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GOALS This study aimed to explore whether quantitative surface antigen [hepatitis B surface antigen (HBsAg)] can be used as a surrogate marker of hepatitis B virus (HBV) DNA to predict hepatitis B transmission before the first hepatitis vaccine dose in infants born to hepatitis B e antigen (HBeAg)-positive pregnant women. BACKGROUND Currently, HBV transmission persistently occurs worldwide, especially in infants born to e antigen (HBeAg)-positive highly viremic mothers. However, due to high cost, the extensive use of viral load testing to identify these high-risk mothers is limited. MATERIALS AND METHODS In total of 275 HBeAg-positive pregnant women paired with 280 infants were enrolled in this study. Quantitative HBsAg and HBV DNA levels were measured in the third trimester. Spearman rank correlation was used to assess the correlation between HBsAg levels and viral load, and multivariate logistic regression to identify factors related to HBV transmission in infants. RESULTS Among 280 infants included, 15 (5.4%) infants were infected with HBV. In this study, we observed that quantitative HBsAg was positively correlated with maternal viral load (r=0.70, P

Introduction: Patients with cirrhosis should be immunized against hepatitis A (HAV) & hepatitis B (HBV) as they are high risk for decompensation if infected. Baseline data at the Atlanta VA hepatology clinics demonstrated 75% of veterans with cirrhosis were immune to HAV and 44% to HBV. One fourth of visits failed to address hepatitis vaccines, and 60% of missed opportunities were from providers not discussing it. Our aim was to reduce missed opportunities to initiate HAV and HBV vaccination to

Background: Globally out of 200 crore population who are getting exposed to the hepatitis B virus (HBV),about 350 million are chronically carrying it resulting in 0.5 to 1.2 million deaths each year . These mortalitiesare due to chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Horizontal transmission in earlychildhood and parental transmission at any age are the important routes of transmission. This study wasconducted with following objectives.(a) To assess the prevalence of adherence to Hepatitis vaccination.(b) To associate this adherence with demographic factors.Methodology: After receiving approval from the Institutional Ethics Committee a record based retrospectivecohort study was conducted at Gastroenterology and Hepatology OPD of IMS and SUM Hospital,Bhubaneswar. Data regarding all the patients who have received First dose of Hepatitis Vaccine from January2019 to December 2019 were followed up till June 2020 to find out how many of them have revisited toobtain second dose as well as third dose of vaccine. Their demographic characteristics collected from theimmunisation register. Data was entered and analysed using SPSS vs 21 using appropriate statistics.Results and conclusion: Total 1134 subjects have received the first dose of Hepatitis B vaccine. Meanage of the participants is 36±15yrs. First dose taken by 453(39.9%) people, 324(28.6%) had completed theschedule by taking the final dose of vaccine. Hardly one third of the patients adheres to the schedule andcompletes it. Inadequate vaccination makes the patients vulnerable to risks of Hepatitis B and its morbidities.

Introduction Adult vaccination coverage rates in the US are well below national targets, leaving many adults at increased risk. Additionally, typical vaccination coverage calculations do not adequately approximate population immunity as they do not consider whether multidose vaccines were administered within the recommended schedules. As timely administration of each dose optimizes overall vaccine effectiveness, we sought to document adherence to and completion of the hepatitis A (HepA), hepatitis B (HepB), and combined hepatitis A and hepatitis B (HepA-HepB) multidose vaccine schedule in an insured adult population in the US. Methods We conducted a retrospective database study of administrative claims from 2008 to 2015 (analyzed in 2017). Completion of 2 (HepA) and 3 doses (HepB and HepA-HepB), and adherence to the 2- and 3-dose recommended schedules were measured among individuals aged 19 years and older at first dose. The proportion of patients who completed 2 and 3 doses and were adherent to the recommended schedule were estimated using Kaplan-Meier methods. Results For HepA, 27.14% of initiating adults were adherent to the recommended schedule, and 32.05% had received a second dose by 42 months. Approximately one-third of adults who initiated the HepB or HepA-HepB series completed all 3 doses within 2 years of the minimum spacing (31.17% and 32.27%, respectively). Generally, completion and adherence were highest in individuals aged 60–64 years at the time of initiation. Conclusions Hepatitis vaccine adherence and completion in adults is suboptimal. As a result, the majority of adults initiating each series may not be receiving the full protective benefit of these multidose vaccines.

Background Human papillomavirus (HPV) vaccines have been shown to be effective for the eradication of HPV and prevention of cervical cancer. However, the number of women who receive HPV vaccinations has decreased over the last several years in Japan, due to concerns about adverse reactions associated with the vaccines. We evaluated the safety of three types of HPV vaccines separately in young women and the difference in the risk of adverse reactions between HPV and other vaccines by conducting a meta-analysis. Methods Primary literature was retrieved from MEDLINE, the Cochrane Central Register of Controlled Trials, and Japana Centra Revuo Medicina. Prospective controlled studies with participants consisting exclusively of healthy women who received bivalent, quadrivalent, or 9-valent HPV (2vHPV, 4vHPV or 9vHPV) vaccines were included. Primary safety outcome was the incidence of solicited local and systemic symptoms, and unsolicited symptoms. When two or more studies were found for the same analysis, a meta-analysis was applied. Results A total of 24 controlled studies from 22 articles were included in our study. Of the 24 studies, 16 were placebo-controlled and eight were active-controlled (different HPV vaccine or hepatitis vaccine). Average ages of the participants ranged from 12 to 37 years. A significantly higher incidence of solicited local symptoms was observed following injection of HPV vaccines (2vHPV and 4vHPV) compared to placebo, but there was no difference between HPV vaccines [risk ratio (RR) for 2vHPV: 1.25, 95% confidence interval (CI): 1.09 to 1.43, RR for 4vHPV: 1.16, 95% CI: 1.11 to 1.20]. The incidence of solicited systemic symptoms was not different between HPV vaccines and placebo (RR: 1.04, 95% CI: 0.99 to 1.09). The incidence of unsolicited symptoms was significantly higher for 2vHPV vaccine compared to placebo (RR: 1.28, 95% CI: 1.01 to 1.63), but was not significantly different between 2vHPV and hepatitis B vaccines. Conclusions HPV vaccines had significantly higher risk of any injection site symptom compared to placebo or other vaccines (hepatitis A and B vaccines), and the incidence of solicited local symptoms was no difference between 2vHPV vaccination and 4vHPV vaccination. However, the most adverse reactions were transient.

