Perception of Medical Students towards Hepatitis B Virus Infection and Hepatitis B Vaccination in a Private Tertiary Hospital in Jos North Local Government, Plateau State, Nigeria

Background: Prevention is one of the safe schemes against the high prevalence of viral Hepatitis. Negative perceptions or perceptions about the risks of hepatitis B among medical students and health care workers may influence the behavioral pattern and adoption of preventive measures against the virus and can affect the uptake of the Hepatitis B vaccine. This study assesses the perception of medical students towards Hepatitis B virus infection and Hepatitis B Vaccination in a Private Tertiary Hospital in Jos North Local Government, Plateau State, Nigeria. Methods: This was a descriptive cross-sectional study done in August 2021 among 236 clinical medical students using a multistage sampling technique. Data was collected using an interviewer-administered structured questionnaire and analysed using the IBM SPSS 28 (Statistical Package for the Social Sciences). Ethical approval was granted by Bingham University Teaching Hospital, Ethics Committee, Jos, Plateau State. Results: Two-thirds of respondents were of the opinion that they are at risk of contracting HBV. Half were of the opinion that the risk is very much while a third believed the risk is moderate. Among those who think they are not at risk of contracting HBV, the majority felt so because they are vaccinated while 10.3% believe that they are safe. 43.2% of respondents think that HBV Vaccine is very effective in preventing HBV infection while 39.8% think it is slightly effective, and 7.6% think it is not effective. Almost all respondents, 99.2% are of the opinion that HBV Vaccination is important for students while 0.8% think it is not important. The majority of the respondents at 95.8% were willing to be screened for HBV. The majority (85.6%) of respondents are willing to pay for HBV Vaccine as against 14.4% of respondents who are not willing to pay. Conclusion: Summarily, 21 (8.9%) of the students had a negative perception of Hepatitis B Vaccination, and 215 (91.1%) had a positive perception of Hepatitis B Vaccination. Perception-sustaining events like seminars, workshops, road shows, and campaigns should be organized among students and health workers.

Hepatitis B Vaccination in Medical and Dental Students: A Cross-Sectional Study

Background: Medical and dental students are at risk of Hepatitis B Virus (HBV) infection. The study aimed to assess the vaccination status against Hepatitis B Virus of students in clinical and non-clinical years of a private medical and dental college, and their knowledge, attitude, and awareness about the subject. Methods: A cross-sectional study was conducted using a pretested, self-administered questionnaire among 203 medical and dental students of CMH Lahore Medical College and Institute of Dentistry (CMH LMC & IOD) in Lahore, Pakistan. Participants were evaluated for their knowledge and vaccination status against Hepatitis B Virus. Students were considered to be fully vaccinated (recipients of 3 doses), partially vaccinated (recipients of 1 or 2 doses), and unvaccinated. Comparisons were made between students of clinical and non-clinical years. Data was entered and analysed using Statistical Package for the Social Sciences (SPSS) version 23. Results: Only 66% (n = 134) of the 203 participants had ever received a Hepatitis B Virus vaccine out of which a meagre 17.2% (n = 35) were fully vaccinated. No significant difference was found in vaccine uptake between students of clinical and non-clinical years (p-value = 0.181) despite significant differences seen in the knowledge of vaccination schedule (p-value = 0.001), the prevalence of needle-stick injuries (p-value = 0.001), and knowledge of protocols to be followed after a needle-stick injury (p-value = 0.001). Conclusion: Our study found that a large proportion of the student population is vulnerable to HBV infection. There is a need to create awareness regarding the subject to increase vaccine uptake. HBV vaccination should be offered to all currently enrolled students and be made mandatory at the time of admission in the future.

Relationship between T-lymphocyte cytokine levels and sero-response to hepatitis B vaccines

AIM: To investigate the cellular defects by analyzing the (Th1/Th2) cytokine levels in vaccine responders and non-responders. METHODS: Peripheral blood mononuclear cell (PBMC) from responders and non-responders were stimulated with or with out recombinant HBsAg or PHA. Broad spectrum of cytokines viz (Th1) IFN-γ, IL-2, TNF-α, IL-12 and (Th2) IL-10, IL-4 were measured after in vitro stimulation with recombinant HBsAg and were compared with respective antibody titers. RESULTS: A significant decrease (P = 0.001) in Th1 and Th2 cytokines namely, IL-2, INF-γ, TNF-α and IL-10in non-responders was observed. The level of IL-4 was not significant between the three groups. Furthermore, despite a strong Th1 and Th2 cytokine response, the level of IL-12 was elevated in high-responders compared to other groups (P = 0.001) and demonstrated a positive correlation with anti-HBs titers and Th1 cytokine response. CONCLUSION: Our findings suggest that unrespon-siveness to recombinant hepatitis B vaccines (rHB) is multifactorial, including specific failure of antigen presentation or the lack of both T helper Th1 and Th2 response.

