Hepatitis B Transmission: Is Vertical Transmission the Major Route in Intermediate Endemic Areas? A Proof-of-Concept Study Based on Mother–Child Genotypes

The route of hepatitis B transmission is believed to be horizontal in India, though pediatric studies showed mother as source in the majority of chronic HBV (CHB) cases. We aimed at establishing the fact that mother–child transmission is the main route of acquisition by documenting genotypically identical viruses in mother–child pairs. Blood samples of consecutive children (≤18 years) with CHB and high DNA (>10,000 IU/mL) and their positive mother were collected from January 2013 to December 2015. Polymerase chain reaction (PCR) products of HBV-DNA were amplified and sequenced by using BigDye Terminator Cycle Sequencing Kit v3.1 and aligned with previously described sequences in the region of interest for genotypes A to G by using BioEdit software. Phylogenetic tree was generated using p-distance algorithm in MEGA software version 6. Genotyping of 59 (33 children and 26 mothers) subjects include genotype A in 24 (40.7%) and genotype D in 35 (59.3%). Both mother–child pair genotyping was possible in 25. The median age of 25 children (20 males) was 9 (interquartile range, IQR: 4–11). The distribution of genotypes among mother–child pairs was similar. The concordance between children and their mothers was 24 of 25 (96%). Evolutionary analyses showed significant similarities between mother and child sequences for both genotype A and D, suggesting thereby the same virus. In conclusion, mother–baby transmission seems to be the major route of acquisition of HBV in children in India and near-complete homology in genetic sequences between mother–child pairs is definite proof for that. However, a larger epidemiological study is required to substantiate our findings.

Sharing of Personal Sanitary Kits as One Risk Factor of Horizontal Transmission of Hepatitis B among Children Resident at Orphanage

BACKGROUND: Hepatitis B is a disease that infects the liver and is caused by the infection of a hepatitis B virus (HBV), and is becoming a global health issue, especially in developing countries including Indonesia. Hepatitis B can be transmitted through several ways such as infected bodily fluids. Indeed, children who live together in an orphanage are prone to having a high chance of transmitting Hepatitis B to each other. AIM: The purpose of this study was to analyze the factors associated with the prevalence of infected Hepatitis B. METHODS: This research used casecontrol study methodology by taking 15 positive case samples and 33 controlled uninfected patients and was conducted in six orphanages in Kupang Municipality in NTT between July 2019 and November 2019. There were 310 orphanage residents participating in this research. RESULTS: The research denotes that variables of using a shared toothbrush, nail clipper, and shaver show a significant connection with their Hepatitis B status (p < 0.05). A further analysis also indicates that using a shared shaver and toothbrush for 12.6 times has a high risk of being infected by Hepatitis B compared to those who do not share their personal items. CONCLUSION: Vaccinations and meeting the basic needs of every child in orphanages are essential in order to minimize the risk of Hepatitis B transmission.

Comparison of Tenofovir with Telbivudine in Preventing Hepatitis B Transmission in Mothers with High Viral Load: A Retrospective Cohort Study

Background: Little data exist regarding comparison of efficacy and safety between tenofovir disoproxil fumarate (TDF) and Telbivudine (LdT) in late pregnancy to prevent hepatitis B mother-to-child transmission (MTCT) in real-world settings.Methods: We retrospectively included HB-s antigen (HBsAg) positive mothers with HBV DNA ≥2*105IU/mL to receive TDF or LdT after gestational weeks 24～32 weeks. All infants received standard immunoprophylaxis. Primary outcomes were MTCT rates at infants’ age of 52 weeks and safety of TDF or LdT use. Secondary outcomes were the decline of HBV-DNA levels at delivery and rates of on-treatment and off-treatment alanine aminotransferase (ALT) elevation>2 upper limits of normal (ULN) during the study.Results: Of 1407 women, 209 received TDF and 1198 received LdT treatment. There were no differences between mean duration of TDF and LdT treatment (TDF vs. LdT: 11.76±2.20 weeks vs 11.64±2.79 weeks, p=0.47). At birth, 213 (9.8%) infants in the TDF-group were HBsAg positive, lower than 1180 (20.8%) in the LdT-group (p<0.001). Among 1405 infants (TDF/LdT=213/1192) of the 1385 (TDF/LdT=205/1180) women completed the 52-weeks study, intention‐to‐treat analysis indicated one infant (0.5 %) was lost to follow-up in TDF treated mothers and three (0.3 %) in LDT treated mothers (p=0.48). On-treatment analysis indicated no HBsAg positive infants in the two groups. Levels of HBV-DNA decline in TDF-treated mothers were observed comparable to LdT-treated mothers (4.05±0.93 log10IU/mlvs.3.99±1.30 log10IU/ml, p=0.50). TDF-treated mothers had complained more symptoms of the digestive system and less arthralgia than LdT-treated mothers. All adverse events in the two groups were grade I-II. Alanine aminotransferase (ALT) elevation(>2ULN) in TDF-treated mothers were lower than in LdT-treated mothers (7.3% vs.15.7%, p<0.05).Conclusions: TDF and LdT use in late pregnancy for highly viremic mothers was equally effective in reducing MTCT. However, TDF has fewer ALT abnormalities than LdT during treatment and is the preferred choice.

