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Brazilian hepatitis B vaccine: a six-year follow-up in adolescents

Alexandre,Kamilla Vêncio Frauzino; Martins,Regina Maria Bringel; Souza,Márcia Maria de; Rodrigues,Isolina Maria Xavier; Teles,Sheila Araujo
Fonte: Instituto Oswaldo Cruz, Ministério da Saúde Publicador: Instituto Oswaldo Cruz, Ministério da Saúde
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2012 Português
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The protective anti-HBs titres were examined six-year post-immunisation with the Brazilian recombinant hepatitis B vaccine. After the primary vaccination, all adolescents (n = 89) responded with protective anti-HBs titres and had a geometric mean titre (GMT) of 4031.8 mIU/mL. In 2010, 94.5% maintained protective anti-HBs (> 10 mIU/mL) antibodies, with a GMT of 236.0 mIU/mL. A positive correlation was observed between the anti-HBs titres after the primary vaccination and the titres at the six-year follow-up (p < 0.01). Eleven subjects showed anti-HBs titres suggestive of a natural booster. Prostitution and tattoos/piercings were marginally associated with natural boosters in the multivariate analysis. This study showed the first data on anti-HBs persistence following the Brazilian hepatitis B vaccine in sexually active individuals and highlights its effectiveness in the medium term.

Occult hepatitis B virus infection in liver transplant patients in a Brazilian referral center

Ferrari,T.C.A.; Xavier,M.A.P.; Vidigal,P.V.T.; Amaral,N.S.; Diniz,P.A.; Resende,A.P.; Miranda,D.M.; Faria,A.C.; Lima,A.S.; Faria,L.C.
Fonte: Associação Brasileira de Divulgação Científica Publicador: Associação Brasileira de Divulgação Científica
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/11/2014 Português
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Estimates of occult hepatitis B virus (HBV) infection prevalence varies among different studies depending on the prevalence of HBV infection in the study population and on the sensitivity of the assay used to detect HBV DNA. We investigated the prevalence of occult HBV infection in cirrhotic patients undergoing liver transplantation in a Brazilian referral center. Frozen liver samples from 68 adults were analyzed using a nested polymerase chain reaction assay for HBV DNA. The specificity of the amplified HBV sequences was confirmed by direct sequencing of the amplicons. The patient population comprised 49 (72.1%) males and 19 (27.9%) females with a median age of 53 years (range=18-67 years). Occult HBV infection was diagnosed in three (4.4%) patients. The etiologies of the underlying chronic liver disease in these cases were alcohol abuse, HBV infection, and cryptogenic cirrhosis. Two of the patients with cryptic HBV infection also presented hepatocellular carcinoma. Markers of previous HBV infection were available in two patients with occult HBV infection and were negative in both. In conclusion, using a sensitive nested polymerase chain reaction assay to detect HBV DNA in frozen liver tissue, we found a low prevalence of occult HBV infection in cirrhotic patients undergoing liver transplant...

Accidents with biological material and immunization against hepatitis B among students from the health area

Gir,Elucir; Netto,Jeniffer Caffer; Malaguti,Silmara Elaine; Canini,Silvia Rita Marin da Silva; Hayashida,Miyeko; Machado,Alcyone Artioli
Fonte: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Publicador: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2008 Português
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Undergraduate students from the health area often handle piercing-cutting instruments in their academic activities, which exposes them to the risk of contracting infections. This study aimed to analyze accidents with biological material among these students. Out of 170 accidents registered, 83 (48.8%) occurred with Dentistry students, 69 (40.6%) with Medical students, 11 (6.5%) with Nursing students and in 06 (3.5%) of the cases there was no such information in the files. Most accidents, 106 (62.4%), occurred with students from private schools and 55 (32.3%) with those from public schools. Percutaneous accidents occurred in 133 (78.2%) exposures and there was immediate search for specialized health care in only 38 (21.3%) accidents. In 127 (74.7%) accidents, the immunization schedule against hepatitis B was complete. Therefore, schools need to offer courses and specific class subjects regarding biosafety measures, including aspects related to immunization, especially the vaccine against hepatitis B.

Role of hyaluronic acid and laminin as serum markers for predicting significant fibrosis in patients with chronic hepatitis B

Li,Feng; Zhu,Chang-Lai; Zhang,Hong; Huang,Hua; Wei,Qun; Zhu,Xiang; Cheng,Xiao-Yang
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2012 Português
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OBJECTIVES: The aim of this study was to evaluate the diagnostic performance of serum HA and LN as serum markers for predicting significant fibrosis in CHB patients. METHODS: Serum HA and LN levels of 87 patients with chronic hepatitis B and 19 blood donors were assayed by RIA. Liver fibrosis stages were determined according to the Metavir scoring-system. The diagnostic performances of all indexes were evaluated by the receiver operating characteristic (ROC) curves. RESULTS: Serum HA and LN concentrations increased significantly with the stage of hepatic fibrosis, which showed positive correlation with the stages of liver fibrosis (HA: r = 0.875, p < 0.001; LN: r = 0.610, p < 0.001). There were significant differences of serum HA and LN levels between F2-4 group in comparison with those in F0-F1 group (p < 0.001) and controls (p < 0.001), respectively. From ROC curves, 185.3 ng/mL as the optimal cut-off value of serum HA for diagnosis of significant fibrosis, giving its sensitivity, specificity, PPV, NPV, LR+, LR- and AC of 84.2%, 83.3%, 90.6%, 73.5%, 5.04, 0.19 and 83.9, respectively. While 132.7 ng/mL was the optimal cut-off value of serum LN, the sensitivity, specificity, PPV, NPV, LR+, LR- and AC were 71.9%, 80.0%, 87.2%, 60.0%...

