Posts filed under ‘Hepatitis B’

Infections in patients affected by rheumatologic diseases associated to glucocorticoid use or tumor necrosis factor-alpha inhibitors.

Rev Chilena Infectol. April 2014 V.31 N.2 P.181-95.

[Article in Spanish]

Fica A.

Abstract

A great diversity of infectious agents can affect patients that use steroids at immunosuppressive doses or tumor necrosis factor alpha (TNF-alpha) antagonists.

The list of participating microorganisms is more restricted in the case of anti TNF-alpha blockers.

Overlapping agents include intracellular bacteria, Mycobacterium tuberculosis, geographic fungal agents that have the ability to establish granulamotous infections, herpes zoster, and reactivation of chronic hepatitis B virus infection.

An important conceptual issue for these infections is the existence of a threshold prednisone daily dose for the emergence of opportunistic infections but higher levels of immunosuppression and cofactors are required in the case of Pneumocystis jiroveci and cytomegalovirus infections.

In order to prevent these threats, a detailed medical evaluation is needed before prescription to detect potential risks and manage them properly.

Prevention rules must be prescribed in every case, that include common sense behaviors, vaccines, and in selected cases, chemoprophylaxis for latent tuberculosis (TB) infection, P. jiroveci pneumonia (PCP) or other specific requirements.

Latent TB infection is probable and requires chemoprophylaxis in the case of remote or recent exposure to a patient with lung TB, a positive tuberculin or interferon-gamma release assay result or residual lung scars in a chest x-ray exam.

PCP prevention is suggested when the patient reaches a daily dose of prednisone of 30 mg but might be needed at lower doses in case of other concomitant immunosuppressive drugs or when lymphopenia arises shortly after prednisone initiation.

PDF

https://scielo.conicyt.cl/pdf/rci/v31n2/art09.pdf

 

November 19, 2018 at 11:12 am

Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices.

MMWR Recomm Rep. 2018 Jan 12;67(1):1-31.

Schillie S1, Vellozzi C1, Reingold A2, Harris A1, Haber P3, Ward JW1, Nelson NP1.

Author information

1 Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

2 University of California, Berkeley School of Public Health, Berkeley, California.

3 Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

Abstract

HEPATITIS B VIRUS (HBV) IS TRANSMITTED VIA BLOOD OR SEXUAL CONTACT. PERSONS WITH CHRONIC HBV INFECTION ARE AT INCREASED RISK FOR CIRRHOSIS AND LIVER CANCER AND REQUIRE MEDICAL CARE. THIS REPORT UPDATES AND SUMMARIZES PREVIOUSLY PUBLISHED RECOMMENDATIONS FROM THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) AND CDC REGARDING THE PREVENTION OF HBV INFECTION IN THE UNITED STATES. ACIP RECOMMENDS TESTING ALL PREGNANT WOMEN FOR HEPATITIS B SURFACE ANTIGEN (HBSAG), AND TESTING HBSAG-POSITIVE PREGNANT WOMEN FOR HEPATITIS B VIRUS DEOXYRIBONUCLEIC ACID (HBV DNA); ADMINISTRATION OF HEPB VACCINE AND HEPATITIS B IMMUNE GLOBULIN (HBIG) FOR INFANTS BORN TO HBV-INFECTED WOMEN WITHIN 12 HOURS OF BIRTH, FOLLOWED BY COMPLETION OF THE VACCINE SERIES AND POSTVACCINATION SEROLOGIC TESTING; UNIVERSAL HEPATITIS B VACCINATION WITHIN 24 HOURS OF BIRTH, FOLLOWED BY COMPLETION OF THE VACCINE SERIES; AND VACCINATION OF CHILDREN AND ADOLESCENTS AGED <19 YEARS WHO HAVE NOT BEEN VACCINATED PREVIOUSLY. ACIP RECOMMENDS VACCINATION OF ADULTS AT RISK FOR HBV INFECTION, INCLUDING UNIVERSAL VACCINATION OF ADULTS IN SETTINGS IN WHICH A HIGH PROPORTION HAVE RISK FACTORS FOR HBV INFECTION AND VACCINATION OF ADULTS REQUESTING PROTECTION FROM HBV WITHOUT ACKNOWLEDGMENT OF A SPECIFIC RISK FACTOR. THESE RECOMMENDATIONS ALSO PROVIDE CDC GUIDANCE FOR POSTEXPOSURE PROPHYLAXIS FOLLOWING OCCUPATIONAL AND OTHER EXPOSURES. THIS REPORT ALSO BRIEFLY SUMMARIZES PREVIOUSLY PUBLISHED AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASEST GUIDELINES FOR MATERNAL ANTIVIRAL THERAPY TO REDUCE PERINATAL HBV TRANSMISSION

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837403/pdf/rr6701a1.pdf

August 2, 2018 at 8:10 am

Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. 36 pags

MMWR RR January 12, 2018 V.67 N.1 P.