INTRODUCTION Hemodialysis (HD) patients are at increased risk of hepatitis B infection in comparison to the general population. Despite a more intensified hepatitis vaccination regimen, response rates in HD patients are typically low. The study was conducted to quantify response rate to a new hepatitis B vaccination protocol initiated in late 2015, determine risk factors affecting response rate, and assess adherence to protocol. METHODS This retrospective chart review evaluated all HD patients eligible for hepatitis B vaccination in two large dialysis clinics from initiation of the hepatitis B protocol to July 2017. Recombinant hepatitis vaccine (Recombivax® HB) 40 μg was administered in a 3-dose regimen at months 0, 1, and 6 to patients with hepatitis B surface antibodies (anti-HBs)

Background Timely and complete vaccination with multi-dose schedules is of public health importance, because an incomplete vaccination series may yield suboptimal disease protection. However, data on adherence of adults to multi-dose vaccines are limited. We sought to estimate adherence to multi-dose hepatitis vaccination schedules among adults in the United Kingdom (UK). Methods This retrospective cohort study was conducted using anonymized electronic health record (EHR) data from the Clinical Practice Research Datalink (CPRD). Individuals aged 19 years and older at their first identified dose of hepatitis vaccine (2009–2016) were included if they had continuous EHR data for 12 months before the first identified hepatitis A dose or for 6 months before the first identified hepatitis B or combination hepatitis A/B dose. We estimated dose and series completion for each vaccine and adherence to recommended vaccination schedules, as well as adherence within additional prespecified time periods after the first vaccine dose, with sensitivity analyses restricted to adults who had available data for up to 24 months after the first dose. Median time to series completion was estimated using Kaplan-Meier methods. Results Mean (SD) age at initiation was 42 (16) years for hepatitis A (n = 374,881), 40 (16) years for hepatitis B (n = 71,634), and 38 (15) years for hepatitis A/B (n = 10,335). Women comprised 52 to 55% of each vaccine cohort. Overall, 42,294 adults (11%) completed the two-dose hepatitis A vaccine series within the recommended 12 months; and 15,564 (22%) and 1076 (10%) completed the three-dose hepatitis B and hepatitis A/B series, respectively, within the recommended 6 months. These percentages rose to only 23, 35, and 33%, respectively, when the follow-up periods were extended to 36 months for hepatitis A and to 30 months for hepatitis B and A/B vaccines. Median times to series completion within recommended schedules were not reached in any cohort. Sensitivity analyses supported the primary findings for the full cohorts. Conclusions Adherence and series completion rates for hepatitis A and B vaccines in the UK are low. Identifying, understanding, and addressing barriers to series completion for multi-dose vaccines for adults in real-world settings are needed. Electronic supplementary material The online version of this article (10.1186/s12889-019-6693-5) contains supplementary material, which is available to authorized users.

Background Hepatitis B continues to affect many people in Saudi Arabia, causing a huge burden on the healthcare system for treating patients and preventing spread of the disease. Because hepatitis B is not curable, transmission of infection can only be prevented by vaccinating those susceptible, paying special attention to children of positive mothers. Guidelines suggest that all infants born to positive mothers should receive both the hepatitis B vaccine and immune globulin within 12 hours of birth. In addition to the remaining two doses of the hepatitis vaccine, infants should also be tested for hepatitis B 3 to 6 months following the last dose of vaccine. The aim of this study was to identify if international guidelines were followed after delivery in hepatitis B-positive mothers at KAMC-Riyadh. Methods This was a retrospective analysis of pregnant mother’s positive to hepatitis B who gave birth in KAMC-Riyadh during 2016–2017. Data regarding administration of vaccine and immune globulin, completion of vaccine series, and follow-up testing were extracted from the child’s medical record. Results During the 2-year study period, a total of 105 hepatitis B-positive mothers gave birth, and all infants were administered the birth dose of the hepatitis B vaccine; however, only 55 children were documented to have completed the three-dose series of the vaccine. Only 101 infants were administered immune globulin after birth, and only two children were tested for the virus. Conclusion Infants born to hepatitis B-positive mothers do not receive special attention or follow-up. It is not known why four infants did not receive immune globulin; however, unclear documentation of the virus in the mother’s file during pregnancy or delivery may be a reason. Many of these children did not receive their full vaccine series and almost all were not tested for the virus. These numbers demonstrate the need for a strategic plan for the management and follow-up of infants born to hepatitis B-positive mothers.

Introduction The paucity of data on hepatitis' epidemiology in Menoua Division, west region, Cameroon, prompted us to assess the prevalence of viral and non-viral hepatitis in this area. Methods A retrospective exhaustive study based on records of patients from January 2008 to June 2014 was conducted in 9 health centres in Menoua Division. Targeted subjects were patients who did not receive hepatitis vaccines for the past year and have been screened for hepatitis B virus (HBV), hepatitis C virus (HCV) and/or a blood transaminase. Associations between variables were quantified with odd ratios (OR) and 95% confidence interval (CI). Cochran-Armitage test of linear trend was used for testing proportions of ordinal variables. Fisher's exact test was used for testing the association between 2 qualitative variables when expected counts were less than 5. Results The overall prevalence were 9.6% and 6.7% for HBV and HCV respectively. HBV mostly infected people aged 21-30 (12.4%) while the prevalence of HCV increased with age up to 35.4% (p=0.03). A 0.6% co-infection was observed. Thirty percent of positive HBV or HCV had high transaminase while 13% of patients with elevated transaminase showed negative viral serology. Conclusion These results show that hospital-based prevalence of HCV and HBV in Menoua Division is under the Cameroon's national range but point out the fact that non-viral hepatitis might be a serious case of concern in this area. There is therefore, a need to identify the risk-factors of non-viral hepatitis.

Background Health care maintenance (HCM) is reduced among inflammatory bowel disease (IBD) patients. This study aims to characterize rates of HCM in a closely monitored subpopulation-postpartum women with IBD-and identify predictors of noncompliance. Methods A national prospective pregnancy registry was utilized to collect completion rates of HCM recommendations (cervical cancer screening; osteoporosis screening; pneumococcal, hepatitis A, hepatitis B, and influenza vaccines). Completion of a recommendation at least once during follow-up was sufficient, except for influenza vaccine, which was assessed yearly. Patients were classified by drug exposures: immunomodulator (Group A), biologic (Group B), combination therapy (Group AB), and unexposed. Confounders assessed were steroid exposure, IBD flare, IBD care site, primary care provider (PCP) access, marital status, income, education level, and race. Results There were 628 postpartum IBD women with at least 1 year of follow-up. HCM rates were as follows: cervical cancer screening (84%), osteoporosis screening (54%), pneumococcal (50%), hepatitis A (61%), hepatitis B (81%), and influenza (72%) vaccines. The unexposed group demonstrated lower pneumococcal vaccination rates than groups A, B, and AB. Group B demonstrated lower cervical cancer screening rates than the unexposed. PCP access and low education predicted hepatitis vaccine noncompliance. Unmarried status and low income predicted cervical cancer screening noncompliance. Low income predicted influenza vaccine noncompliance. Conclusions Postpartum women have multiple providers, yet they complete HCM at suboptimal rates. Risk factors include biologic exposure, unmarried status, low income, low education, and access to a PCP. Awareness among providers and patients is important and needs to be enhanced.

