Four-year follow up of hepatitis C patients vaccinated against hepatitis B virus

AIM: Patients with chronic hepatitis C have been recommended to receive vaccinations against hepatitis B. Our study aimed at evaluating the hepatitis B immunogenicity and efficacy against hepatitis B virus infection 4 years after primary immunization series in a group of patients with chronic hepatitis C.METHODS: We recruited 36 out of 48 hepatitis C virus (HCV) infected individuals who were vaccinated against hepatitis B virus (20 μg of recombinant HBsAg at 0-1-6mo schedule) in 1998. Here we measured anti-HBs titers and anti-HBc 4 years after delivery of the third dose of primary immunization series.RESULTS: After 4 years a total of 13/36 (36%) HCV infected patients had seroprotective titers of anti-HBs compared with 9/10 (90%) in the control group, (P＜0.05).Similarly the mean concentration of anti-HBs found in hepatitis C patients was significantly lower than that found in healthy subjects (18.3 and 156.0 mIU/mL respectively (P＜0.05). None of the HCV infected patients or controls became infected with HBV during the study period as confirmed by anti-HBc negativity.CONCLUSION: We demonstrated that 4 years after HBV immunizations' more than 60% of vaccinated HCV patients did not maintain seroprotective levels of anti-HBs, which might put them at risk of clinically significant breakthrough infections. Further follow-up studies are required to clarify whether memory B and T lymphocytes can provideprotection in chronic hepatitis C patients in the absence or inadequate titers of anti-HBs.

Known and probable risk factors for hepatitis C infection:A case series in north-eastern Poland

AIM： To describe the risk profile of patients in hospita with hepatitis C virus （HCV） infection in Poland. METHOD： Using a structured questionnaire, all patients with confirmed HCV infection were interviewed about the risk factors. RESULTS： Among the 250 patients studied, transfusion before 1993 was the primary risk factor in 26%, intravenous drug use setting in 9% and occupational exposure in health-care in 9%. Women were more likely to have a history of occupational exposure or transfusion before 1993 and less likely to undergo minor surgery. Known nosocomial risk factors （transfusion before 1993, dialysis） were responsible for 27% of infections, probable nosocomial factors （transfusions after 1992, minor surgery） for 14% and further 9% were occupationally acquired infections. CONCLUSION： A careful history investigation can identify a known or probable risk factor for HCV acquisition in 59% of patients with HCV infection. Preventive activities in Poland should focus on infection control measures in health-care setting.