's elimination plan for HBV will require teamwork among the government health administration, researchers, physicians, specialists, and civil society advocates to overcome this task jointly.
Asunto(s)
Virus de la Hepatitis B , Hepatitis B , Humanos , Virus de la Hepatitis B/genética , México/epidemiología , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Antígenos de Superficie de la Hepatitis B/genética , Genotipo , Prevalencia , ADN Viral/genéticaRESUMEN
El uso preventivo de antimicrobianos es de larga data y no se restringe a antibacterianos. Lo más consensuado y estructurado es la profilaxis antimicrobiana perioperatoria y ante procedimientos invasivos. Fuera de este contexto hay gran cantidad de situaciones, menos caracterizadas, con riesgo de infecciones en que se usan ampliamente, muchas veces con menor sistematización. Esta presentación presenta las bases conceptuales y operativas de este segundo tipo de profilaxis. Conceptualmente la profilaxis primaria pretende evitar la infección por agente único conocido o variados, por exposición ambiental o susceptibilidad específica de ese hospedero y es implementable antes o después de la exposición. Producida esta infección la meta de la profilaxis secundaria intenta evitar la enfermedad y puede tomar dos modalidades, en infecciones sin evidencias de enfermedad clínica o daños, la profilaxis corresponde a "tratamiento de infección latente" y, si aún en ausencia de manifestaciones clínicas, hay elementos de laboratorio precoces premonitorios de progresión, la profilaxis se denomina "tratamiento anticipatorio". Se presentan operacionalmente y resumidas las situaciones en contexto médico no invasivo con uso potencial preventivo de antimicrobianos en base a agentes posibles, situaciones ambientales de riesgo, vulnerabilidad del hospedero, medicamentos a usar, su duración y efectividad con enfoque mayoritario en medicina de adultos.
Antimicrobial use with preventive purpose probably began shortly after its therapeutic use, especially antibiotics. More consensus and sistematization exist with perioperative and invasive procedures prophylaxis. However, beyond that context, there is great number of non invasive medical situations with high risk of secondary infections either by acquisition of pathogens or activation of latent ones, in which antimicrobials are routinely used with preventive purpose, albeit with less sistematization and consensus. This presentation aims to lay down the conceptual and operational basis for antimicrobial prophylaxis in these settings, whose objective is preventing an infection (primary prophylaxis) by a known or a variety of pathogens, either by person to person transmission, enviromental exposure or particular susceptibility of the host, and can be implemented before or after exposure. If already infected, the antimicrobial prophylaxis goal is to avoid progression to disease (secondary prevention) and may take two conceptual approaches; first, without clinical disease but significant risk of progression, the modality can be called "treatment of latent infection". In the second, also clinically asymptomatic, but with premonitory laboratoy signs of impending progression present, early use of antimicrobial is called "preemptive treatment". This presentation will describe the most frequent medical situations where preventive use of antimicrobials is employed, together with the medications most consensually used, according to the host, the agent(s) and medical situation, with emphasis in adults.
Asunto(s)
Humanos , Control de Infecciones/métodos , Profilaxis Antibiótica/métodos , Antiinfecciosos/uso terapéutico , Neumonía por Pneumocystis/prevención & control , Tuberculosis/prevención & control , Profilaxis Posexposición , Profilaxis Pre-Exposición , Hepatitis B/prevención & controlRESUMEN
BACKGROUND: The hepatitis B vaccine (HBV) is recommended at birth to prevent perinatal hepatitis B transmission; however, many newborns still do not receive HBV. The extent to which planned out-of-hospital births, which have increased over the past decade, are associated with nonreceipt of the HBV birth dose is unknown. The purpose of this study was to determine whether a planned out-of-hospital birth location is associated with the nonreceipt of the HBV birth dose. METHODS: We performed a retrospective cohort study of all births from 2007 to 2019 recorded in the Colorado birth registry. χ2 analyses were used to compare maternal demographics by birth location. Univariate and multiple logistic regression were used to evaluate the association of birth location with nonreceipt of the HBV birth dose. RESULTS: In total 1.5% of neonates born in freestanding birth centers and 0.1% of neonates born at a planned home birth received HBV compared to 76.3% of neonates born in a hospital location. After adjusting for confounders, this translated to a large increase in the odds of not receiving HBV compared to in-hospital births [freestanding birth center (aodds ratio (aOR): 172.98, 95% confidence interval (CI): 136.98-219.88); planned home birth (aOR: 502.05, 95% CI: 363.04-694.29)]. Additionally, older maternal age, White/non-Hispanic race and ethnicity, higher income, and private or no insurance were associated with nonreceipt of the HBV birth dose. CONCLUSIONS: Planned out-of-hospital birth is a risk factor for nonreceipt of the HBV birth dose. As births in these locations become more common, targeted policies and education are warranted.