Sarah Schillie, MD1 Claudia Vellozzi, MD1 Arthur Reingold, MD2 Aaron Harris, MD1 Penina Haber, MPH3 John W. Ward, MD1 Noele P. Nelson, MD1

1Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

2University of California, Berkeley School of Public Health, Berkeley, California

3Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC

El virus de la hepatitis B (HBV) se transmite a través de la sangre o el contacto sexual. Las personas con infección crónica por HBV tienen un mayor riesgo de cirrosis y cáncer de hígado y requieren atención médica.

Este informe actualiza y resume recomendaciones previamente publicadas del Comité Asesor sobre Prácticas de Inmunización (ACIP) y el CDC con respecto a la prevención de la infección por el HBV en los EEUU.

El ACIP recomienda realizar pruebas a todas las embarazadas para detectar el antígeno de superficie de la hepatitis B (HBsAg) y analizar las embarazadas con el HBsAg-positivo realizando test molecular para el ácido desoxirribonucleico del virus de la hepatitis B (DNA del HBV); administración de vacuna HepB e inmunoglobulina antihepatitis B (HBIG) para recién nacidos de mujeres infectadas por el HBV dentro de las 12 horas posteriores al nacimiento, seguido de la finalización de la serie de vacunas y las pruebas serológicas post-vacunación; vacunación universal contra la hepatitis B dentro de las 24 horas posteriores al nacimiento, seguida de la finalización de la serie de vacunas; y la vacunación de niños y adolescentes < 19 años que no han sido vacunados previamente.

ACIP recomienda la vacunación de adultos en riesgo de infección por HBV, incluida la vacunación universal de adultos en entornos en los que una gran proporción tiene factores de riesgo de infección por HBV y vacunación de adultos que solicitan protección contra el HBV sin reconocimiento de un factor de riesgo específico. Estas recomendaciones también proporcionan orientación de los CDC para la profilaxis después de la exposición después de ocupacional y otras exposiciones.

Este informe también resume brevemente la Asociación Americana para el Estudio de Enfermedades Hepáticas publicada previamente, las guías para la terapia antiviral materna para reducir la transmisión perinatal del HBV.

PDF

https://www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6701-H.pdf

May 16, 2018 at 9:05 am

Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant.

MMWR Morb Mortal Wkly Rep. 20 Abr 2018;67(15):455-458.

Schillie S, Harris A, Link-Gelles R, Romero J, y cols.

Hepatitis B (HepB) vaccination is the primary means of preventing infections and complications caused by hepatitis B virus (HBV). On February 21, 2018, the Advisory Committee on Immunization Practices (ACIP) recommended Heplisav-B (HepB-CpG), a yeast-derived vaccine prepared with a novel adjuvant, administered as a 2-dose series (0, 1 month) for use in persons aged ≥18 years. The ACIP Hepatitis Vaccines Work Group conducted a systematic review of the evidence, including data from four randomized controlled trials assessing prevention of HBV infection and six randomized controlled trials assessing adverse events in adults. Seroprotective antibody to hepatitis B surface antigen (anti-HBs) levels were achieved in 90.0%–100.0% of subjects receiving HepB-CpG (Dynavax Technologies Corporation), compared with 70.5%–90.2% of subjects receiving Engerix-B (GlaxoSmithKline Biologicals). The benefits of protection with 2 doses administered over 1 month make HepB-CpG an important option for prevention of HBV…..

