HEPATITIS B VIRUS INFECTION AMONG PREGNANT WOMEN ATTENDING A TERTIARY CARE HOSPITAL IN KUMAOUN REGION OF UTTARAKHAND.

Background: Hepatitis B virus (HBV) infection remains an important worldwide cause of chronic liver disease, which may lead to the development of cirrhosis. Prevalence of Hepatitis B in pregnant women worldwide is 02.5 to 1.5% whereas in India it is 0.2 to 7.7%. Method :This prospective study was conducted between January, 2018 to September, 2019 total 100 patient included in the study. Result : Total 7650 Pregnant patient was screened and 100 came out to the Hepatitis B virus (HBV) positive. It was observed that HBV most common in 21 to 25 Age group (55.0%) and it was more common in Multigravida (61%) and more common in women who studied upto Class 10 (34%) and more common in Urban population. Pre term labour was found to be the most common complication (17%). In Neonatal out come 41% was low birth weight. Maternal mortality was 1% and neonatal mortality was 7%. Conclusion : Pregnant women who are HBs Ag positive are mostly asymptomatic. Universal screening of antenatal cases and immunization with hepatitis B vaccine of the community is denitely going to reduce the disease prevalence in future.

ASSOCIATION OF BLOOD GROUP SYSTEMS WITH BLOOD-BORNE INFECTIONS AND ITS IMPLICATION ON CADAVER SELECTION IN THE POST COVID ERA: A STUDY AMONG BLOOD DONORS OF KOLKATA

Introduction: Blood group antigens play a vital role in transfusion safety, understanding genetics, inheritance pattern, researching population migration patterns, as well as resolving certain medico-legal issues Aims & Objectives: The aim of this study was to investigate the prevalence of hepatitis B, Hepatitis C, HIV and Syphilis infections in blood donors referred to Blood Bank of Calcutta National Medical College and to determine any association between blood groups and blood borne infections and their impact on procurement and dissection of dead bodies. Methods: An observational study with cross sectional design of data collection was conducted in the Blood Bank of Calcutta Nation Medical College for a period of three months. All of the eligible donor serum samples were screened for HBV, HCV, HIV and syphilis. Test result of the collected blood was noted and tabulated in Microsoft Excel Sheet. Statistical analysis was carried out using SPSS 20 software. Chi-square test was performed for Qualitative comparison. Result:Total number of HIV, HbS Ag, Anti HCV, VDRL, MP positive cases were 16 (1.54%), 51(4.92%), 18(1.74%), 28(2.7%), 30(2.9%) respectively. 56.2% HIV positive cases were in the age group of 18-30 and 87.5% HIV positive cases were male.3.9% of HbS Ag positive cases, 10.7% VDRL positive cases, 3.3% MP positive cases were also HIV Positive. Signicant correlation was obtained HIV & VDRL and VDRL & anti HCV Conclusion: Hepatitis C was highest among the study population and signicant correlation was present between Syphilis and HIV or Hepatitis C. In the background of novel emergent diseases with spread via body uids, such information on blood borne infections may help us to formulate future guidelines on cadaver dissection.

Blood Safety: On-Site Verification Of The Screening Of HIV, HBV And HCV By Enzyme Linked Immuno-Sorbent Assay (ELISA) Kits From Bio-Rad Laboratories At The “Centre National De Transfusion Sanguine” (CNTS) Of Lomé In Togo

Background: Blood transfusion improves health and saves lives. Safe blood must be ensured for our populations. Quality assurance is a process that includes a set of coordinated activities in order to achieve the quality objective. Compliance with the quality management rules of medical biology laboratories requires verification of methods prior to their use. This study aimed to verify the on-site verification of the performance of the Enzyme Linked Immuno-Sorbent Assay (ELISA) method performed at the serology laboratory of the CNTS of Lomé. Methods: The performance of ELISA method performed at the serology laboratory of CNTS for the diagnosis of HIV, Hepatitis B and C with Bio-Rad Genscreen ULTRA-HIV Ag-Ac, Bio-Rad Monolisa-HBs Ag ULTRA and Bio-Rad Monolisa HCV Ag-Ac ULTRA V2 kits respectively was evaluated on repeatability, reproducibility, sensitivity and specificity according to COFRAC's SH GTA 04 reference. Results: The evaluation of the repeatability and reproducibility of each kit used in the laboratory resulted in compliant Coefficients of Variation (CV) with manufacturers’ ones. Sensitivities obtained with Bio-Rad Monolisa HCV Ag-Ac ULTRA V2, Bio-Rad Monolisa HBs Ag ULTRA and Bio-Rad Genscreen ULTRA HIV Ag-Ac kits were 94.59%, 98.08% and 100% respectively. For specificity tests, we found 86.49% with BIO-Rad Genscreen ULTRA-HIV Ag-Ac kit, 94.34% with Bio-Rad Monolisa HCV Ag-Ac ULTRA V2 kit and 97.37% with Bio-Rad Monolisa-HBs Ag ULTRA. Conclusion: In general, results were compliant except HIV diagnosis specificity. This study appears as a contribution to the establishment of a verification file for ELISA method used at the serology laboratory of CNTS of Lomé.