Background Systemic Lupus erythematous (SLE) is a multi-system autoimmune disease with an increased mortality and morbidity rate compared to the controlled population. One of the commonest causes of mortality and morbidity in SLE is infection. This is a result of not only the immunosuppressive effect of the disease process itself but also treatment involving disease modifying anti-rheumatic drugs (DMARDs). In fact, corticosteroids and immunosuppressants increase the risk of opportunistic infection, in addition to the more common pathogens. Vaccines provide long lasting protective immunity against microbial pathogens and prevent clinically relevant infections. Recommended vaccinations in SLE patients include H. Influenza, Pneumococcal, Hepatitis A and B, and Human Papilloma Virus (HPV). Influenza vaccines are given annually and a Pneumococcal booster dose is given at 5 years following the initial vaccine. Objectives To assess whether, in routine clinical practise, patients with SLE are immunised against preventable disease according to EULAR recommendations and to assess the level of patient awareness. Methods A questionnaire was designed to assess the degree of compliance with current recommendations adapted from the EULAR-recommended vaccinations in patients with autoimmune inflammatory rheumatic diseases on DMARD therapy. The questionnaire enquired into the awareness and uptake of the influenza B, pneumococcal and hepatitis B vaccines. They were sent out by postal mail, with an enclosed stamped address envelope, to all SLE patients within the university hospitals of Leicester (UHL) NHS trust identified via the rheumatology patient database. Questions included awareness of the need to have vaccinations whilst on DMARDs. The audit was conducted over a three month period and the results were compiled in Microsoft excel. Results Of the 396 SLE patients within UHL, 86 responded. Among the patients studied 38% were on DMARD therapy, an equal proportion claimed they were not and 23% were unclear if they were on DMARD therapy. Approximately 60% were unaware of the need for vaccinations and only 27.9% acknowledged awareness for the need of the 3 vaccines mentioned above. Fifty-six (60%) patients had the influenza vaccine yet only 26 (28%) and 15 (21.8%) had the Pneumococcal and Hepatitis vaccines respectively. Conclusions The increased infection rate in SLE can be reduced through vaccination. This highlights the importance of increasing both physician and patient awareness. Although the sample size was small, the above audit has revealed that current local practice, with regards to ensuring that all SLE patients are appropriately vaccinated, requires improvement. This can be achieved through patient and healthcare worker education, and also creating a checklist that can be added to the clinic notes. Working together with our primary care colleagues will also help bridge the divide between compliance and non-compliance. Such measures will aim to improve mortality and morbidity in SLE patients. References [1] www.lupusuk.org.uk/bsr-guidelines/ [2] www.rheumatology.org.uk/Knowledge/Excellence/Guidelines [3] www.hss.edu/conditions_vaccinations-lupus-update.asp [4] http://ard.bmj.com/content/75/suppl_2/771.2 [5] http://ard.bmj.com/content/annrheumdis/70/3/414.full.pdf Disclosure of Interest None declared

Hepatitis B and A account for considerable morbidity and mortality worldwide. Immunization is the most effective means of preventing hepatitis B and A. However, the immune response to both hepatitis vaccines seems to be reduced in HIV-infected subjects. The aim of this review was to analyze the immunogenicity, safety, long-term protection and current recommendations of hepatitis B and A vaccination among HIV-infected adults. The factors most frequently associated with a deficient level of anti-HBs or IgG anti-HAV after vaccination are those related to immunosuppression (CD4 level and HIV RNA viral load) and to the frequency of administration and/or the amount of antigenic load per dose. The duration of the response to both HBV and HAV vaccines is associated with suppression of the viral load at vaccination and, in the case of HBV vaccination, with a higher level of antibodies after vaccination. In terms of safety, there is no evidence of more, or different, adverse effects compared with HIV-free individuals. Despite literature-based advice on the administration of alternative schedules, revaccination after the failure of primary vaccination, and the need for periodic re-evaluation of antibody levels, few firm recommendations are found in the leading guidelines.

Objective To evaluate the long-term efficacy of Chinese hamster ovary (CHO) cell derived hepatitis B vaccine after being used for 14–16 years in country community in Hebei province in China. Method A cross-sectional investigation was carried out in 3 of 7 randomly selected rural communities in Zhengding County in 2013. The children who were born between 1997 and 1999 and were vaccinated with three doses of CHO-derived hepatitis B vaccine were eligible to participate in the study. Their sera samples were tested for HBV serological markers. For HBsAg positive children, their historical results were compared, in order to see whether these were new infections. Results Among the 920 participating children, the prevalence of HBsAg, anti-HBs and anti-HBc were 0.65%, 73.15% and 1.20% respectively. The differences between birth-year groups were not significant. When compared with baseline, the vaccine efficacy was 94.2% and the anti-HBs titers of 668 children with sole anti-HBs positivity were 178.8 mIU/ml. By comparing with historical data, no new infection was found in this latest survey. Among 6 mothers of HBsAg positive children, 4 were HBsAg positive, 1 was negative and 1 was unknown. Conclusion The long-term efficacy of the CHO derived hepatitis vaccine is good and stable for 14–16 years after vaccination. A booster dose seems not necessary. Implementing mother–newborn blocking measures for newborns from HBsAg carrier mothers is urgently needed in the future.

Background: The development of success-oriented hepatitis-B vaccine uptake approach among dental surgeons is dependent on the availability of comprehensive baseline data. Objective: To determine the hepatitis-B vaccination status among dental surgeons in Benin City. Materials and Methods: This questionnaire-based cross-sectional study of dental surgeons in Benin City was conducted in May 2011. The questionnaire elicited information on demography, occupational risk rating of contracting hepatitis-B infection, hepatitis-B vaccination status, barriers to uptake of hepatitis vaccine, and suggestions on how to improve hepatitis-B vaccination rates among dental surgeons. Results: Participation rate in the study was 93.3%. More than half (51.4%) of the respondents were 20–30 years old and 52 (74.3%) were males. The occupational risk of contracting hepatitis-B infection among dental surgeons was rated as either high or very high by 51 (72.9%) of the respondents. Amongst the respondents, 14 (20.0%) had received three doses of the hepatitis-B vaccine, 34 (48.6%) either two doses or a single dose, and 22 (31.4%) were not vaccinated. The major barriers reported among the respondents who were not vaccinated were lack of opportunity and the fear of side effects of the vaccines. The suggested ways to increase the vaccination rate among the respondents in descending order include: Making the vaccine available at no cost (51.4%), educating dentists on the merits of vaccination (17.1%), and using the evidence of vaccination as a requirement for annual practicing license renewal (14.3%) and for the employment of dental surgeons (11.4%) and others (2.9%). Conclusion: This study revealed low prevalence of complete hepatitis-B vaccination among the respondents. Improvement in uptake following the respondents’ recommendations will serve as a template in developing success-oriented strategies among stakeholders. Keywords: Dental surgeon, Hepatitis-B, Vaccination status

Newborns are subject to pain during routine invasive procedures. Pain caused by immunization injections is preventable, but remains untreated in neonates.The purpose of the study was to compare the effectiveness of three nonpharmacological pain relief strategies on newborns' pain, physiological parameters, and cry duration before, during, and after hepatitis B intramuscular (IM) injection.In this prospective, randomized clinical trial, we enrolled 165 newborns (gestational age, ≥36 weeks). The infants received IM injections and were randomized to three treatment groups: nonnutritive sucking (NNS), 20% oral sucrose, or routine care. Pain was measured by the Neonatal Facial Coding System, physiological signals by electrocardiogram monitors, and cry duration using a stopwatch.Pain was significantly lower among infants in the NNS (B=-11.27, P0.001) and sucrose (B=-11.75, P0.001) groups than that in controls after adjusting for time effects, infant sleep/wake state, number of prior painful experiences, and baseline pain scores. Infants in the NNS and sucrose groups also had significantly lower mean heart and respiratory rates than the controls. Cry duration of infants receiving sucrose was significantly shorter than those in the NNS (Z=-3.36, P0.001) and control groups (Z=-7.80, P0.001).NNS and oral sucrose can provide analgesic effects and need to be given before painful procedures as brief as a one-minute IM injection. Sucrose orally administered two minutes before injection more effectively reduced newborns' pain during injection than NNS. Both nonpharmacological methods more effectively relieved newborns' pain, stabilized physiological parameters, and shortened cry duration during IM hepatitis injection than routine care.