Immunogenicity and reactogenicity of a recombinant hepatitis B vaccine in subjects over age of forty years and response of a booster dose among nonresponders

AIM:The study was initiated to evaluate the reactogenicity and immunogenicity of a recombinant hepatitis B vaccine in age group >40 years and to study the response of a single booster dose in primary non-responders to the hepatitis B vaccination. METHODS:A total of 102 volunteers without markers of hepatitis B infection (negative for HBsAg,anti-HBc antibody, HBeAg and anti-HBs antibody) received 20μg of recombinant HB vaccine intramuscularly at 0,1,and 6 months.Anti HBs titers were evaluated by a quantitative Elisa kit at 90 and 210 days.A booster dose of 20μg HB vaccine was given after 6 months of the 3^(rd) vaccine dose to the 15 non- responders and anti-HBs titers were measured after i month. RESULTS:Seroprotection (anti-HBs GMT^3 10 IU/L) was achieved in 85.3 % (87/102) volunteers.The mean GMT titers of the vaccine responders was 136.1 IU/L.Of the seroprotected individuals,there were 32.4% (33/102) hyporesponders (anti- HBs titers <10-99 mIU/ml) and 52.9% (54/102) were responders (anti-HBs titers >100 IU/L).All the non-responders (15/15) responded to a single dose of the booster dose of recombinant HB vaccine and their mean anti-HBs antibody titers were more than 100.5 mIU/ml after the booster dose. CONCLUSION:Recombinant hepatitis B vaccine offers good seroprotection in the age group >40 years and has a good safety profile.A single booster dose after 6 months in primary non-responders leads to good seroprotective anti-HBs antibody titers.However,larger population based studies are needed to evaluate the role of a booster dose in selected group of non-responders and whether such an approach will be cost effective.

Prevention of vertical transmission of hepatitis B virus infection

Hepatitis B virus(HBV)is the leading cause of chronic viral hepatitis.Annually,almost two million children younger than 5 years acquire the infection,mostly through vertical or horizontal transmission in early life.Vertical transmission of HBV is a high efficacy phenomenon ranging,in the absence of any preventive interventions,from 70%to 90%for hepatitis e antigen positive mothers and from 10%to 40%for hepatitis e antigen-negative mothers.Maternal viraemia is a preeminent risk factor for vertical transmission of HBV.Maternal screening is the first step to prevent vertical transmission of HBV.Hepatitis B passive and active immunoprophylaxis at birth together with antiviral treatment of highly viraemic mothers are the key strategies for global elimination of HBV infection.Strategies are needed to promote implementation of birth-dose vaccination and hepatitis B immunoglobulins in low-and middle-income countries where the prevalence of the infection is at the highest.

Construction and characterization of an experimental ISCOMS-based hepatitis B polypeptide vaccine

AIM: To characterize the biochemical and immunological properties of an experimental ISCOMS vaccine prepared from a novel therapeutic polypeptide based on T cell epitopes of HBsAg, and a heptatis B-ISCOMS was prepared and investigated. METHODS: An immunostimulating complexes(ISCOMS)-based vaccine containing a novel therapeutic hepatitis B polypeptide was prepared by dialysis method, and its formation was visualized by electron microscopy and biochemically verified by SDS-polyacrylamide gel electrophoresis. Amount of the peptide within ISCOMS was determined by Bradford assay, and specific CTL response was detected by ELISPOT assay. RESULTS: Typical cage-like structures of submicroparticle with a diameter of about 40nm were observed by electron microscopy. Results from Bradford assay showed that the level of peptide incorporation was about 0.33g.L(-1). At the paralleled position close to the sixth band of the molecular weight marker(3480kDa) a clear band was shown in SDS-PAGE analysis, indicating successful incorporation of polypeptide into ISCOMS. It is suggested that ISCOMS delivery system could efficiently improve the immunogenicity of polypeptide and elicit specific immune responses in vivo by the results of ELISPOT assay, which showed that IFN-gamma producing cells(specific CTL responses) were increased(spots of ISCOMS-treated group: 47+/-5, n =3; control group: 5+/-2, n =3). CONCLUSION: ISCOMS-based hepatitis B polypeptide vaccine is successfully constructed and it induces a higher CTL response compared with short polypeptides vaccine in vivo.