YMDD motif mutations in chronic hepatitis B antiviral treatment naïve patients: a multi-center study

Tan,You-Wen; Ge,Guo-Hong; Zhao,Wei; Gan,Jian-He; Zhao,Yun; Niu,Zhi-Lin; Zhang,Dong-Jun; Chen,Li; Yu,Xue- Jun; Yang,Li-Jun
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2012 Português
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OBJECTIVE: This study aimed to determine the natural prevalence of variants of tyrosine-methionine-aspartic acid-aspartic acid (YMDD) motif in patients with chronic hepatitis B (CHB), and to explore its relation with demographic and clinical features, hepatitis B virus (HBV) genotypes, and HBV DNA levels. METHODS: A total of 1,042 antiviral treatment naïve CHB patients (including with lamivudine [LAM]) in the past year were recruited from outpatient and inpatient departments of six centers from December 2008 to June 2010. YMDD variants were analyzed using the HBV drug resistance line probe assay (Inno-Lipa HBV-DR). HBV genotypes were detected with polymerase chain reaction (PCR) microcosmic nucleic acid cross-ELISA, and HBV deoxyribonucleic acid (DNA) was quantitated with real-time PCR. All serum samples underwent tests for HBV, HCV, and HDV with ELISA. RESULTS: YMDD variants were detected in 23.3% (243/1042) of CHB patients. YMDD mutation was accompanied by L180M mutation in 154 (76.9%) patients. Both wild-type HBV and YMDD variant HBV were present in 231 of 243 patients. Interestingly, 12 patients had only YIDD and/or YVDD variants without wild YMDD motif. In addition, 27.2% (98/359) of HbeAg-positive patients had YMDD mutations...

Response to the complete hepatitis B vaccine regimen in infants under 12 months of age: a case series

Miralha,Alexandre Lopes; Malheiro,Adriana; Miranda,Angélica Espinosa; Rutherford,George Williams; Alecrim,Maria das Graças Costa
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2013 Português
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OBJECTIVES: Describing rates of seroconversion and its associated factors in a series of Brazilian infants following the final dose of the vaccine at 6 months of age. METHODS: Peripheral blood samples were collected after the third dose of the vaccine for the detection of anti-hepatitis B surface antibodies among infants of 7-12 months of age. We measured the association between seroconversion and birthweight, gestational age, time since administration of the vaccine in the maternity hospital and whether or not testing for hepatitis B surface antigen had been performed during pregnancy. RESULTS: We examined 40 infants. The mean birthweight was 2787 g (standard deviation = 853 g) and mean gestational age was 37.5 (standard deviation = 3.08) weeks. The proportion that seroconverted was non-significantly higher in infants who weighed >2000 g at birth (96.7%) than in those with birthweights <2000 g (80%, p = 0.149). There was no difference between the infants who were born at <37 weeks of gestational age and those born at >37 weeks (p < 0.178) neither between seroconversion and the time of application of the first dose of the vaccine after delivery (p = 0.202). CONCLUSION: The proportion of infants who seroconverted was similar to that found in other Brazilian studies. There were no differences in the proportion seroconverting by age at first immunization.

Prevalence of the precore G1896A mutation in Chinese patients with e antigen negative hepatitis B virus infection and its relationship to pre-S1 antigen

Zhang,Jing; Xu,Wei-Jia; Wang,Qing; Zhang,Yong; Shi,Ming
Fonte: Sociedade Brasileira de Microbiologia Publicador: Sociedade Brasileira de Microbiologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2009 Português
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This study investigated the prevalence of the precore G1896A mutation in Chinese patients with hepatitis B e antigen (HBeAg) negative HBV infection and its relation to serum HBV pre-S1 antigen. The overall prevalence of the precore G1896A mutation was 72.6% in HBeAg-negative Chinese patients with detectable serum HBV DNA. The prevalence of the precore G1896A is significantly higher in Chinese HBeAg-negative patients with chronic hepatitis B than that in inactive HBV carriers with detectable serum HBV DNA. Serum pre-S1 and the precore G1896A mutation were simultaneously detected in most of Chinese HBeAg-negative patients.