I was born in Luoyang in 1963, a city in China with thousands of years' history. The city is the eastern starting point of the Silk Road (BC 206-260 AD), a famous and long trade route in human history. Living in this ancient city, I grew up under the influence and impact of Chinese traditional culture. When I was a teenager, I once read a book "Yellow Emperor's Inner Canon" (Huang Di Nei Jing, written about 5th century BC), which is the oldest extant classic of traditional Chinese medicine. I was immediately attracted by an idea in it "prevention is better than cure," which is mean that the highest level of medical treatment is not to cure a disease, but to prevent the occurrence of diseases. I think even in the modern society, this is still the highest realm of medical treatment. Inspired by this view, I developed a strong interest in preventive medicine and majored in it during my college years. With an increasingly deeper understanding of preventive medicine, I gradually realized the importance of epidemiology and vaccinology in preventing infectious diseases. Fortunately, in 1991 I entered the group of professor Zhuang Hui in Peking University Health Science Center for a doctorate degree in epidemiology. Professor Zhuang who is an academician of the Chinese Academy of Engineering not only taught me how to do research, but showed me how to act like a scientist. I benefited greatly from his rigorous attitudes toward life and research. During this period, I focused on transmission routes of hepatitis C virus which made me increasingly recognized the great harm of hepatitis in China. It is well known that more than three-quarters of all liver cancer cases are thought to be attributable to hepatitis B or C. In China about 110 000 people die from liver cancer each year, accounting 45% of the total number of deaths caused by liver cancer worldwide.

Background Adult vaccination compliance rates vary according to sample and type of vaccine administered (influenza, pneumococcal). This study looked at vaccination of a community sample of low-income, minority adults. Methods Nurses offered free vaccination for hepatitis A and B in the form of the combined Twinrix vaccine to adults on a walk-in basis. In addition to dosing information, participants completed the Risk Behavior Assessment, the Coping Strategies Indicator and the Cardiovascular Risk Assessment. Skaff's extended Health Belief Model was used as the theoretical framework. Count regression was used to model receipt of one, two, or three doses. Results The majority of participants were male with a mean age of 40 years. The distribution of doses was: 173 individuals (27.6%) received one dose only, 261 (41.7%) received two doses, and 191 (30.5%) received three doses of vaccine. The multivariate count regression model including being male, having previously been told by a health care provider that one has syphilis, having severe negative emotions, and perceived social support were associated with participants' receiving fewer doses of hepatitis vaccine. A greater problem-solving score was associated with a higher number of vaccine doses received. Conclusion Despite free vaccinations offered in an easily accessible community setting, the majority of participants failed to complete the hepatitis vaccine series. More effort is needed to get adult men to participate in hepatitis vaccination clinics. Additional research is necessary to understand barriers other than cost to adults receiving vaccination.

Summary Background Viral hepatitis is the most common cause of liver disease in the world. In the past 25 years, vaccines have become available for two of the five hepatitis viruses, and, where implemented, vaccination has become a key component of hepatitis prevention. Aims To provide an update on recent advances in the use of current hepatitis vaccines and to examine progress in the development of vaccines for the remaining hepatitis viruses. Methods A Medline search was undertaken to identify the recent relevant literature. Search terms included hepatitis vaccines, hepatitis vaccination and hepatitis A–E vaccines. Results Dramatic vaccine-induced declines in the incidence of both hepatitis A and B have occurred in the USA. Strategies to integrate hepatitis A vaccine into universal childhood immunization are being adopted. Similarly, strategies with the goal of eliminating transmission of hepatitis B have been promulgated. A vaccine for hepatitis E has been reported to be effective and safe, but progress in the development of vaccines for hepatitis C and D has been limited. Conclusion During the next few decades, the goals of eliminating hepatitis A and B virus transmission may be reached in the USA and elsewhere.

Background Since the protection time by hepatitis B (HB) vaccination is unclear, the strategy of immunization of junior students who previously received hepatitis vaccine is controversial. Objectives This study aimed to determine the status of immunity to hepatitis B in junior medical, nursing and obstetrics students with different hepatitis B virus (HBV) vaccination patterns. Patients and Methods In an analytical cross-sectional study, 255 junior medical sciences students were tested for quantitative antibodies to hepatitis B surface antigen (anti-HBs). The proportion of protective immunity was compared in different vaccination patterns. Results Vaccination coverage rates were 74.1%. About half the participants didn’t show serological evidence of protective immunity; 68.9% had their last shot more than 10 years ago and 30.4% had a vaccination history of five years or less (P < 0.001). Geometric mean level of anti-HBs titer among students, who had received a primary series vaccine at birth, was significantly lower than students who had started vaccination at an older age (P < 0.001). Also, analysis of variance for geometric mean of anti-HBs titer showed significant differences between groups based on injection time from the last shot (P < 0.001) (post hoc comparisons resulted in a P value of < 0.001 for birth versus < 5 year group, and P < 0.001 for the 5 to 10 year group). The lowest rate of non-protective level belonged to participants with complete three doses and a booster additional shot (27.1%). The final model for independent predictors of anti-HBs positive status was made by a binary logistic regression analysis. The model included presence of a booster dose, injection time from last shot, and discipline of study. Conclusions This study shows lower anti-HBs among students who were vaccinated at infancy compared to those vaccinated at older childhood or adolescence. Also, subsequent measurement of anti-HBs level at the time of entrance to university is recommended for all previously immunized students.

Few data are available concerning the long term immunogenicity of the pediatric doses of hepatitis B vaccines given to preteenagers. The long term effect of the booster dose in teenagers is unknown. We evaluated the immunogenicity of 2 pediatric hepatitis vaccines after primary vaccination and after a booster dose.A prospective 15-year follow-up study of the immunogenicity of 2 hepatitis B vaccines was initiated in 1995 in Quebec City, Canada. One year apart, 1129 children 8-10 years old received Engerix-B 10 microg (EB), and 1126 received Recombivax-HB 2.5 microg (RB) vaccine after a 0-, 1-, 6-month schedule. After 5 years, one-third of the 2 cohorts were randomly selected. A booster dose of EB 10 microg or RB 5 microg was administered according to the vaccine used in the primary immunization. Antibodies were measured before, 1 month after and 1 year after the booster injection.Before the booster dose, anti-HB surface antibody (HBs) was detected in 94.7% of the EB subjects and in 95.2% of the RB subjects (P = 0.85). The geometric mean titer (GMT) was higher in the EB than in the RB group (252 mIU/mL versus 66 mIU/mL, P0.0001). One month after the booster, 99.7% of subjects in the EB group and 99.6% in the RB group had a detectable anti-HBs, and 99.0 and 99.3%, respectively, had anti-HBsor =10 mIU/mL. The anti-HBs GMT was 113,201 mIU/mL in the EB and 16,623 mIU/mL in the RB groups (P0.0001). One year after the booster, 99.3% of subjects in the EB group and 100% in the RB group had detectable anti-HBs, and 97.9 and 98.5% respectively, had anti-HBsor =10 mIU/mL. The anti-HBs GMT was 14,028 mIU/mL in the EB and 3437 mIU/mL in the RB group (P0.0001).The immunity persists for at least 5 years after the primary vaccination with both pediatric vaccines in 99% of children vaccinated at the age of 8-10 years. It confirms that no booster is needed at that point.