Clinical management of hepatitis B virus infection correlated with liver transplantation

BACKGROUND: As a radical cure for post-hepatitis B virus (HBV)-related liver cirrhosis and hepatocellular carcinoma, liver transplantation has been applied in many medical centers. Before the use of effective measures, hepatitis B recurrence and the existence of HBsAg(+) donors, patients with hepatitis B-related diseases are contraindicated for liver transplantation. Application of interferon, hepatitis B immunoglobulin (HBIG), and nucleotide analogues (e.g., lamivudine) has made great progress in the clinical care of HBV. However, there are still many shortcomings such as low viral suppression rate, rising expense, and the induction of HBV tyrosine-methionine-aspartate-aspartate (YMDD) mutation. This article systematically reviews the current evidence that immunotherapy, conventional drug combinations, and some special fields of HBV infection correlate with liver transplantation. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed for articles using the keywords 'hepatitis B virus', 'hepatitis B vaccination', 'lamivudine', 'adefovir', 'entecavir', 'tenofovir', 'HBV genotype', and 'liver transplantation' up to October 2009. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Hepatitis B vaccine and human monoclonal antibody have very good clinical prospects. Compared with traditional therapies, the new medical regimens have many benefits such as boosting viral suppression rate and decreasing medical expenses. The triple therapy for YMDD mutation also has an excellent therapeutic effect and a low barrier to resistance. New nucleos(t)ide analogues (entecavir and tenofovir) eliminate virus more effectively with few adverse reactions, and may replace lamivudine or HBIG in future. CONCLUSIONS: Hepatitis B vaccine needs further large-scale and rigorous randomized controlled trials to confirm its effective dose and injection frequency. Monoclonal antibody is still experimental, and the next step is to carry out the relevant animal and human studies. A consensus standard regimen for the treatment of hepatitis B should be developed.

Epidemiologic and socioeconomic factors impacting hepatitis B virus and related hepatocellular carcinoma

Chronic Hepatitis B is a highly prevalent disease worldwide and is estimated to cause more than 800000 annual deaths from complications such as cirrhosis and hepatocellular carcinoma(HCC).Although universal hepatitis B vaccination programs may have reduced the incidence and prevalence of chronic hepatitis B and related HCC,the disease still imposes a significant healthcare burden in many endemic regions such as Africa and the Asia-Pacific region.This is especially concerning given the global underdiagnosis of hepatitis B and the limited availability of vaccination,screening,and treatment in low-resource regions.Demographics including male gender,older age,ethnicity,and geographic location as well as low socioeconomic status are more heavily impacted by chronic hepatitis B and related HCC.Methods to mitigate this impact include increasing screening in high-risk groups according to national guidelines,increasing awareness and health literacy in vulnerable populations,and developing more robust vaccination programs in under-served regions.

Evaluation of immunogenicity and reactogenicity of recombinant DNA hepatitis B vaccine produced in India

AIM： （1） To gain information on immune responses to an accelerated schedule of 0, 1, and 2 mo in paramedical staff and BDS students who are at an increased risk of getting hepatitis B infection and come under high risk groups. （2） To assess the efficacy and safety of En/vac- HB in different age groups, using genetically modified yeast strain Pichia pastoris, a new recombinant hepatitis B accine developed and manufactured in India. METHODS： A prospective, comparative, and single blinded trial of rapid （0, 1, and 2 mo） hepatitis B immunization schedulewas reported. A total of three hundred and seven （212 females and 95 males） healthy volunteers divided into three age groups （18-29, 30-39, and 40-49） were enrolled after screening for markers of hepatitis B. All the volunteers received 20 mg of the vaccine intramuscularly at 0, 1, and 2 mo. RESULTS： Geometric mean titers were calculated pre and post vaccination. Before immunization the GMT was 0.0124 mIU/mL. One month after the administration of the third dose of recombinant vaccine 296/307 （96.5%） subjects achieved seroprotective levels of anti-HBs. The geometric mean anti-HBs titers achieved after one month of the third dose was 2 560.0 mIU/mL. The geometric mean anti-HBs titer of males was 2 029.0 mIU/mL, while that of the females was 2 759.0 mIU/mL. In the age group of 18-29 years, anti-HBs titer was 3 025.0 mIU/ mL, while that in the age group of 30-39 years was 2 096.0 mlU/mL. In third age group of 40-49 years, anti- HBs titer was 1 592.0 mIU/mL. Hyper-responses （anti-HBs≥100 mIU/mL） were shown in 88.0% （271/307） of subjects. Eleven （3.5%） subjects responded poorly to the vaccine in the age group of 40-49 years. There was only mild pain at the site of injection otherwise there were no other adverse drug reactions （ADRs）. CONCLUSION： This vaccine （Enivac-HB） is safe and efficacious, providing significant protection after the third dose and rapid hepatitis B immunization schedule of 0, 1, and 2 mo can be recommended whenever rapid protection is the goal.