Tenofovir Alafenamide to Prevent Perinatal Hepatitis B Transmission: A Multicenter, Prospective, Observational Study

Background Few safety and effectiveness results have been published regarding the administration of tenofovir alafenamide fumarate (TAF) during pregnancy for the prevention of mother-to-child transmission (MTCT) of hepatitis B virus (HBV). Methods In this multicenter prospective observational study, pregnant women with HBV DNA levels higher than 200,000 IU/ml who received TAF or tenofovir disoproxil fumarate (TDF) from gestational weeks 24-35 to delivery were 1:1 enrolled and followed until postpartum month 6. Infants received immunoprophylaxis. The primary endpoint was the safety of mothers and infants. The secondary endpoint was the hepatitis B surface antigen (HBsAg)-positive rate at 7 months for infants. Results In total, 116 and 116 mothers were enrolled, and 117 and 116 infants were born, in the TAF and TDF groups, respectively. TAF was well tolerated during a mean treatment duration of 11.0 weeks. The most common maternal adverse event was nausea (19.0%). One (0.9%), 3 (2.6%), and 9 (7.8%) mothers had abnormal alanine aminotransferase levels at delivery and at postpartum months 3 and 6, respectively. The TDF group had safety profiles that were comparable to those of the TAF group. No infants had birth defects in either group. The infants’ physical and neurological development at birth and at 7 months in the TAF group were comparable with those in the TDF group. The HBsAg positive rate was 0% at 7 months in all 233 infants. Conclusion Antiviral prophylaxis with TAF was determined to be generally safe for both mothers and infants and reduced the MTCT rate to 0%.

Familial transmission of hepatitis B: an interesting case report

Hepatitis-B is a health problem of global importance. India falls in the low intermediate endemicity zone (prevalence rate 2-4%) for hepatitis-B virus infection. Intrafamilial transmission of HBV has an important role in maintaining endemicity in our country. Here we report an interesting case of intrafamilial clustering of HBV infection from western India. Out of 14 family members, 12 members (85.7%) were hepatitis-B infected (overt or occult). This report highlights that vertical transmission of hepatitis-B is also an important route of hepatitis-B transmission. Screening of family members and contacts of HBsAg positive individuals with both HBsAg and Anti-HBc is required for timely active immunization and adaptation of hygienic precautions to prevent the chain of transmission of hepatitis B.

Hepatitis B; Acquaintance and Prevention in Beauty Therapists, Peshawar

OBJECTIVES: To assess the knowledge and practices of beauty therapists regarding hepatitis B virus. METHODOLOGY: A cross-sectional study conducted on beauty therapists of Peshawar. It was an interview-based questionnaire. Beauty therapists were investigated about hepatitis B transmission, vaccination, sterilization, use of gloves, and sterile equipment. Data was collected from most of the beauty salons of Peshawar. Data was analysed using SPSS 17. RESULTS: Around 90.6% therapists reported that they have knowledge about hepatitis B transmission by reuse of pointers (needles), 56.1% identified that vaccine can prevent hepatitis B, 98.7% beauty therapists that were interviewed reported exposure to blood during their work. 14.3% reported using gloves and 19.4% reported using only aprons. 20.4% of beauty therapists claimed sterilizing their instruments between clients, 51.4% reused needles whereas 88% reused orange sticks. CONCLUSION: Alertness about hepatitis and risks of transmission among beauty therapists is minimum, and their repetition of needles and inappropriate cleaning of tools is one of the reasons to spread hepatitis, which is widespread. KEYWORDS: Beauty Therapists, Hepatitis B, Transmission, Piercing, Barbers, Beauty Industry, Tattooist