Asunto(s)
Vacunas contra Hepatitis B , Hepatitis B , Embarazo , Femenino , Recién Nacido , Humanos , Estudios Retrospectivos , Factores de Riesgo , Hospitales , Vacunación , Hepatitis B/epidemiología , Hepatitis B/prevención & controlRESUMEN
BACKGROUND: Constructing serologic profiles of donors is the first step in establishing traceability in the donation and transplant process. These data allow us to implement various strategies to enhance the recipients' quality of care. We present the serologic profiles of donors in Argentina between 2017 and 2021. METHODS: Donation processes initiated in 2017 to 2021 and registered in the National Information System of Procurement and Transplantation of the Argentine Republic were selected. The presence of complete serologic studies was considered an inclusion criterion. The serologic variables for viruses included HIV, human T-cell lymphotropic virus (HTLV), cytomegalovirus (CMV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Those for bacteria included Treponema pallidum and the genus Brucella, and those for parasites included Trypanosoma cruzi and Toxoplasma gondii. RESULTS: A total of 18,242 processes were initiated in the period 2017 to 2021. A total of 6015 processes had documented complete serologic studies. Most donors came from 2 jurisdictions: Buenos Aires (27.72%) and CABA (15.13%). Cytomegalovirus (84.70%) and T. gondii (40.94%) were the most prevalent serologies. We identified 0.25% reactive serologies for HIV, 0.24% for HTLV, 0.79% for HCV, and 2.49% for T. pallidum. In reference to HBV markers, 0.19% of donors presented Ag HBs, and the Ac HBc + Ac HBs association was observed in 2.31% of donors. Reactive serology for brucellosis was demonstrated in 1.11% of donors. Reactive serology for Chagas disease was found in 0.9% of donors. CONCLUSIONS: Given the wide variation in seroprevalence in the different jurisdictions of the country, the jurisdictional and national levels of government should be responsible for monitoring changes in behavior that require modification of selection and prevention strategies.
Asunto(s)
Infecciones por VIH , Hepatitis B , Hepatitis C , Humanos , Estudios Seroepidemiológicos , Argentina/epidemiología , Virus de la Hepatitis B , Hepatitis C/epidemiología , Hepacivirus , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Donantes de SangreRESUMEN
Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson's regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p < 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations.
Asunto(s)
Hepatitis B Crónica , Hepatitis B , Humanos , Niño , Adolescente , Virus de la Hepatitis B , Antígenos de Superficie de la Hepatitis B , Prevalencia , Brasil/epidemiología , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Anticuerpos contra la Hepatitis B , Vacunas contra Hepatitis BRESUMEN
O risco de contaminação das hepatites virais pode ser acentuado por lesõesacidentais e pela manipulação de fluidos biológicos durante a prática odontológica. Este estudo teve como objetivo avaliar o nível de conhecimento dos estudantes de Odontologia sobre as hepatites virais e sua relevância na prática clínica. Realizou-se um estudotransversal,de caráter exploratório e abordagem quantitativa, com graduandos em Odontologia de uma universidade pública brasileira matriculados no ano de 2019. A amostragem foi do tipo não-probabilística intencional e o grupo de estudo incluiu 184 estudantes que já desenvolviam atividades clínicas. Os voluntários responderam a um questionário com perguntas abertas sobre aspectos gerais das hepatites virais e sua relevância na Odontologia. Empregou-se os testes do qui-quadrado de Pearson e exato de Fisher para mensurara associação entre o conhecimento dos estudantes e a sua fase acadêmica. Considerou-se como significantes valores de p≤0,05.A taxa de respostas obtidas foi de 40,2% (n=74). Houve uma maior proporção de respostas corretas sobre os sinais e sintomas das hepatites virais entre os estudantes do sétimo ao décimo semestre (p<0,001). Esse grupo também demonstrou maior conhecimento sobre as medidas específicas de prevenção contra a hepatite B (p=0,01). Apenas 23% (n=17) dos participantes do estudo estavam cientesquanto às complicações clínicas mais comuns das hepatites virais. O nível de conhecimento dos estudantes de Odontologia sobre as hepatites virais foi considerado baixo.Os graduandos dos dois grupos analisados exibiram um desempenho similar para a maioriados itens avaliados (AU).
El riesgo de contaminación por hepatitis viral puede aumentar por lesiones accidentales y el manejo de fluidos biológicos durante la práctica dental. Este estudio tuvo como objetivo evaluar el nivel de conocimiento de los estudiantes de odontología sobre las hepatitis virales y su relevancia en la práctica clínica. Se realizó un estudio transversal, de carácter exploratorio y enfoque cuantitativo, con estudiantes de pregrado en Odontología de una universidad pública brasileña matriculados en el año 2019. El muestreo fuede tipo no probabilístico intencional y el grupo de estudio estuvo integrado por 184 estudiantes que ya desarrollaron actividades clínicas. Los voluntarios respondieron un cuestionario con preguntas abiertas sobre aspectos generales de las hepatitis virales y su relevancia en odontología. Se utilizaron las pruebas chi-cuadrado de Pearson y exacta de Fisher para medir la asociación entre el conocimiento de los estudiantes y su etapa académica. Se consideraron significativos valores de p≤0,05. La tasa de respuesta obtenida fue del 40,2% (n=74). Hubo mayor proporción de respuestas correctas sobre los signos y síntomas de las hepatitis virales entre los estudiantes del séptimo al décimo semestre (p<0,001). Este grupo también mostró mayor conocimiento sobre medidas específicas para prevenir la hepatitis B (p=0,01). Solo el 23% (n=17) de los participantes del estudio conocían las complicaciones clínicas más comunes de la hepatitis viral. El nivel de conocimiento de los estudiantes de odontología sobre las hepatitis virales se consideró bajo. Los estudiantes de pregrado de los dos grupos analizados mostraron un desempeño similar en la mayoría de los ítems evaluados (AU).
