Hepatitis B Envelope Antigen in Children and Adults with Hepatitis B Infection in Tertiary Health Facility in North East Nigeria During the Period 2000-2015

Introduction: Worldwide, most people living with chronic HBV infection are in in low- and middle-income countries. Most of the burden of disease from HBV infection comes from infections acquired before the age of 5 years. Materials and Methods: Records of Hepatitis B surface and envelope antigen results of children and adults in Federal Teaching Hospital, Gombe between May 2000 and May 2015 were analyzed Results: 22,862 individuals were tested for Hepatitis B surface antigen. 19.5% (4456) tested positive. 24.7 % (3146) and 12.9% (1310) of males and females respectively were HBsAg positive. HBsAg Peak prevalence of 21.8% was in the age group 26-46 (2533) and the lowest prevalence in infancy (3.5%). Amongst males, the 19-25year age group had the peak prevalence of 28.6% and in females the age group 5-9 years constituted the highest (20.3%). 36% (1602/4456) of HBsAg positive children and adults were tested for HBeAg. 26.2% (420/1602) of individuals with HBsAg carriage were HBeAg. More males (307/1105) than females (113/495) were HBeAg positive but not statistically significant. (P=0.034). Prevalence of HBeAg was highest in infants (50%) and children 1-4 years (50%) age group and thereafter declined with increasing age. Females of the younger age group <1year, 1-4 years and 5-9 years and older age group, 56-65 and >65 years, compared to their male carriers of HBsAg had higher prevalence of HBeAg but these were not statistically significant. Conclusion: A fifth of HBsAg carriers were HBeAg positive and HBeAg positivity decreased with increasing age. Hepatitis B vaccination in Nigeria requires urgent strengthening. Keywords: Hepatitis, HBsAg, HBeAg Children, Adults, Nigeria.

Ribavirin Therapy in Immunodeficient Patients with Chronic Hepatitis E Virus Infection

Hepatitis E virus (HEV) infection, usually self-limiting in immunocompetent individuals, may adopt a chronic course in immunodeficient patients. A low threshold for HEV screening in immunodeficient patients is advocated so early management can be initiated to minimise liver injury. This retrospective, observational study evaluated all cases (n=11) of chronic HEV diagnosed in immunodeficient patients in 2 university hospitals in Bristol, UK between February 2014 and October 2017. We report our experiences in the management of chronic HEV including ribavirin use. No patients achieved viral clearance spontaneously or with reduction of immunosuppression and so all were treated with ribavirin. The median time between chronic HEV diagnosis and initiation of ribavirin was 91 days (range, 1–293 days). The median ribavirin dose at initiation was 1000 mg/day (range 800-1200 mg/day) and at cessation was 900 mg/day (range 600–1200 mg/day), reduced due to anaemia. Different end points guided treatment cessation including negative HEV RNA PCR serology +/- negative stool HEV RNA PCR +/- biochemical remission at various time points. Following ribavirin therapy, HEV relapse occurred in 1 patient. The mean duration of ribavirin therapy, excluding the patient who was re-treated, was 4.6 months. One significant adverse event of severe anaemia requiring transfusion was observed. This case series supports the use of ribavirin monotherapy for chronic HEV in immunodeficient patients. Anaemia commonly developed prompting ribavirin dose reduction. We advocate 2 consecutive negative serum and stool HEV RNA PCR results sampled at 4 weekly intervals to guide ribavirin cessation.

Sialylation of HCV E2 Glycoprotein-Specific and Natural Anti-Glycan (TF, αGal) Antibodies as Signatures of Liver Damage

The E2 glycoprotein is the target of broadly neutralizing antibodies against Hepatitis C Virus (HCV). There is evidence that the HCV E2-specific antibody glycosylation profile is associated with hepatic fibrosis progression. The main aim of this study was to compare the sialylation of E2-specific and naturally occurring antiglycan Abs to determine whether their combination could be beneficial for the non-invasive evaluation of hepatic damage. Fifty-eight patients with various stages of hepatic fibrosis or without were tested. The sialylation of HCV E2 glycoprotein-specific antibodies (E2-Abs), the Thomsen-Friedenreich antigen- and αGal glycotope-specific antibodies (TF-Abs, αGal-Abs) was analysed using the ELISA platform. The level of IgG Abs and their reactivity to Sialospecific Sambucus Nigra Lectin (SNA) were determined and changes in Abs sialylation were analysed based on the stage of liver fibrosis, HCV genotype and antiviral therapy efficacy. The late stage of liver Fibrosis (F4) was characterized by dramatically decreased E2-Ab SNA reactivity unlike stages with no fibrosis (P=0.003) and stages F1–F3 (P=0.0007). In contrast, antiglycan Abs showed an increased sialylation. In multiple regression analysis, the combination of E2 and TF-Abs sialylation patterns gave a significant advantage in assessing liver damage. A high rate of discrimination between F0 and F4 stages of fibrosis as well as between F1–F3 and F4 was obtained (ACC=0.948 and ACC=0.90, respectively). Thus, the combined analysis of disease-specific and natural Abs sialylation can remarkably enhance the clinical value of the approach in the non-invasive evaluation of hepatic damage.

