Hepatitis Monthly
Volume:21 Issue: 12, Dec 2021

The quantification of hepatitis B surface antigen (qHBsAg) was proposed as a helpful tool to monitor treatment efficacy with nucleos(t)ide analogs (NA) in HB e antigen-negative chronic HB.

The present study aimed to assess the effect of entecavir (ETV) and tenofovir dipivoxil (TDF) on qHBsAg kinetics and estimate the time necessary to achieve HBsAg clearance with each of these drugs.

The study was conducted on 93 patients, 54 and 39 of whom were treated with ETV and TDF for a median time of 42 months, respectively. The qHBsAg was measured in 6-month intervals with the Elecsys HBsAg II Quantitative assay. The estimated time to undetectable HBsAg was calculated using the best-fitted curve analysis.

There was a significant decrease in qHBsAg titers in 79 (84.9%) patients with no difference between ETV and TDF groups (P = 0.754). The median quantitative HB drop was 2003 IU/mL (interquartile range: 638.1 - 5010). The HBsAg levels decreased by 40.3 ± 25.9% on average. The expected time required for HBsAg clearance was comparable in both groups, equaling 104 and 114 months for TDF and ETV, respectively.

The HBsAg clearance can be achieved in a substantial proportion of patients after additional 5 years of treatment with NA. The potency of TDF and ETV in qHBsAg reduction is similar.

Mongolia introduced vaccination against hepatitis B (HepB) in 1991, leading to a significant decline in the number of infections and mortality associated with the liver disease among this generation. However, the prevalence of hepatitis B virus (HBV) infection and mortality rates among people born before the vaccination program have not declined. Although several studies have been conducted in Mongolia since the introduction of the HepB immunization program, long-term immunity has not been studied at the national level.

This study aimed to determine the prevalence of HBV infection in adolescents and young adults who received HepB vaccinations at 0, 2, and 8 months after birth and to assess their post-vaccination immunity against hepatitis B.

A population-based cross-sectional study was conducted between December 2016 and December 2018 and included a sample aged 10 to 27 years in Mongolia who had received HepB vaccination according to the national program. A total of 3591 individuals were randomly selected, and data were collected using a structured questionnaire. Blood samples were collected, and serum titers of hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc) were determined by a two-step sandwich chemiluminescent enzyme immunoassay. The age-specific geometric mean of anti-HBs was also estimated.

Overall, 98.3% of participants were vaccinated against HepB as infants, according to the interview. The majority had an inadequate anti-HBs titer, while 17.9% had an anti-HBs level of > 10 mIU/mL, of whom 5.7% had immunity induced by HBV infection. Up to 4% of children aged 10 - 19 years and an average of 8% of young adults were serologically positive for HBsAg. The geometric mean anti-HBs titer declined with age, from an average of 40.4 mIU/mL in 10-year-old children to 14.1 IU/mL in 27-year-old adults (P < 0.001).

In Mongolia, a small proportion of the population aged 10 - 27 years is immune to HBV, and the geometric mean titer of anti-HBS tended to decrease with age. In order to attain long-term protection against HBV, booster vaccination in adulthood may be necessary.

Hepatitis A virus (HAV), the most common cause of acute viral hepatitis, afflicts millions of people and causes the loss of thousands of lives annually.

This study aimed to detect the seroprevalence of anti-HAV IgG in Fars province, Iran.

This cross-sectional study was conducted using multi-stage cluster random sampling from 12 cities and 24 villages. All age groups, excluding infants (≤ 1-year-old), were included in this study. A valid checklist consisting of demographic and sanitation items and questions about the transmission routes of HAV were filled out for each individual. In the case of children, interviews were performed with one of the parents. Furthermore, anti-HAV IgG was detected by enzyme-linked immunosorbent assay (Dia.pro kits, Italy) on 3 cc of the blood sample of each participant. Data were analyzed using univariate and multivariate (binary logistic regression) tests by SPSS. We applied both World Health Organization (WHO) and age at mid-point of population immunity (AMPI) protocols for HAV endemicity classification. In addition, the geographical variation of hepatitis A chronic immunity was analyzed by the Bayesian spatial model. OpenBUGS program was used to estimate parameters, and ArcGIS was used to display the results on a map.

A total of 547 participants with an age range of 1 - 82 years, mean age of 33.07 ± 15.1 years, and female to male ratio of 1.1 were studied. Overall, 380 (69.5%) individuals had anti-HAV IgG, and 124 of 282 (44%) adults ≤ 30 years old had HAV immunity. AMPI was 25 years old. Being married (OR = 10.7), non-Fars ethnicity (OR = 2.8), knowledgeable about HAV (OR = 2.2), and employed (OR = 1.7) were the strongest determinants of anti-HAV seropositivity. Southern cities of Fars province, which have a hot climate, had the highest prevalence of HAV immunity.

Fars province is a very low and intermediate HAV endemic area based on WHO and AMPI protocols, respectively. High-risk groups, such as patients with chronic liver diseases or coagulopathy, travelers to highly-endemic areas, intravenous drug abusers, and homosexuals, should be given priority in the HAV vaccination program. However, the strategy of HAV vaccination should be tailored to subsequent cost-effectiveness studies and national HAV vaccination strategy.

During the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccination is essential for controlling the outbreak and preventing severe disease. However, there are still uncertainties about the safety of COVID-19 vaccination in individuals with chronic liver disease.

Three patients with hepatitis B virus (HBV) infection presented to our hospital with acute-on-chronic liver failure (ACLF) due to HBV flare after COVID-19 vaccination (mRNA-1273 and ChAdOx1 nCoV-19). Their COVID-19 antibodies were tested by Elecsys Anti-SARS-CoV-2 S immunoassay, which showed good response after full two-dose course of vaccine. One patient refused the test. The patients’ clinical conditions deteriorated during hospitalization. Patient 1 received Entecavir (Baraclude) 1 mg/day upon presentation, but the serum bilirubin level and international normalized ratio (INR) kept increasing. He was comatose in one week and underwent urgent living donor liver transplantation. Patient 2 was on regular Entecavir (Baraclude) 0.5 mg/day and was increased to 1 mg/day upon admission. The serum bilirubin level and INR kept increasing, and he developed grade 3 hepatic encephalopathy in three weeks. The patient then received urgent living donor liver transplantation. Patient 3 received Entecavir (Baraclude) 1 mg/day upon presentation. Her serum bilirubin and INR kept increasing, and her mental status altered in a week. She did not undergo liver transplantation for her old age.

It is not still unclear whether there is a cause-and-effect relationship between COVID-19 vaccination and HBV infection flare. Furthermore, the mechanism of COVID-19 vaccine-induced HBV reactivation is not established. Further studies are needed in this regard. However, during the COVID-19 pandemic, prophylactic antiviral therapy for HBV infection before COVID-19 vaccination should be considered.