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.

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.

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.

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.

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.

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.

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.

A Study on Long-term Efficacy and Immunologic Persistence of Hepatitis B Plasma Vaccine Made in China

In order to demonstrate the long term protective efficacy and immunologic persistence of domestically made hepatitis B plasma derived vaccine, 371 children had been followed up for 5 to 8 years after primary vaccination (10 μg×3). The results showed that the positive rate of antibody to hepatitis B surface antigen (anti HBs) in 371 subjects was 77.6% and the geometric mean titre (GMT) of anti HBs was 47.32 IU/L. The anti HBs positive rates in the subjects who had been vaccined for five, six, seven and eight years remained 83.91%, 73.68%, 81.25% and 72.24%, respectively, while the GMTs were 59.53, 43.64, 42.21 and 46.20 IU/L, respectively. The protective efficacy rate of hepatitis B vaccine was 94.26% if both HBsAg and anti HBc were considered as infective indicators, and 88.28%, if only HBsAg positive cases were taken into account. The study indicated that the domestically made hepatitis B vaccine could provide at least 5 to 8 years protection against hepatitis B infection.

SIX-YEAR EFFICACY OF HEPATITIS B REVACCINATION:A DOUBLE-BLIND,PLACEBO-CONTROLLED AND RANDOMIZED FIELD TRIAL

in order to observe the efficacy or a booster dose of hepatitis B vaccine, ic4 primaryschool children with a good response were enrolled in a double-bind, placebo-controlled and randomized field trial three years after the primary vaccination. At the end of the 6-year follow-up anti-HBspositive rate and GMT (of S/N value) In the revaccinated group were 54. 5% and 12. 0. still higherthan those in the control group (40. 5 % & 4. 8), but the difference of the positive rates was not statistically significant this time. Anti-HBs I,osltlve rate and GMT not only in the control group but inthe revaccinated group had dramatically declined against those 3 years arter the revaccination (thecontrol group: 69. 4 % & 20. 6 1 the revaccinated group: 87' 8% & 43. 3) (P < 0. of ). The higher anti-HBs titer before the revaccination, the better the persistence of anti-HBs after the revaccination.HBV infection rate (calculated by person-year) In the revacclnated group was l' 44%, without statistical difference from 3. 19% In the control group (P > 0. 05) as before. Considering the perfect longterm efficacy of hepatitis B vaccine, we concluded that a booster dose 9 years arter the primary immunization seems unnecessary.

ASSOCIATION OF GENETIC BACKGROUND WITH NON-ANDHYPORESPONSIVENESS TO HEPATITIS B VACCINE

HBV infection data of so first degree relatives from hepatitis B vaccine nonresponderand hyporesponder families stere compared 'vith those of 79 first degree relatives from high responder families. For further observation of their antibody response. those without the vaccination lwfore, and negative for HBsAg, anti-HBs and anti-HBc, or 'vith isolated ic'v anti-HBs (S/N M 10 )were given three 10 ig doses of hepatitis B vaccine at 0, 1 .6 months. The results Showed that. in thefirst degree relatives of nonresponders and hyporesponders, anti-HBs seroconversion rate and GMTwere lower (P > 0. 05), and the distribution or detected anti-HBs levels was significantly differentfrom that of the rirst degree relatives or high respondrs. In addition, before the vaccination. theHBV infection rate or the former was remarkably higher (33. 75% VS 15. 19% ), and the antibodyGMT of those positive ror anti-HBs was significantly ic'ver. This finding suggested that genetic background may play an important role in the n on -a nd-typo res ponsi yeness to hepat it is B vacc me.

Seroprevalence of anti-HBs antibodies and the need for booster vaccination in children under 5 years of age born to HBsAg-negative mothers

Objective:To determine the proportion of HBV surface antigen(anti-HBs)antibody positive children under five years of age born to HBs Ag-negative mothers and to analyze the possible related factors following implementation of a hepatitis B vaccination program for infants in Indonesia 22 years ago.Methods:Blood samples were taken from children under five years of age born to HBsAg-negative mothers who have completed primary vaccination series.Anti-HBs antibodies were determined by using rapid test.Data of age,gender,nutritional status,vaccination timing or vaccination compliance,and booster vaccination were collected from vaccination card.Results:Ninety children were enrolled,consisting of 47 females and 43 males with a mean age of 2.3 years.Twenty two(24.4%)children received booster vaccine between 18 and 24 months and 55(61.1%)were anti-HBs positive.Among factors of age,gender,nutritional status,compliance to vaccination and booster vaccine,only administration of booster vaccine was significantly associated with anti-HBs status(OR 5.45,95%CI 1.45,20.52).Children who received booster vaccine at age of 18-24 months were 5.45 times more likely to be anti-HBs positive than that of children who did not receive booster vaccine.Conclusions:Booster vaccine rate is low among children under 5 years of age but is associated with anti-HBs positivity.Booster vaccination may be required to improve anti-HBs seropositivity.