Knowledge, Attitude and Practice of Hepatitis B among Informal Caregivers at Ndola Teaching Hospital

Introduction: Hepatitis B is a highly contagious infection. It is 50 to 100 times more infectious than HIV. It is the world’s most common liver infection, which is caused by a DNA-virus, the hepatitis B virus and is transmitted between people through blood, semen, vaginal fluids and mucous membranes. Basic knowledge about hepatitis B is necessary; with more knowledge people take preventive actions against hepatitis B, such as using stick proof cannulas. The general objective of this study was to assess the knowledge, attitude and practice of HBV infection among informal caregivers at Ndola Teaching Hospital, Ndola, Zambia. Method: A Cross sectional study was carried out at Ndola Teaching Hospital from June 2020 to September 2020. Systematic random sampling was used using questionnaire based interviews to consenting informal caregivers above the age of 18 years who were waiting for their patients in Gynecological ward, surgical wards and internal medicine wards. Results: A total number of 165 informal caregivers at Ndola Teaching Hospital were interviewed using a pretested questionnaire. The highest age group (44.2%) interviewed was between 25 to 34 years of age. The majority of informal caregivers (52.1%) went up to secondary education level and 63.0% of the informal caregivers were females. Most informal caregivers (53.3%) only had an average knowledge about hepatitis B infection. Informal caregiver’s education level was directly associated with the level of knowledge about Hepatitis B (p-value<0.001). Majority (87.3%) of the informal caregivers had good attitude towards hepatitis B. There was a direct association (p value <0.001) between informal caregiver’s knowledge on hepatitis B with their attitude. All the informal caregivers (100%) had bad practices on Hepatitis B and majority of the respondents 159 (96.4%) were not vaccinated only 6 (3.6%) were vaccinated against HBV. Conclusion: Hepatitis B is a major health problem globally casting an enormous burden on the health-care system a major source of patient’s misery. This illness or disease is preventable. In this study, the majority of the participants had good attitudes making knowledge as the main determinant of their practices. Therefore, primary prevention approach be taken by extensively and frequently teaching all informal care givers in all hospitals and clinics on how to protect themselves from the disease. Pictorial Posters depicting the proper way of handling patients by informal caregivers be displayed in health centers (wards and OPDs).

Hepatitis B Virus Infection among Prison Inmates in Borno State: Determination of Prevalence of Surface Antigen (HBsAg) and Possible Risk Factors of Disease

An epidemiological study on hepatitis B virus infection among prison inmates in Borno state, Nigeria, was carried out using a questionnaire survey to determine the possible risk factors of the disease and serological method [using an Enzyme Linked Immunosorbent Assay (ELISA)] to determine the prevalence of hepatitis B surface antigen (HBsAg) among the inmates. The study was conducted in correctional facilities in Maiduguri, Biu and Bama local government area of Borno State. Out of a total of 300 sera tested, 49 (16.3%) had detectable ELISA antibody to HBsAg. A significant difference (p<0.001) in seroprevalence of HBsAg among inmates of different educational qualifications was observed and those with higher education had the highest prevalence (20.9%). Although there was no significant difference in prevalence of HBsAg among the different age groups, the age group 60-69 years had the highest infection rate (33.3%). Homosexuality and duration of stay in prison are shown to be significantly associated with HBsAg infection (P<0.05) among inmates. A significant gender difference was noted among inmates with the males (16.1%) having higher prevalence when compared with females (20.0%). Analysis of spatial distribution of prevalence of HBsAg showed that Maiduguri prison had (20.5%), followed by Biu prison (12.7%) and Bama prison (6.7%) and there was significant difference (P<0.05) in prevalence between prisons. There was no significant (P>0.05) association of prevalence of HBsAg with marital status or occupation of prison inmates. In conclusion, hepatitis b virus infection was found to be prevalent among prison inmates in Borno state with homosexuality and duration of stay in prison as risk factors.