Viral hepatitis risk of contamination can be increased by accidental injuries and by the manipulation of biological fluids during dental practice. This study aimed to assess the level of knowledge of dentistry students about viral hepatitis and its relevance in clinical practice. A cross-sectional study, with an exploratory character and a quantitative approach, was carried out with undergraduate students in Dentistry from a Brazilian public university enrolled in the year 2019. The sampling was of the intentional non-probabilistic type and the study group included 184 students who hadalready started clinical activities. The volunteers answered a questionnaire with open questions about general aspects of viral hepatitis and its relevance in Dentistry.Pearson's chi-square and Fisher's tests were used to measure the association between students' knowledge and their academic stage. Values of p≤0.05 were considered significant. The response rate obtained was 40.2% (n=74). There was a higher proportion of correct answers about the signs and symptoms of viral hepatitis among students from the seventh to the tenth semester (p<0.001). This group also showed greater knowledge about specific measures to prevent hepatitis B (p=0.01). Only 23% (n=17) of study participants were aware of the most common clinical complications of viral hepatitis. The level of knowledge of dentistry students about viral hepatitis was considered low. Undergraduate students from the two groups analyzed showed similar performance for most of the assessed items (AU).
Asunto(s)
Humanos , Masculino , Femenino , Estudiantes de Odontología , Conocimientos, Actitudes y Práctica en Salud , Exposición Profesional , Hepatitis Viral Humana/patología , Distribución de Chi-Cuadrado , Estudios Transversales/métodos , Encuestas y Cuestionarios , Hepatitis B/prevención & controlRESUMEN
OBJECTIVE: to identify the vaccination and serological status against hepatitis B among community health workers; to vaccinate against hepatitis B virus and to evaluate the immune response of susceptible workers. METHOD: phase I, cross-sectional and descriptive study, among community health workers in a capital city of the Midwest region, through a self-administered questionnaire, checking of vaccination cards, and blood collection for testing of serological markers for hepatitis B. Phase II, cohort study carried out in vaccinated non-immune workers identified in phase I. They received one dose of vaccine (challenge dose) and serological testing. RESULTS: a total of 109 workers participated in the study. Most had vaccination record (97; 89.0%) and vaccination completeness (75; 77.3%), while the isolated anti-HBs (Antibodies against hepatitis B virus) marker was detected in 78 (71.6%) workers. The prevalence of hepatitis B virus exposure was 8.2%. Of the ten non-immune vaccinated workers, after challenge dose, one remained susceptible. CONCLUSION: although most workers are vaccinated and show immunological response to hepatitis B, susceptibility after challenge dose was identified. Therefore, it is necessary to have a surveillance program of the vaccination situation and serological status for this virus, to promote these workers' safety.
Asunto(s)
Agentes Comunitarios de Salud , Hepatitis B , Humanos , Estudios de Cohortes , Estudios Transversales , Hepatitis B/prevención & control , Virus de la Hepatitis B , Anticuerpos contra la Hepatitis BAsunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Control de Enfermedades Transmisibles/normas , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Hepatitis B/prevención & control , Antivirales/uso terapéutico , Tamizaje Masivo , Hepatitis B/diagnóstico , Hepatitis B/tratamiento farmacológico , Hepatitis B/transmisiónRESUMEN
Introduction: Eliminating hepatitis B and C in immigrant and refugee populations is a significant challenge worldwide. Given the lack of information in Brazil, this study aimed to estimate the prevalence of infections caused by hepatitis B and C viruses and factors associated with hepatitis B in immigrants and refugees residing in central Brazil. Methods: An observational, cross-sectional, and analytical study was conducted from July 2019 to January 2020 with 365 immigrants and refugees. Hepatitis B was detected by a rapid immunochromatographic test, enzyme immunoassay, and chemiluminescence, and hepatitis C by rapid immunochromatographic test. Multiple analysis was used to assess factors associated with hepatitis B infection. Results: Of the participants, 57.8% were from Haiti and 35.6% were from Venezuela. Most had been in Brazil for less than 2 years (71.2%). The prevalence of HBV infection and exposure was 6.6% (95% CI: 4.5-9.6%) and 27.9% (95% CI: 23.6-2.8%), respectively, and 34% had isolated anti-HBs positivity. Reporting a sexually transmitted infection was statistically associated with HBV infection (OR: 7.8; 95% CI: 2.3-26.4). No participant with positive anti-HCV serology was found. Conclusions: The study showed that participants were outside the reach of prevention and control actions for hepatitis B. Therefore, public health strategies must be designed to reach, inform, and vaccinate this group.