FULL TEXT

https://www.cdc.gov/mmwr/volumes/67/wr/mm6715a5.htm

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6715a5-H.pdf

May 9, 2018 at 7:56 am

Eliminating viral hepatitis: time to match visions with action

Lancet  November 11, 2017  V.390 N.10.108 P.2121

EDITORIAL

Eliminating viral hepatitis: time to match visions with action

 

PDF

http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32856-8.pdf

 

 

November 10, 2017 at 4:02 pm

Elimination of Perinatal Hepatitis B: Providing the First Vaccine Dose Within 24 Hours of Birth

Pediatrics September 2017 V. 140 N.3

COMMITTEE ON INFECTIOUS DISEASES, COMMITTEE ON FETUS AND NEWBORN

Kristi Watterberg, MD, FAAP, Chairperson, William Benitz, MD, FAAP, Ivan Hand, MD, FAAP, Eric Eichenwald, MD, FAAP, Brenda Poindexter, MD, FAAP, Dan L. Stewart, MD, FAAP, Susan W. Aucott, MD, FAAP, Karen M. Puopolo, MD, PhD, FAAP, Jay P. Goldsmith, MD, FAAP

Abstract

After the introduction of the hepatitis B vaccine in the United States in 1982, a greater than 90% reduction in new infections was achieved. However, approximately 1000 new cases of perinatal hepatitis B infection are still identified annually in the United States. Prevention of perinatal hepatitis B relies on the proper and timely identification of infants born to mothers who are hepatitis B surface antigen positive and to mothers with unknown status to ensure administration of appropriate postexposure immunoprophylaxis with hepatitis B vaccine and immune globulin. To reduce the incidence of perinatal hepatitis B transmission further, the American Academy of Pediatrics endorses the recommendation of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that all newborn infants with a birth weight of greater than or equal to 2000 g receive hepatitis B vaccine by 24 hours of age.

FULL TEXT

http://pediatrics.aappublications.org/content/140/3/e20171870

PDF

http://pediatrics.aappublications.org/content/pediatrics/140/3/e20171870.full.pdf

September 22, 2017 at 8:02 am

Serum HBeAg and HBV DNA levels are not always proportional and only high levels of HBeAg most likely correlate with high levels of HBV DNA.

MEDICINE August 2017 V.96 N.33

Chen, Ping PhDa,b; Xie, Qinfen MSa; Lu, Xuan BAb; Yu, Chengbo PhDb; Xu, Kaijin PhDb; Ruan, Bing PhDb; Cao, Hongcui PhDb; Gao, Hainv PhDa; Li, Lanjuan MDb,*

Abstract

This study aimed to investigate the correlation between quantitative hepatitis B e antigen (HBeAg) and hepatitis B virus (HBV) DNA levels, and to determine whether semiquantitative measurement of HBeAg can indicate the extent of HBV replication in HBeAg-positive subjects in the immune tolerant phase.

A cross-sectional, community-based survey was carried out in 12 communities of 2 counties in Zhejiang Province, China.

A panel of 788 HBeAg-positive subjects was divided into 4 groups according to HBV DNA level.

Groups I (n = 111), II (n = 91), III (n = 124), and IV (n = 462) had HBV DNA levels below 103 copies/mL (PCR undetectable), between 103 and 105 copies/mL (PCR detectable), between 105 and 2 × 107 copies/mL (hybridization detectable), and >2 × 107 copies/mL, respectively.

The HBeAg level correlated well with the HBV DNA level (R2 = 0.658; P < .01) on a log scale.

The average HBeAg level in group IV was significantly higher than those in the other 3 groups, and the best HBeAg cut-off value for differentiating group IV from the other 3 groups was 768 S/CO, with a sensitivity of 94.4% and specificity of 91.1%.

Semiquantification of HBeAg could indicate a relative HBV DNA level in HBeAg-positive subjects in the immune tolerant phase.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/08180/Serum_HBeAg_and_HBV_DNA_levels_are_not_always.22.aspx

PDF (hacer CLIC en “Article as PDF”)

August 19, 2017 at 12:08 pm

Time to re-evaluate the effect of the adolescent booster of hepatitis B vaccine

International Journal of Infectious Diseases July 2017 V.60 N.7 P.88-90

Editorial –

Ellie Carmody

Division of Infectious Diseases and Immunology, New York University School of Medicine, New York, New York, USA

Neutralizing antibodies (anti-HBs) conferred by immunization with hepatitis B virus (HBV) vaccine against HBV surface antigen (HBsAg) have been found to wane or reach undetectable levels in many individuals after 10–15 years of the vaccination (Wainwright et al., 1997, Dentinger et al., 2005).

It is uncertain whether individuals with low or absent levels of anti-HBs remain protected against HBV infection.