Potential role of killer immunoglobulin receptor genes among individuals vaccinated against hepatitis B virus in Lebanon

AIMTo explore the role of killer immunoglobulin receptor (KIR) genes in responsiveness or non-responsiveness to vaccination against hepatitis B virus. METHODSWe recruited 101 voluntary participants between March 2010 and December 2011. Sera samples from vaccinated and non-vaccinated participants were tested for the presence of anti-HBs antibodies as a measure of protection against hepatitis B, hepatitis B surface antigen and hepatitis B core antibody as indicators of infection by enzyme-linked immunosorbent assay. KIR gene frequencies were determined by polymerase chain reaction. RESULTSSera samples from 99 participants were tested for the levels of anti-HBs as an indicator of protection (&ge; 10 mIU/mL) following vaccination as defined by the World Health Organization international reference standard. Among the vaccinated participants, 47% (35/74) had anti-HBs titers above 100 mIU/mL, 22% (16/74) had anti-HBs ranging between 10-100 mIU/mL, and 20% (15/74) had values of less than 10 mIU/mL. We report the lack of significant association between the number of vaccine dosages and the titer of antibodies among our vaccinated participants. The inhibitory KIR2DL1, KIR2DL4, KIR3DL1, KIR3DL2, and KIR3DL were detected in more than 95%, whereas KIR2DL2, KIR2DL3, KIR2DL5 (KR2DL5A and KIR2DL5B) were expressed in 56%, 84% and 42% (25% and 29%) of participants, respectively. The observed frequency of the activating KIR genes ranged between 35% and 55% except for KIR2DS4, detected in 95% of the study participants (40.6% 2DS4*001/002; 82.2% 2DS4*003/007). KIR2DP1 pseudogene was detected in 99% of our participants, whereas KIR3DP*001/02/04 and KIR3DP1*003 had frequencies of 17% and 100%, respectively. No association between the frequency of KIR genes and anti-HBs antibodies was detected. When we compared the frequency of KIR genes between vaccinated individuals with protective antibodies titers and those who lost their protective antibody levels, we did not detect a significant difference. KIR2DL5B was significantly different among different groups of vaccinated participants (group I > 100 mIU/mL, group II 10-100 mIU/mL, group III CONCLUSIONTo our knowledge, this is the first study screening for the possible role of KIR genes among individuals vaccinated against hepatitis B virus (HBV). Our results can be used to design larger studies to better understand the role of KIR genes in protection against or susceptibility to HBV post vaccination.

Hepatitis elimination by 2030: Progress and challenges

Globally, over 300 million people are living with viral he-patitis with approximately 1.3 million deaths per year. In 2016, World Health Assembly adopted the Global Health Sector Strategy on viral hepatitis to eliminate hepatitis by 2030. Different World Health Organization member countries are working on hepatitis control strategies to achieve hepatitis elimination. So far, only 12 countries are on track to achieve hepatitis elimination targets. The aim of the study was to give an update about the progress and challenges to achieving hepatitis elimination by 2030. According to the latest data, 87% of infants had received the three doses of hepatitis B virus （HBV） vaccination in the frst year of their life and 46% of infants had received a timely birth dose of HBV vaccination.There is a strong need to improve blood and injection safety. Rates of hepatitis B and C diagnosis are very low and only 11% of hepatitis B and C cases are diagnosed. There is a dire need to speed up hepatitis diagnosis and find the missing millions of people living with viral hepatitis. Up to 2016, only 3 million hepatitis C cases have been treated. Pricing of hepatitis C virus drugs is also reduced in many countries. The major hurdle to ach-ieve hepatitis elimination is lack of finances to support hepatitis programs. None of the major global donors are committed to invest in the fght against hepatitis. It will be very diffcult for the low and middle-income countries to fund their hepatitis control program. Hepatitis elimination needs strong fnancial and political commitment, support from civil societies, and support from pharmaceutical and medical companies around the globe.