Objectives:To evaluate infection control knowledge and practices, provide training on universal-standard precautions (USP), and improve infection control knowledge and practices among dentists.Setting:Private and public dental offices in Vâlcea, Romania.Methods:Information about the use of hepatitis B vaccine, knowledge of and training in USP, perceived risks of disease transmission, and infection control practices was gathered from a sample of dentists through interviews, direct observations, and a survey administered during a training session.Results:Interviews among dentists and direct observations of infection control practices revealed that resources were often scarce in public clinics; however, availability of supplies in private or public clinics often did not correlate with adherence to proper infection control. Of 125 registered dentists, 46 (37%) attended the session and completed the survey. Of these, 75% worked in public clinics, 40% in private practices, and a few in both. More than 50% believed that the prevalence of hepatitis B virus (HBV) was low in their patients compared with the Romanian population. Only 26% of dentists had received hepatitis B vaccine. Dentists reported a mean of six percutaneous injuries a year. Most (89%) reported that gloves were effective in preventing HBV transmission; 24% wore them for every patient. Most used dry heat sterilization; however, chemical disinfectants were also used.Conclusions:Resources were limited, receipt of hepatitis vaccine was low, and infection control knowledge and practices varied. Training and education are needed regarding the importance of USP, hepatitis B vaccination, and alternative practices when resources are insufficient.

Sexually transmitted disease clinics can deliver hepatitis vaccines to men who have sex with men, but have been reluctant to do so because of perceived low vaccination completion rates.The goal was to evaluate hepatitis A and B vaccination eligibility, acceptance, and completion and the effectiveness of reminder/recall in a sexually transmitted disease clinic serving men who have sex with men.Clients self-reported their eligibility for free vaccine. Consenting clients who accepted a first dose of vaccine were systematically assigned to receive telephone reminder/recall or standard follow-up.Of 1203 clients, 71.8% were eligible for both vaccines; 62.6% of those eligible accepted both. Reminder/recall was associated with increased receipt of the second dose of hepatitis B vaccine (86.7% versus 80.4% among intervention and control groups, respectively), but not with completion of both vaccine series (55.9% versus 58.8%).The majority of clients were eligible for both hepatitis vaccines, and most eligible clients accepted a first dose of both vaccines. Reminder/recall, as delivered at this clinic, failed to increase the proportion of clients who received all vaccine doses. New delivery mechanisms should be explored.

Despite the availability of hepatitis A vaccines that might provide protection for decades, hepatitis B vaccines that provides protection for at least 15 years and the recent introduction of a combined hepatitis A and B vaccine, these infections continue to spread in both the developed and developing world. Hepatitis A vaccine coverage has been limited to high-risk groups: such a selective immunisation policy is unlikely to have a major impact. If adequate immunogenicity in infants is confirmed, dosing schedules can be improved and the costs of vaccination reduced, universal paediatric immunisation with combined hepatitis A and B products is likely to result in the eventual eradication of these infections. In the interim, novel hepatitis A vaccines are being investigated and additional studies on hepatitis A vaccine immunogenicity in infants are in progress. Worldwide use of hepatitis B vaccines for the newborn, young children and high-risk groups should control this infection and obviate the need for a vaccine against hepatitis D. Newer hepatitis B vaccines that may reduce the likelihood of non-responsiveness and have immunotherapeutic value are under study. A recombinant hepatitis E vaccine for use in endemic regions is currently in clinical trials. The development of an effective hepatitis C vaccine has been agonisingly slow and many impediments have been recognised. These include the lack of a susceptible small animal, a high degree of hepatitis C virus (HCV) genomic diversity and failure to produce high quantities of HCV in tissue culture. The development of a novel HCV replicon system may be a major breakthrough. Nonetheless, it may still be exceedingly difficult to produce a vaccine that uniformly provides sterilising immunity; the possibility of developing a hepatitis C vaccine that can prevent chronic infection is an exciting concept that requires further investigation. Advances in recombinant technology, the use of novel genetic (DNA-based) vaccines, expression of hepatitis antigens in plants and improved adjuvants also hold considerable promise.

Objective To evaluate the long-term efficacy of Chinese hamster ovary (CHO) cell derived hepatitis B vaccine in country community in China. Methods A cross-sectional investigation was carried out. Children who were born between 1997 and 1999 and vaccinated with the three doses of CHO-derived hepatitis B vaccine were selected as study objects. Their serum samples were taken to test for hepatitis B virus (HBV) markers, and the results were compared to that before vaccination. In addition, for HBsAg positive children, their mothers were visited. Results 1254 Children were enrolled in the study. The prevalence of HBsAg was 0.24% and the vaccine efficacy was 97.0%, similar to that of yeast derived hepatitis vaccines. Among 3 mothers of HBsAg positive children, 2 were HBsAg positive, indicating maternal HBV transmissions. Conclusion The long-term efficacy of the CHO-derived hepatitis B vaccine is good and after vaccination maternal transmission is the most important route of spreading HBV.

Since the publication of the last extensive review of hepatitis vaccines, use of inactivated hepatitis A vaccines has been extended to high-risk regions of the United States and specific patient groups, such as those with chronic liver disease, and use of the recombinant hepatitis B vaccines has been recommended for older adolescents. A combination hepatitis A and B vaccine, recently approved for licensure by the US Food and Drug Administration, should increase convenience and compliance, reduce the costs of vaccination, and provide prolonged and dual protection for those at risk for hepatitis. Although commercially available vaccines for hepatitis C, D, and E remain a distant goal, advances in vaccine and adjuvant technology, including immunization with DNA-based vaccines, hold promise for the future.

This report reviews hepatitis A and B immunization recommendations and assesses the potential role of a combined hepatitis vaccine. Although hepatitis A and B are very different diseases, overlap exists in their epidemiologic patterns. Both are most prevalent in developing countries, with areas of low endemicity in industrialized nations. Potential sources of infection common to both hepatitis A and hepatitis B (i.e., international travel, close contact with residents of institutions or young children and infants, male homosexual activity, and drug use) indicate that certain groups may be at increased risk of both diseases. Well-tolerated and immunogenic vaccines are available for both hepatitis A and hepatitis B. Although hepatitis B vaccine is now being introduced into universal infant immunization programs in many countries, hepatitis A vaccination is currently recommended for high-risk groups only. This review examines the potential role of a single vaccination against both forms of hepatitis.