Vaginal Delivery and Breastfeeding Benefit Infant Immune Response to Hepatitis B Vaccine:A Prospective Cohort Study

Background and Aims:Natural vaginal delivery and breastfeeding favor the development of a strong immune system in infants,and the immune response of infants to vaccines is closely related to their immune system.This large prospective cohort study aimed to explore the effects of delivery and feeding mode on infant’s immune response to hepatitis B vaccine(HepB).Methods:A total of 1,254 infants who completed the whole course of HepB immunization and whose parents were both HBsAg negative were enrolled from infants born in Jinchang City during 2018-2019 by cluster sampling method.Results:Twenty(1.59%)of the 1,254 infants were nonresponders to HepB.Among the other 1,234 infants,10.05%(124/1,234),81.69%(1,008/1,234)and 8.27%(102/1,234)of infants had low,medium,and high responses to HepB,respectively.Logistic regression analysis showed that cesarean section(OR:8.58,95%CI:3.11-23.65,p<0.001)and birth weight<3.18 kg(OR:5.58,95%CI:1.89-16.51,p=0.002)were independent risk factors for infant nonresponse to HepB,and cesarean section(OR:7.63,95%CI:4.64-12.56,p<0.001),formula feeding(OR:4.91,95%CI:1.47-16.45,p=0.001),maternal antiHBs negativity(OR:27.2,95%CI:10.67-69.35,p<0.001),paternal non-response history of HepB(OR:7.86,95%CI:2.22-27.82,p=0.014)and birth weight<3.22 kg(OR:4.00,95%CI:2.43-6.59,p<0.001)were independent risk factors for infant low response to HepB.In cases where birth weight and genetic factors are unmodifiable and maternal anti-HBs effects are controversial,it makes sense to enhance infant response by changing delivery and feeding patterns.Conclusions:Natural vaginal delivery and breastfeeding are beneficial to the infant’s immune response to HepB.

Field epidemiological and experimental study on relationship between genetic factor and nonresponse or hyporesponse to hepatitis B vaccine

Objective To evaluate the role of genetic factor in the development of nonresponder or hyporesponder to hepatitis B vaccine in Chinese people from field epidemiology and experimental study Methods Six hundred and thirty four susceptible healthy students were vaccinated with three doses of plasma derived hepatitis B vaccine Twenty nine non or hypo responders (subjects) and 30 hyperresponders (controls) as well as their 80 and 79 first degree relatives were determined and recruited in the study The first degree relatives of subjects and controls were then immunized with hepatitis B vaccine and followed up On the basis of the above results, alleles of HLA A,B,C,DR and DQ locus were further detected in the two groups Results The non and hypo response rate in immunized students was 4 6% (29/634) After administered with hepatitis B vaccine, the first degree relatives of the subjects displayed a 17 9% frequency of nonresponsiveness, higher than in the controls The phenotype frequency of HLA DR7 and B54 was 52 2% and 21 7% in subjects, 9 1% and 0 0% higher than in controls, respectively The extended haplotype B54 DR7 was more frequent in the former (17 0%) than in the latter (0 0%) ( P <0 01) Conclusion These results demonstrated that the genetic factor was likely associated with the non and hypo response to hepatitis B vaccine in Chinese people

Protective Effect of Neonatal Hepatitis B Vaccine Against HBV Breakthrough Infection in Children with Leukemia:A Real-world Study

Background and Aims:Hepatitis B vaccine is the most effective preventive measure against hepatitis B virus(HBV)infection.However,the risk of HBV breakthrough infection in fully immunized children(neonatal hepatitis B immunization)who receive immunosuppressive therapy and transfusion of blood components is not well characterized.In this real-world study,we aimed to investigate the immune protection conferred by neonatal hepatitis B vaccine in children with acute lymphoblastic leukemia(ALL)who were treated with immunosuppressive therapy and blood component transfusions.Methods:Children with ALL who had received all three doses of neonatal hepatitis B vaccine were included in this study.HBV seromarkers were detected before and after the initiation of immunosuppressive therapy.Results:A total of 1,011 children with ALL who were fully vaccinated against hepatitis B in infancy before the initiation of immunosuppressive therapy were eligible for inclusion.HBV infection was detected in four of 410 children(0.98%)with an HBsAg test after the initiation of immunosuppressive therapy.The median interval from treatment initiation was 19 months.Conclusions:Three doses of neonatal hepatitis B vaccine conferred adequate protection.In endemic regions,there is a low risk of HBV breakthrough infection in fully immunized children with immunosuppressive therapy.