Testing for hepatitis B virus alone does not increase vaccine coverage in non-immunized persons

AIM To determine whether hepatitis B virus(HBV)-testing could serve as a gateway to vaccinate non-immunized individuals in a low-prevalent country.METHODS Non-immunized subjects participating in a multi-center, HBV-testing campaign in Paris, France were identified and contacted via telephone 3-9 mo after testing in order to determine vaccination status. Vaccination coverage was evaluated in per-protocol(for all respondents) and intent-to-treat analysis(assuming all non-responders did not vaccinate).RESULTS In total, 1215/4924(24.7%) enrolled subjects with complete HBV serology were identified as nonimmunized and eligible for analysis. There were 99/902 successfully contacted subjects who had initiated HBV vaccination after screening: per-protocol, 11.0%(95%CI: 9.0-13.2); intent-to-treat, 8.2%(95%CI: 6.7-9.8). In multivariable analysis, vaccination was more likely to be initiated in individuals originating from moderate or high HBV-endemic countries(P < 0.001), patients with limited healthcare coverage(P = 0.01) and men who have sex with men(P = 0.02). When asked about the reasons for not initiating HBV vaccination, the most frequent response was "will be vaccinated later"(33.4%), followed by "did not want to vaccinate"(29.8%), and "vaccination was not proposed by the physician"(21.5%). Sub-group analysis indicated a stark contrast in vaccination coverage across centers, ranging from 0%-56%.CONCLUSION HBV-vaccination after HBV screening was very low in this study, which appeared largely attributed to physician-patient motivation towards vaccination. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level.

Role of general practitioners in prevention and treatment of hepatitis B in China

BACKGROUND： Hepatitis B virus（HBV） infection may impose an economic burden to patients or their families. The prevention and control of HBV could effectively reduce the burden. However, the management of HBV-related patients has not been well controlled in China. With the development of general practitioner（GP） system in this country, GPs may greatly improve the management of the patients with HBV infection. However, the role of GPs in controlling HBV infection has been rarely studied.DATA SOURCES： A literature search of PubMed, CNKI,Wanfang data and VIP was performed with the following key words： ＂general practitioner＂, ＂family physician＂, ＂community management＂, ＂community health care workers＂, ＂family practice＂, ＂hepatitis B virus＂, ＂HBV＂, ＂HBV vaccination＂, ＂HBV prevention＂, ＂HBV management＂, ＂HBV treatment＂, ＂antiviral therapy＂ and ＂chronic hepatitis B（CHB）＂. The information about the GPs-involved prevention, diagnosis and treatment of CHB was reviewed.RESULTS： The reports on the role of GPs in the prevention,diagnosis and treatment of HBV infection are few. But the experiences from Western countries demonstrated that GPs could play a significant role in the management of patients withCHB. The importance of GPs is obvious although there are some difficulties in China. GPs and health officials at different levels should work together in the management of patients with CHB.CONCLUSIONS： The involvement of GPs in the management of patients with HBV infection is effective in China. But GPs＇ knowledge and skills for the control of HBV infection have to be improved currently. GPs＇ involvement will enforce the management of CHB in China in the near future.

THREE－YEAR FOLLOW－UP AFTER A SINGLE BOOSTER DOSE OF VACCINE IN THE NONRESPONDERS AND HYPORESPONDERS TO HEPATITIS B VACCINE

Immuuoresponsiveness of revacclnation in nonresponders and hyporesponders to hepatitis B vaccine was evaluated.10 nonresponders and kyporesponders as well as 18 normal responders to the primary vaccination were offered a 10μg dose or blood-derived vaccine in May 1989,three years after a 3-dose primary vaccine schedule,and were rollowed up and checked at 2,6,12 and 36 months after the booster dose.The results showed that Anti-HBs titre increased in both poor and normal responders,but the antibody level in nonresponders and hyporesponders was lower and the duration of persistence was much shorter,while the antibody GMT in normal responders remained above protective level at 36 months arter revaccination.Thererore,it is difficult to say,according to the data,that revaccination can satisfactorily boost anti-HBs level in the poor responders.