Supplemental Digital Content is available in the text, Although routine immunoprophylaxis has been known to reduce hepatitis B virus (HBV) transmission, immunoprophylaxis failure still occurs. The study aimed to investigate the protective efficacy of an improved immunoprophylaxis protocol to prevent mother-to-infant transmission of HBV and to explore the potential risk factors associated with immunoprophylaxis failure and low antibody response. A prospective observational cohort study was conducted from July 2012 to April 2015. A total of 863 HBsAg-positive mothers and their 871 infants (8 pairs of twins) were included in the study. Two different hepatitis B vaccine doses (20 or 10 μg) were administered to the infants based on the hepatitis B e-antigen (HBeAg) status of their mothers. Simultaneously, hepatitis B immunoglobulin (HBIG) was administered to the infants. Initial injections of HBIG and the hepatitis vaccine were given within 2 hours after birth. Rates of HBV infections among the infants were evaluated at 7 months of age. Factors associated with immunoprophylaxis failure and low responses to vaccination were analyzed by unconditional logistic regression.. At 7 months of age, no immunoprophylaxis failure was observed in the 565 infants born to HBeAg-negative mothers. Among the 306 infants born to HBeAg-positive mothers, immunoprophylaxis failed in 16 infants (5.2%) of the infants and they were found to be HBsAg-positive. Further analysis showed that HBV DNA levels ≥108 IU/mL [odds ratio (OR) = 4.53, 95% confidence interval (95% CI): 1.19–17.34], delayed vaccination (OR = 4.14, 95% CI: 1.00–17.18), and inadequate initial injections (OR = 7.69, 95% CI: 1.71–34.59) were independently associated with immunoprophylaxis failure. Adequate titers of antibody to HBsAg (anti-HBs, ≥100 mIU/mL) were present in 96.5% of immunoprophylaxis-successful infants. For full-term infants, birth weights

Online: 20 July 2010DOI: http://dx.doi.org/10.3329/bmrcb.v36i1.5264 Bangladesh Med Res Counc Bull 2010; 36: 41-42

Hepatitis B virus infection is preventable by vaccine and the correlate of immunity is the induction of antibody. The 2.5 μg antigen per dose of H-B-VAX II given in appropriate regimens is adequate to immunize normal newborn infants and children up to 11 years of age. A 5 μg dose may be needed to protect newborn infants born to mothers who are carriers of hepatitis B infection and should be used when the carrier status is either positive or is unknown. The immune response in newborn infants is usually of lower titre than in infants who are 2–3 months of age or older. The level of protection afforded in otherwise healthy individuals by plasma-derived vaccine is high and lasts for longer than 7 years, even though the level of circulating antibody may have declined to a less than detectable amount. A similar pattern of antibody decline follows administration of recombinant vaccine. The mechanism for sustained protection is in long-term immunological memory with rapid recall of antibody production on exposure to the virus in nature. Administration of hepatitis B vaccine will be simplified by combination with DPT and poliomyelitis vaccines in single-dose formulations that are under current development. An experimentally killed hepatitis A virus vaccine prepared by formaldehyde inactivation of attenuated live virus purified from infected MRC-5 cell cultures induces rapid and high level antibody response when the vaccine is given in as little as 100 ng of antigen per dose and in two- or three-dose regimens. The vaccine is highly protective when assayed in challenge studies in animals and the levels of antibodies achieved are far in excess of those provided by immune globulin when used for passive protection in humans. Field investigations to demonstrate protective efficacy against natural challenge in human beings have been in progress and protective efficacy has been established.

Franciscan missionary Giovanni Di Plano Carpini traveled in 1245 to a country named Yeke Tartar, to visit a certain man called Genghis Khan. His journey's report narrated peculiar dietary habits of the locals: "they eat anything, even lice". Little that Carpini knew, he had actually documented the earliest known to us record of oral vaccination against blood-borne infections - an approach that is still used occasionally in the present-day Mongolia for therapy of hepatitis. Currently, efforts aimed at developing therapeutic hepatitis vaccines have switched to more palatable path, but we may still benefit from the insight of medieval Mongols. This review provides an update on development of hepatitis B and C vaccines as related to immunotherapy of hepatitis. Immune therapy is a fast-moving field but the results so far failed to pitch woo. Current trends in research on therapeutic vaccine candidates and liver immunology are discussed. We subscribe to the idea that viral hepatitis is essentially an autoimmune disease generating immune-mediated liver damage. Therapeutic vaccines need to be designed in such a way that self-destructive immunity of the host is targeted not the virus, which is not cytopathic.

We surveyed 420 paramedics employed by a large metropolitan fire department to determine the effects of educational seminars on their knowledge base, perceptions, and attitudes about AIDS and hepatitis B. All surveys were completed on an anonymous, voluntary, and confidential basis. Our educational efforts improved the paramedics' knowledge base concerning the medical manifestations of AIDS, identification of risk factors, modes of transmission, and means of infection control, but had no impact on paramedics' fear of contracting AIDS. While paramedics have a strong fear of contracting AIDS, we note that they underestimate their risk of acquiring hepatitis B. Only 17% of paramedics surveyed had received the hepatitis vaccine, despite attending an infectious disease seminar addressing the occupational risks of acquiring hepatitis B infections during the previous year. Further educational efforts to address the paramedics' attitudes about AIDS, as well as to encourage paramedics to recognize hepatitis B exposure as a significant personal health risk, are currently being pursued.

Current pediatric vaccination schedules in the United States are based on age. In contrast, adults are vaccinated against most infectious diseases, including hepatitis A and B, only when they are identified as at high risk or after a known exposure. There are multiple risk factors for hepatitis A and B of which clinicians often are not aware. Consequently, many persons at high risk are never vaccinated. Universal vaccination against hepatitis A and B is recommended for adults to halt transmission of the virus and prevent long-term sequelae. Women and their offspring are an especially important population to consider in efforts to reduce the incidence of hepatitis. The following recommendations for expanding the use of hepatitis vaccines in obstetrics and gynecology are made in this article: all older adolescents and adults should be vaccinated regardless of risk factors, and greater efforts should be made to educate physicians about the need to vaccinate their patients against hepatitis.

Hepatitis A and B vaccinations can and should be integrated into public health settings that serve adults at high risk for infection (e.g., sexually transmitted disease and/or human immunodeficiency virus clinics, criminal justice settings), and a policy of universal immunization may be the best way to accomplish this goal in these settings. Although hepatitis vaccines should be given to all susceptible persons at risk, many opportunities to vaccinate adults at high risk are missed, and there are several barriers and challenges to vaccination of adults. These challenges and barriers can be overcome. Successful integration of hepatitis vaccination for adults into existing public health services and clinics has been accomplished across the United States at both state and local levels. Additional funds must be provided for the infrastructure and purchase of vaccines for adults in these settings.