The Safety, Immunogenicity, and Immunopersistence of Hepatitis A Vaccine in HBs-Ag-Positive Participants: A Retrospective Study

ObjectivesTo compare the safety, immunogenicity, and immune persistence of hepatitis A (HA) vaccines between HBs-Ag-positive and -negative participants.Method9000 participants were enrolled in the phase IV study of live attenuated HA (HA-L) or inactivated HA (HA-I) vaccines. The HBs-Ag-positive subjects were detected and became an independent observation group. Adverse reactions (ARs), geometric mean concentrations (GMCs) and seroconversion rates (SRs) of the vaccines were analyzed at five time points until three years after vaccination. Results: 120 HBs-Ag-positive subjects were screened out, only 1 participant had grade 1 experienced ARs after HA-L injection. Except the time point of two years, the SRs of HBs-Ag-positive group were 100% for both vaccines. The GMCs were not statistically different between HBs-Ag-positive and -negative groups after the HA-L vaccination. The logarithmically transformed GMCs for HBs-Ag-positive and -negative groups were 3.21 mIU/mL (95% CI, 2.03-4.39 mIU/mL) and 2.95 mIU/mL (95% CI, 2.88-3.02 mIU/mL) 28 days after the HA-L vaccination, respectively.ConclusionsBoth HA-L and HA-I vaccines were safe for HBs-Ag-positive participants and may provide an excellent long-term protection against HAV in this study. The results indicated that people positive or negative for HBs-Ag can receive both HA-L and HA-I vaccines (ClinicalTrials.gov number, NCT02601040).

Determination of the prevalence of the HBs antigen and evaluation of the vaccination status against Hepatitis B among the staff of the Dschang district hospital in West Cameroon

Hepatitis B infection is a major global health problem. Sub–saharan Africa is particularly affected. The aim of this study was to determine the prevalence of HBs antigen (HBs Ag) and to assess the hepatitis B vaccine status among medical and paramedical staff at Dschang District Hospital. A descriptive cross-sectional study was conducted at Dschang District Hospital from November 2018 to June 2019. All medical and paramedical staff of the Dschang District Hospital were included, regardless of sex or age, vaccinated and unvaccinated. We assessed the level of knowledge of hepatitis B, investigated hepatitis B markers like HBs antigen (HBs Ag), HBc antibody (HBc Ab), HBs antibody (HBs Ab); we performed HBs Ab assay, investigated hepatitis B risk factors, and low hepatitis B immunization factors, among an average of 171 health personnel aged 36.48 ± 9.58. Of these, 94.7 % said they knew hepatitis B. The prevalence of hepatitis B was 7%. Nursing and paramedical professions were the main concerned by the HBs Ag positivity. The risk factors found in HBs Ag carriers were unprotected sex, scarification and blood exposure accident. There was an association between HBs antigen portage and unprotected sex (P=0.021), blood exposure accident (P=0.021) and piercing (P=0.004). However, there was no association between HBs Ag carrying and age group (P=0.779), sex (P=0.248) and marital status (P=0.779). On the basis of the statements, without a certificate, 57% of the staff said they had already been vaccinated against hepatitis B; of these, 89% had received at least 3 doses of vaccine, of which 53.3% had acquired immunity from HBV. Advanced age (over 40 years) and overweight were associated with a low response to hepatitis B vaccine. In addition, sex and smoking were not associated with low hepatitis B seroprotection. In conclusion, this study found that the prevalence of HBs Ag is still high in our context and low hepatitis B seroprotection in the study population. Hence the need for awareness-raising, systematic screening and vaccination of health personnel, training of vaccinators and monitoring of the vaccination chain.

Real-World Experience of Telbivudine and Lamivudine as Antiviral Prophylaxis for Chemotherapy-Related Hepatitis B Reactivation

Background: There is currently no data regarding the efficacy of prophylactic telbivudine in hepatitis B patients undergoing chemotherapy. This study aims to describe the results of preemptive telbivudine and lamivudine to prevent chemotherapy-related HBV reactivation.Methods: The medical records of all patients with HBsAg positive or HBs-Ag negative, anti-HBc positive, who were referred to the hepatology clinic between May 2014 and December 2016, were retrospectively reviewed. As this is a descriptive study, no statistical analysis was done.Results: A total of 52 patients with prophylactic telbivudine or lamivudine therapy were included, with 26 patients in each group. Rituximab-based treatment was given in nine and five patients in the telbivudine and lamivudine group, respectively. The number of patients who completed antiviral treatment up to six months after chemotherapy was 17 patients in each group. There was less incidence of HBV reactivation in the telbivudine group (2 of 17 patients, 11.8%) than in the lamivudine group (7 of 17 patients, 41.2%). Delayed reactivation was noticed in 1 of 2 patients in the telbivudine group and 3 of 7 patients in the lamivudine group. The median log10[HBV DNA] at reactivation was 4.52 (1.70 – 8.35) IU/mL. Severe hepatitis was observed in two patients in the lamivudine group and one patient in the telbivudine group. Of 34 patients who completed antiviral treatment, two patients died due to primary cancer. No interruption of chemotherapy or mortality due to hepatitis was noticed in both groups.Conclusions: Preemptive telbivudine or lamivudine in HBsAg positive or HBsAg negative, anti-HBc positive patients seems to be a good treatment option.