Sex bias in response to hepatitis B vaccination in end-stage renal disease patients:Meta-analysis

AIM： To systematically review the literature for studies investigating the potential effect of gender of dialysis patients on the immunogenicity of hepatitis B virus vaccines. METHODS： Literature searches were conducted by the MEDLINE and Google Scholar. The key words used included “hepatitis B （HB）”, “vaccine”, “dialysis”, “hemodialysis”, “sex”, “male” and “female”. Data of seroresponse to HB vaccine in clinical trials regarding sex of the recipients have been achieved and analyzed. Finally data from 19 clinical trials have been pooled and analyzed.RESULTS： Analysis of response to HB vaccination in our dialysis population showed males significantly res-pond less to hepatitis B vaccination （P = 0.002, Z = 3.08） with no significant heterogeneity detected [P = 0.766; heterogeneity χ2 = 14.30 （df = 19）; I2 = 0%]. A reanalysis of the pooled data was conducted regarding the dialysis mode to evaluate potential differential impact of sex on HB vaccine response. Hemodialysis was the only subgroup that showed a signifcant difference regarding dialysis mode in response to HB vaccination regarding sex （ P = 0.042, Z = 2.03）.CONCLUSION： This Meta-analysis showed significant effect for the sex of chronic kidney disease and dialysis patients on the immunogenicity of HB vaccine. This sex discrimination was most prominent among hemodialysis patients.

Advances in treatment and prevention of hepatitis B

Chronic hepatitis B(CHB)continues to contribute to worldwide morbidity and mortality significantly.Scientists,clinicians,pharmaceutical companies,and health organizations have dedicated substantial Intellectual and monetary resources to finding a cure,increasing immunization rates,and reducing the global burden of CHB.National and international health-related organizations including the center for disease control,the national institute of health,the American Association for the study of liver disease(AASLD),The European association for the study of the Liver(EASL),The Asia Pacific association for the study of the Liver(APASL)and the world health organization release periodic recommendations for disease prevention and treatment.Our review of the most recent guidelines by EASL,AASLD,APASL,and Taiwan Association for the Study of the Liver revealed that an overwhelming majority of cited studies were published before 2018.We reviewed Hepatitis B-related literature published 2018 onwards to identify recent developments and current barriers that will likely direct future efforts towards eradicating hepatitis B.The breakthrough in our understanding of the hepatitis B virus life cycle and resulting drug development is encouraging with significant room for further progress.Data from high-risk populations,most vulnerable to the devastating effects of hepatitis B infection and reactivation remain sparse.Utilization of systems approach,optimization of experimental models,identification and validation of next-generation biomarkers,and precise modulation of the human immune response will be critical for future innovation.Within the foreseeable future,new treatments will likely complement conventional therapies rather than replace them.Most Importantly,pragmatic management of CHB related population health challenges must be prioritized to produce real-world results.

Immunogenicity of recombinant hepatitis B vaccine in treatment-nave and treatment-experienced chronic hepatitis C patients: The effect of pegylated interferon plus ribavirin treatment