HBV vaccine does elicit immunologic memory, in which memory B cells can appropriately generate a robust anamnestic response to HBsAg even if the anti-HBs titer falls below 10 mIU/mL (West and Calandra, 1996, Watson et al., 2001, van der Sande et al., 2007).

However, the duration and uniformity of this immunologic memory after primary vaccination at infancy is unclear. HBV breakthrough infection in young adults may occur if the immunologic memory to HBsAg is absent upon sexual, parenteral, or horizontal (household) HBV exposure….

PDF

http://www.ijidonline.com/article/S1201-9712(17)30131-5/pdf

July 30, 2017 at 12:41 pm

Revisiones – Diagnóstico microbiológico de las hepatitis virales

Enf Infecc & Microbiol. Clínica Noviembre 2015 V.33 N.9 e53-e62

Roberto Alonso, Antonio Aguilera, Juan Córdoba, Antonio Fuertes

a Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España

b Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España

c Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, España

d LABCO QualityDiagnostics, Madrid, España

La inflamación hepática o hepatitis tiene causas diversas, tanto infecciosas como no infecciosas. Entre las primeras, cabe destacar la etiología viral que es la causa de, al menos, la mitad de todas las hepatitis en el mundo.

Se han descrito distintos virus con tropismo primario por el tejido hepático. Estos microorganismos se han ido nombrando sucesivamente con las letras del abecedario: A, B, C, D, E y G.

El objetivo de este artículo es revisar este grupo heterogéneo de virus en sus aspectos más básicos, sus implicaciones clínicas, su tratamiento, las principales medidas preventivas frente a estas infecciones y, con especial interés, las aproximaciones diagnósticas, tanto serológicas como moleculares, que se utilizan para su detección, cuantificación y caracterización

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90443319&pident_usuario=0&pcontactid=&pident_revista=28&ty=51&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=es&fichero=28v33n09a90443319pdf001.pdf

February 20, 2017 at 3:26 pm

Requirements for global elimination of hepatitis B: a modelling study

Lancet Infectious Diseases December 2016 V.16 N.12 P.1399–1408

Dr Shevanthi Nayagam, MBBS, Prof Mark Thursz, MD, Elisa Sicuri, PhD, Lesong Conteh, PhD, Stefan Wiktor, MD, Daniel Low-Beer, PhD, Prof Timothy B Hallett, PhD

Background

Despite the existence of effective prevention and treatment interventions, hepatitis B virus (HBV) infection continues to cause nearly 1 million deaths each year. WHO aspires to global control and elimination of HBV infection. We aimed to evaluate the potential impact of public health interventions against HBV, propose targets for reducing incidence and mortality, and identify the key developments required to achieve them.

Methods

We developed a simulation model of the global HBV epidemic, incorporating data on the natural history of HBV, prevalence, mortality, vaccine coverage, treatment dynamics, and demographics. We estimate the impact of current interventions and scaling up of existing interventions for prevention of infection and introducing wide-scale population screening and treatment interventions on the worldwide epidemic.

Findings

Vaccination of infants and neonates is already driving a large decrease in new infections; vaccination has already prevented 210 million new chronic infections by 2015 and will have averted 1·1 million deaths by 2030. However, without scale-up of existing interventions, our model showed that there will be a cumulative 63 million new cases of chronic infection and 17 million HBV-related deaths between 2015 and 2030 because of ongoing transmission in some regions and poor access to treatment for people already infected. A target of a 90% reduction in new chronic infections and 65% reduction in mortality could be achieved by scaling up the coverage of infant vaccination (to 90% of infants), birth-dose vaccination (to 80% of neonates), use of peripartum antivirals (to 80% of hepatitis B e antigen-positive mothers), and population-wide testing and treatment (to 80% of eligible people). These interventions would avert 7·3 million deaths between 2015 and 2030, including 1·5 million cases of cancer deaths. An elimination threshold for incidence of new chronic infections would be reached by 2090 worldwide. The annual cost would peak at US$7·5 billion worldwide ($3·4 billion in low-income and lower-middle-income countries), but decrease rapidly and this would be accelerated if a cure is developed.

Interpretation

Scale-up of vaccination coverage, innovations in scalable options for prevention of mother-to-child transmission, and ambitious population-wide testing and treatment are needed to eliminate HBV as a major public health threat. Achievement of these targets could make a major contribution to one of the Sustainable Development Goals of combating hepatitis.

Funding

Medical Research Council.

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(16)30204-3.pdf

November 15, 2016 at 12:19 pm

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