Sub-Saharan Africa remains the region most affected with HIV. The wide use of highly active anti-retroviral therapy has led to improvement in life expectancy among HIV infected individuals. However, hepatitis B virus related complications like liver cirrhosis and liver failure are now becoming common causes of morbidity and mortality in this group. The aim of this study was to determine the seroprevalence and risk factors of HBV/HIV co-infection among HIV infected children enrolled into care at Kilimanjaro Christian Medical Centre (KCMC). This cross sectional analytical study was conducted among 323 HIV infected children at KCMC between February 2013 and May 2013. Investigations included interviews, physical examination and HBsAg analysis. HIV serostatus and CD4 counts/percentages were obtained from patients records. In addition, information on hepatitis vaccine status was recorded. Among 323 HIV-infected children enrolled, 177 (54.8%) were males. The prevalence of hepatitis B virus and HIV co-infection was found to be 1.2% (n=4). Hepatitis B virus co-infection was not significantly associated with any of the sociodemographic or behaviour risk factors which were assessed. CD4 counts were significantly associated with hepatitis B virus status whereby children with CD4 counts less than 350 cells/mm3 were 14 times more likely to have hepatitis B virus co- infection as compared to those who had CD4 counts greater than 350 cells/mm3. All of the hepatitis B virus co-infected children had no records of hepatitis B virus immunization, though one was born during the period of universal infant’s hepatitis B vaccination (

Vaccines are now available for the prevention of hepatitis A and hepatitis B. In this article, biologics are reviewed with special attention to their use in the pediatric patient. Special attention is paid to issues that developed in 1999. For hepatitis A vaccine, it is the change in US recommendations regarding increased use in higher-risk US locations. For hepatitis B vaccine, it is the concern about toxicity, real or imagined.

Pediatric multiple sclerosis (MS) accounts for fewer than 5% of MS cases. Nevertheless, these young patients with MS may provide invaluable insights regarding the pathogenesis of the disorder. Children with MS are closest to the onset of their disease, enabling detailed examination of potential environmental, viral, and genetic triggers. An ongoing controversy well-suited for study in a pediatric MS population is whether immunizations, particularly hepatitis B (HB) virus vaccine, increase the risk of MS and other forms of CNS demyelinating disease. In this issue of Neurology ®, Mikaeloff et al.1 examine the timing and type of HB vaccine with respect to pediatric MS risk. Despite the benefits of HB prevention, implementation of universal HB immunization has been controversial. Case reports raising the concern of CNS demyelinating disease following HB vaccination emerged in the mid-1990s, but no association between HB vaccination and MS was found in a retrospective cohort study.2 Subsequent case–control studies also failed to identify an association between recent HB immunization and MS3–5 or subsequent relapse. …

The incidence of Hepatitis B infection has been steadily increasing over the last 5 years. The current literature has established that eye care practitioners are in the high risk category for contracting and transmitting this serious viral infection. Hepatitis B Virus (HBV) is present in all bodily fluids including tears and is considered to be more easily transmitted with a higher degree of infectiousness than Human Immunodeficiency Virus (HIV). Fortunately, unlike Acquired Immune Deficiency Syndrome (AIDS), hepatitis can be prevented with a vaccine. Recent improvements in the hepatitis vaccine have made it safer and more effective. As optometrists expand their scope of practice, it becomes essential to increase the knowledge base and awareness of this clinical entity so informed decisions can be made regarding vaccination by eye care practitioners, teaching faculty, and students.

Humoral and cellular immune responses of mice and guinea-pigs to hepatitis B virus surface antigen when alum-precipitated or administered with Syntex Adjuvant Formulation (SAF) were compared. Two doses of HBsAg in SAF were sufficient to elicit antibody responses, and using SAF the dose of antigen could be reduced to one-tenth of that required to elicit antibody responses by alum-adjuvanted HBsAg. The use of SAF increased and made more consistent the antibody responses in young mice and in strains of mice with inherited low responses to HBsAg. Cellular responses to HBsAg were more consistently observed when SAF was used than when alum was used. SAF increased the formation of IgG2a antibodies in mice except in the B10.M strain; antibodies of this isotype activate complement and act synergistically with antibody-dependent effector cells more efficiently than antibodies of other isotypes. If SAF proves acceptable for human use it could improve vaccines against hepatitis B virus.

This chapter discusses the use of recombinant DNA technology to produce a vaccine, that is, a protection against infection. Hepatitis B virus (HBV) is the major infective agent of liver and it can cause either acute or chronic viral hepatitis. In acute hepatitis, the virus can be cleared, leading to recovery. In chronic hepatitis B, the virus persists and may lead to progressive liver disease, cirrhosis, and primary hepatocellular carcinoma. The virus is maintained in the population primarily via maternal transmission. In the developed countries, infection is also transmitted by exposure to contaminated needles or instruments, by blood transfusion, or by sexual contact. The main steps in the production of hepatitis vaccine (HB-Vax) are yeast fermentation, culture harvest, cell rupture and extraction, absorption onto silica, butyl agarose adsorption, thiocyanate treatment, sterile filtration, formaldehyde treatment, adsorption onto alum, and filling and packaging. One of the key properties associated with the immunogenicity of a vaccine is the availability of epitopes (antigenic determinants) capable of eliciting the production of specific antibodies.

Following immunization with hepatitis B vaccine, 39 infants were followed prospectively for hepatitis B surface antigen (HBsAg). A total of 69.2% of the infants tested positive for antigenemia at least once. Antigenemia was identified most often at 2-3 days (43.5%) and 5-6 days (43.5%) after immunization. The longest documented duration of antigenemia was 21 days. In all cases the antigenemia was transient and cleared by the 28th day post-vaccination.

Diamond correctly points out the difficulty of making comparisons between the presence of hepatitis B surface antibodies (anti-HBs) among persons reporting prior immunizations (Seattle Young Men’s Survey [YMS]) and anti-HBs seroconversion measured after a documented immunization series (the UFO Study). Recall bias and waning anti-HBs could certainly have contributed to the lower proportion (70%) of subjects with isolated anti-HBs that YMS investigators observed.1 In the UFO Study, 62% of young injection drug users (IDUs) who reported 3 prior immunizations demonstrated isolated anti-HBs. We reported anti-HBs seroconversion in 78% of young IDUs after 3 doses of a monovalent recombinant hepatitis B virus (HBV) vaccine.2 Physiological factors that may blunt the immune response include lifestyle (e.g., smoking and obesity), biological factors (e.g., male sex and older age), and the coexistence of other immune-mediated diseases.3 Among homosexual and bisexual men, HIV infection has been associated with poorer HBV vaccine responses.4 The role of hepatitis C virus (HCV) antibody status in suboptimal HBV vaccine responses is still controversial. Some studies have reported an association,5,6 while others have found none.7,8 Our observation of a lower vaccine response among anti-HCV–positive subjects occurred in a subset too small for statistical significance. However, we plan to investigate this issue further in a new trial of hepatitis vaccine adherence among young IDUs in San Francisco. We agree with Diamond that prevaccination screening of high-prevalence populations for prior infection or immunity makes sense. At the San Francisco STD Clinic, screening was cost saving when seroprevalence was greater than 22% (J. D. Klausner, MD, MPH, STD Prevention and Control Services, San Francisco Department of Public Health; written communication; September 17, 2003). Because many young IDUs and young men who have sex with men are lost to follow-up and cannot afford to pay for either blood tests or vaccines, public health providers must often decide whether to assume these costs. Some providers have chosen a catch-as-catch-can approach, administering the first vaccine dose on the day of prevaccination screening. Finally, while understanding the factors that impair vaccine responses is important, 78% effectiveness is not all that bad. Future HIV vaccine candidates may be licensed with much lower partial efficacy.9 Strategies to improve vaccine series completion among high-risk adolescents and adults arguably present the greater challenge for the prevention of HBV transmission in the United States. Those strategies are likely to be useful not just for the delivery of HBV vaccines but also for the delivery of promising HIV vaccine candidates in the future.