AIM： To retrospectively evaluate the vaccinationinduced anti-HBs seroconversion rates in treatmentnaive and treatment-experienced chronic hepatitis C （CHC） patients. Also to prospectively evaluate the seroconversion rates in CHC patients during pegylated interferon （PEG） plus ribavirin （RIB） treatment. METHODS： Seventy treatment-naive CHC patients （group A）, 22 sustained virological responders-SVR following interferon （IFN） plus RIB treatment CHC patients （group B） and 121 healthy subjects （group C） had been participated in the same HBV vaccination schedule （20 μg, 0-1-6 mo）. Seroconversion was considered if anti-HBs levels were above 10 mIU/mL within 3 mo following the third dose of the vaccine. Moreover, we prospectively selected 30 non-cirrhotic CHC patients and evaluated them for the efficacy of the same vaccine schedule randomizing them in two groups： Group-1, 15 CHC patients received the first dose of the vaccine in parallel with the initiation of PEG plus RIB treatment and Group-2, 15 patients received the same vaccination schedule without concomitant treatment. Determination of anti-HBs was performed at mo 1, 2, and 7. Statistical analysis of data was based on ANOVA student＇s t-test and chi-square analysis （P 〈 0.05）. RESULTS： Fifty-eight of 70 group A patients （82.85%）, 20/22 group B （90.9%） and 112/121 healthy subjects （92.56%） had been seroconverted. The seroconversion rates were significantly higher in the control group than in treatment-naive CHC patients （P = 0.04）. The corresponding rates were comparable between group A and group B CHC patients （P = 0.38）. The vast majority of non-responders （10/14, 71.43%） had been infected by genotype-1 of HCV. The seroconversion rates were comparable between group 1 and 2 CHC patients at mo 1 （20% versus 26.7%, P = 0.67）, mo 2 （46.7% vs 60%, P = 0.46） and mo 7 （86.7% versus 93.3%, P = 0.54） of follow-up. CONCLUSION： The immunogenicity of HBV vaccine seems to be lower in CHC patients compared to healthy subjects. SVR following IFN plus RIB treatment does not affect the antibody response to HBV vaccine. Infection by genotype-1 seems to negatively influence the seroconversion rates. Vaccination against HBV during PEG plus RIB combination treatment is not beneficial in terms of anti-HBs seroconversion rates.

Progress on global hepatitis elimination targets

In 2016,the World Health Assembly adopted a Global Health Sector Strategy on viral hepatitis,with targets set for the years 2020 and 2030 to achieve hepatitis elimination.The main target of hepatitis elimination strategy is to reduce the incidence of hepatitis B virus(HBV)and hepatitis C virus(HCV)by 90%and mortality by 65%in 2030.In last 5 years,the number of people receiving HCV treatment has increased from 1 million to 9.4 million;however,this number is far from the 2030 target of 40 million people receiving HCV treatment.HBV and HCV incidence rates are down from 1.4 million to 1.1 million annual deaths but this is far from the 2030 target of<0.5 million deaths.The coronavirus disease 2019 pandemic has severely affected the efforts in the fight against hepatitis.No major donor has committed to investing in the fight against hepatitis.Time is running out.There is a need to speed up efforts in the fight against hepatitis to achieve hepatitis elimination by 2030.

Factors affecting effectiveness of vaccination against hepatitis B virus in hemodialysis patients

Hepatitis B virus(HBV)is a major global health problem.Despite the success of the general measures against blood transmitted infections in hemodialysis(HD)units,the prevalence of HBV infection among the HD patients is still high.Thus vaccination against HBV is indicating in this population.However,compared with the general population the seroprotection achieved in HD patients remains relatively low,at about 70%.In this review patient,HD procedure and vaccine-associated factors that affect the efficacy of HBV vaccination are analyzed.Also alternative routes of HBV vaccine administration as well as new and more immunogenic vaccine formulations are discussed.However,besides scientific progress,vigilance of HD physicians and staff regarding the general measures against the transmission of blood borne infections and the vaccination against HBV is also required for reducing the prevalence of this viral infection.

INTRAMUSCULAR VERSUS INTRADERMAL HEPATITIS B REVACCINATIONIN HEALTHY NON-RESPONDER CHILDREN: A 5-YEAR PROSPECTIVE RANDOMIZED STUDY

Objective With the same times of injection to compare low-dose intradermal regimen with routine-dose intramuscular inoculation in revaccination of non-responders to hepatitis B vaccine. Methods 40 healthy non-responder children collected by screening were administrated a three-dose revaccination randomly by intramuscular or intradermal route (10vs 2g per dose), and regularly tested for serologic markers up to five years. By the end of follow-up, a booster dose (5μg) was given to those who had lost anti-HBs of ≥10mIU/mL (seroprotection) and anamnestic response was estimated thereafter. Results All 17 intramuscular and 22 of 23 intradermal children effected seroprotection after revaccination. Intradermal children lost seroprotection over time significantly rapider compared with intramuscular children (Log Rank test, P= 0.029). In year 5, 50% of intramuscular but only 18.2% of intradermal children still maintained seroprotection (P=0.075). 12-14 days after the booster dose, all the eight intramuscular children developed an anamnestic response with anti-HBs titer increasing greater, but two of the 18 intradermal children failed to mount seroprotective level. Conclusion Three-routine-dose intramuscular revaccination was significantly effective than low-dose intradermal one with the same times of injection, especially in long-term immunity. We recommend routine-dose intramuscular protocol in revaccination of non-responders.