Spontaneous Negative Seroconversion of Both Hepatitis B and C in an Egyptian HD Patient

Background: Hepatitis b virus infection (HBV) was recognized as an important hazard for patients and staff in Hemodialysis Units (HDU), and this issue was first recognized in the 1960s with a set of guidelines for the control of HBV in HDU. HCV is a blood-borne infection and is the most significant cause of viral hepatitis which is mainly transmitted by blood transfusion. Thus, it is reasonable to perform initial screening for HCV in HD patients. Patients admitted or re-admitted to an HD unit are recommended to be tested for HBsAg, HCV, and HIV antibodies and to be followed up monthly or at least every three months after admission to HDU. We aim to present this case of spontaneous clearance of HBV and HCV positive after being positive for more than twelve years on HD. Case Presentation: A 66 years old Egyptian male patient with Chronic Kidney Disease (CKD) from Alexandria had started HD 14 years ago while he tested positive for HCV-Ab and HBs Ag positive, although fared well with normal liver function, while the source of infection was not known. HCV-Ab turned into seronegativity after twelve years on HD. Astonishingly, after 13 years on HD; the test of HBs Ag became negative and hepatitis B surface antibody appears by Elisa testing. This was noticed or observed following the implementation of quality enhancement of the HD parameters in most of the HD services provided units according to the regulations of Ministry of Health (MOH), and this was accompanied by better anemia and more frequent utilization of high flux dialysis with a consequent reduction to the need for blood transfusion in the last four years. Previous publications advocated hypothetical mechanisms of HCV clearance during the process of HD: namely, filtration of the virus particles through the pores of the dialysis membrane and or their adsorption to the HD membrane. These welcome spontaneous clearances of the HBV and HCV in this patient could be attributable to the improvement of anemia state and use of high flux dialysis that might have improved the immunity of this patient. Conclusion: Spontaneous clearance of HBV and HCV could potentially possible and could benefit from the improvement of both patients and HD states that could enhance the immune system or mechanical entrapment of the virus particles. Suggestions need further studies for confirmation.

Manganese Breaks the Immune Tolerance of HBs-Ag

Background Manganese (Mn2+) has been shown to promote type I interferon (IFN) production and activate the cyclic GMP-AMP synthase (cGAS)/Stimulator of Interferon Genes (STING) signaling pathway, suggesting that Mn2+ could be used as an adjuvant for vaccination. Methods In present study, the effects of Mn2+ on vaccination against hepatitis B virus (HBV) were evaluated. We treated mouse hepatocytes and kuppfer cells with Mn2+ with or without adeno-associated virus (AAV)–HBV infection. Expression of IFN-α and IFN-β and activation of TBK1 and IRF3 were monitored. Wild-type and STING-/- mice were treated with Mn2+ and then infected with AAV-HBV. Serum levels of HBV surface antigen (HBsAg), alanine aminotransferase (ALT) activity, IFN-α, and IFN-β were detected. Lymphocyte infiltration in the liver was evaluated. HBsAg-Tg mice were vaccinated with Mn2+ and HBsAg. The serum levels of HBsAg antibody, alanine transaminase activity, and IFN-β were monitored after vaccination. Results Mn2+ promoted IFN-α and IFN-β production in mouse hepatocytes and kuppfer cells. Mn2+ failed to promote IFN-α and IFN-β production in kuppfer cells deficient in STING. Mn2+ promoted activation/phosphorylation of TBK1 and IRF3 during AAV-HBV infection. Mn2+ decreased serum levels of HBsAG, increased serum levels of alanine aminotransferase (ALT), IFN-α and IFN-β, and enhanced lymphocyte infiltration and the percentage of IFN-γ-producing CD8+ T cells in the liver of AAV-HBV-infected mice. In contrast, Mn2+ treatment did not affect serum levels of HBsAG, ALT, IFN-α, or IFN-β in STING-deficient mice. Conclusions Mn2+ promoted HBsAG antibody, ALT, and IFN-β production after HBsAG immunization. Mn2+ promoted type I IFN production in AAV-HBV infection and HBsAG immunization and could be used as an adjuvant for vaccination.