The incidence of hepatitis B virus infection in Italy is 10 per 100,000 population, with most cases occurring in young adults. Vaccination against hepatitis B has been compulsory since 1991 for all newborns and 12-year-olds. In the Puglia region, this programme has reduced the incidence of hepatitis B from 7.4 per 100,000 population in 1990 to 2.4 per 100,000 population in 1996. The number of notified cases of hepatitis B in Puglia decreased from 212 in 1992 to 73 in 1997. As 50% of these cases occurred in young adults, the main aim of the current vaccination programme is to achieve high coverage rates among teenagers and young adults within the next few years. Although the incidence of hepatitis A is only about 5 per 100,000 overall in Italy, Puglia is an area of intermediate endemicity with a seroprevalence of antibodies to hepatitis A virus (anti-HAV) of about 40% in 18-year-olds. The incidence of hepatits A is up to 30 per 100,000 between the periodic outbreaks that occur every 2–4 years. Most notified cases occur in adolescents and young adults. The last outbreak of about 11,000 cases of hepatitis A in the Puglia region occurred in 1996–1997, mainly in the summer months in towns with harbours or near the coast. The most important risk factor was initially consumption of raw seafood, but later was personal contact, probably between children. A vaccination programme against hepatitis A was initiated in Puglia in 1997, aiming to vaccinate all infants of 15–18 months and all 12-year-olds against hepatitis A. Infants receive monovalent hepatitis A vaccine with the first dose of mumps/measles/rubella vaccine. Monovalent hepatitis vaccine can be given with the second and third doses of hepatitis B vaccine in 12-year-olds, but use of combined hepatitis A and B vaccine is recommended to aid compliance and reduce the commitment of physician/nurse time. Vaccination can be performed in school.

:Hepatitis A is an acute fecal-spread disease without chronicity. Gamma immunoglobulin is preventative. Eventually a vaccine will be used for those in developed countries, who have not acquired antibody in childhood. Hepatitis B is a blood-borne disease which can lead to chronic hepatitis, cirrhosis, and liver cancer. It is carried worldwide by many millions, especially in South-East Asia, the Pacific, Africa, and Southern Europe. Australian Aboriginals have a very high carrier rate. It also affects drug abusers, many partner homosexuals, and hospital workers in contact with blood. A safe vaccine is effective and particularly valuable for babies born to carrier mothers. Treatment of chronic hepatitis depends on whether the patient is in the replicative (‘e’ antigen positive) stage, where anti-viral therapy might be considered, or in the integrated (‘e’ antibody positive) stage where a trial of corticosteroids may be justifiable. Non-A, non-B hepatitis is a diagnosis of exclusion. There is no diagnostic test and no proven therapy. There are probably at least four types, parenteral short and long incubation and enteric sporadic and epidemic.

A survey of community-based physicians and dentists from the Washington, D.C., metropolitan area was conducted to assess the practices and attitudes of these health professionals relative to hepatitis B prevention. Mail questionnaires were sent to 200 physicians and 200 dentists. An overall response rate of 50 percent was obtained with one follow-up to all nonrespondents. The preventive practices adopted by the physicians were found to differ significantly from those of the dentists, including risk factors, history taking, using gloves and/or masks, and routinely screening for serologic markers. The physicians were significantly more likely than the dentists to be unwilling to take a safe, effective, hepatitis vaccine (p Though most survey respondents believed that if they were to become a hepatitis B chronic carrier, it would be better to know about it. Twenty six percent of the physicians and 14 percent of the dentists believed that not knowing about being a chronic carrier would be protective in a legal action against them. A majority of all of the health professionals surveyed felt that knowing their carrier status could jeopardize their career.

Since the hepatitis B vaccine was licensed in 1981, emergency physicians have had the opportunity to be immunized against the hepatitis B virus (HBV). The factors that affect the decision to undergo vaccination include (1) the risk of acquiring an HBV infection in emergency practice, (2) the prevaccination immune status of emergency physicians who have knowledge of their hepatitis serum marker profile, and (3) the efficacy and safety of the vaccine. Emergency physicians have a significant risk of acquiring an HBV infection and are recommended by the Centers for Disease Control to receive vaccination. However, emergency physicians are often incidentally tested for HBV serum markers before immunization. Recent investigations have shown that seropositivity for hepatitis surface antibody (anti-HBs) does not necessarlly preclude the need for immunization. Finally, experience with 750,000 doses has shown that it is a highly effective and extremely safe vaccine.

In 1980, 18 institutionalized children, carriers of hepatitis B virus (HBV), were enrolled into two special education schools, and staff and students were monitored for HBV markers. Eleven HBV exposures were observed and those exposed were given hepatitis B immune globulin. After 3.5 years, no remaining staff showed serological evidence of HBV infection but three of 61 susceptible students did so. The three students probably acquired the infection outside the school. At the conclusion of the project, one school located in the community decided not to institute a vaccine program for students or staff. The other school, located inside the mental retardation institution, established an organized vaccine initiative. Indications for use of hepatitis vaccine in schools should be individualized to accommodate for differences in student and staff interaction, physical design of the school, and number and behaviors of HBsAg carrier students.

To evaluate the addition of hepatitis vaccine to health schemes for hospital workers in Zimbabwe we undertook a cross sectional study of viral markers in 226 hospital workers and compared the results with 97 volunteer blood donor controls. One hundred and thirty one (58%) hospital workers had hepatitis markers compared with 45 (46%) of the donor group. Racial group was the strongest risk factor. Blacks were 70% more likely to have markers than whites. This racial difference was not explained by job status or patient contact. Our data suggest that work in a district general hospital does not constitute a clinically important hazard for hepatitis B infection. Because of the high cost of the vaccine, additional studies to assess the risk of hospital work in other settings in Zimbabwe are required before health policy regarding routine hepatitis B vaccination is determined.

AFTER decades of investigative frustration, it now appears that the viruses causing both type A and B hepatitis have been identified, that clear-cut serologic distinctions between these infectious agents have been demonstrated, and that a practical basis for a type B hepatitis vaccine has been established. These events have derived from the explosive proliferation of hepatitis research that followed the first description of the Australia antigen in 1965 by Blumberg et al.1This commentary will not deal with the many important early discoveries in this area that have been extensively reviewed,2,3but will focus on more recent findings that provide an experimental framework for our emerging concept of the agents responsible for viral hepatitis. The Dane Particle In addition to its clinical association with viral hepatitis, the Australia antigen, hereafter referred to as the hepatitis B surface antigen (HBsAg), became a candidate for the elusive type