A large population study of spontaneous HBeAg seroconversion and acute exacerbation of chronic hepatitis B infection: implications for antiviral therapy

Yuen, M-F; Yuan, H-J; Hui, C-K; Wong, D K-H; Wong, W-M; Chan, A O-O; Wong, B C-Y; Lai, C-L
Fonte: Copyright 2003 by Gut Publicador: Copyright 2003 by Gut
Tipo: Artigo de Revista Científica
Publicado em /03/2003 Português
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Background and aim: Clinical data on spontaneous hepatitis B e antigen (HBeAg) seroconversion and acute exacerbation of chronic hepatitis B (CHB) virus infection from large population studies are lacking. In the present study we examined the clinical features and significance of HBeAg seroconversion and acute exacerbation in 3063 Chinese CHB patients.

Flares in chronic hepatitis B patients induced by the host or the virus? Relation to treatment response during Peg-interferon α-2b therapy

Flink, H J; Sprengers, D; Hansen, B E; van Zonneveld, M; de Man, R A; Schalm, S W; Janssen, H L A;
Fonte: Copyright 2005 by Gut Publicador: Copyright 2005 by Gut
Tipo: Artigo de Revista Científica
Publicado em /11/2005 Português
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Background and aims: Flares are a well known phenomenon during antiviral treatment for chronic hepatitis B. Little is known about the effect of flares on response. We investigated the timing and characteristics of flares, in relation to treatment response (hepatitis B e antigen loss).

Optimal Management of the Hepatitis B Patient Who Desires Pregnancy or Is Pregnant

Bzowej, Natalie H.
Fonte: Current Science Inc. Publicador: Current Science Inc.
Tipo: Artigo de Revista Científica
Português
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Women of childbearing age with recognized hepatitis B infection should have their liver disease assessed before pregnancy occurs since the management of hepatitis B virus (HBV) infection in this setting is complex. Initiation of treatment in a woman of child-bearing age will depend on when she intends on conceiving, as well as the severity of her liver disease. During pregnancy, all decisions about initiating, continuing or stopping HBV therapy must include an analysis of the risks and benefits for both mother and fetus. The trimester of the pregnancy and the stage of the mother’s liver disease are important factors. Treatment in the third trimester may be considered to aid in prevention of perinatal transmission, which appears to be most pronounced in mothers with high viral loads. Consideration of initiation of third trimester treatment should occur after a high viral load is documented in the latter part of the second trimester, to allow adequate time for initiation of antiviral therapy with significant viral suppression before delivery. This discussion should include the topic of breastfeeding, since it is generally not recommended while on antiviral therapy. Until recently lamivudine and tenofovir appeared to be the therapeutic options with the most reasonable safety data in pregnancy. There are emerging data that telbivudine may also be considered in this setting.

A duck hepatitis B virus strain with a knockout mutation in the putative X ORF shows similar infectivity and in vivo growth characteristics to wild-type virus

Meier, P.; Scougall, C.; Will, H.; Burrell, C.; Jilbert, A.
Fonte: Academic Press Inc Publicador: Academic Press Inc
Tipo: Artigo de Revista Científica
Publicado em //2003 Português
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Hepadnaviruses including human hepatitis B virus (HBV) and duck hepatitis B virus (DHBV) express X proteins, HBx and DHBx, respectively. Both HBx and DHBx are transcriptional activators and modulate cellular signaling in in vitro assays. To test whether the DHBx protein plays a role in virus infection, we compared the in vivo infectivity and growth characteristics of a DHBV3 strain with a stop codon in the X-like ORF (DHBV3-X-K.O.) to those of the wild-type DHBV3 strain. Here we report that the two strains showed no significant difference in (i) their ability to induce infection that resulted in stable viraemia measured by serum surface antigen (DHBsAg) and DHBV DNA, and detection of viral proteins and replicative DNA intermediates in the liver; (ii) the rate of spread of infection in liver and extrahepatic sites after low-dose virus inoculation; and (iii) the ability to produce transient or persistent infection under balanced age/dose conditions designed to detect small differences between the strains. Thus, none of the infection parameters assayed were detectably affected by the X-ORF knockout mutation, raising the question whether DHBx expression plays a physiological role during in vivo infection with wild-type DHBV.; http://www.elsevier.com/wps/find/journaldescription.cws_home/622952/description#description; Copyright © 2003 Elsevier Inc

Hepatitis B virus binding to leucocyte plasma membranes utilizes a different region of the preS1 domain to the hepatocyte receptor binding site and does not require receptors for opsonins.

Atkins, G.; Qiao, M.; Coombe, D.; Gowans, E.; Ashman, L.
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Artigo de Revista Científica
Publicado em //1997 Português
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A quantitative assay of hepatitis B virus (HBV) binding to hepatocyte plasma membranes was adapted to show that leucocyte plasma membranes bind serum-derived HBV saturably, and that this binding is inhibited using synthetic peptides representative of the large envelope protein of HBV. Using a panel of ligand-blocking monoclonal antibodies (mAb) to opsonin receptors, it was shown that the three classes of Fc gamma R and CR3 are not major receptors for HBV on leucocytes or hepatocytes. It was also shown that HBV does not utilize the receptor for IgA, Fc alpha R, for attachment to leucocytes, despite reported sequence homology between the large envelope protein of HBV and the Fc portion of human IgA. Evidence is presented that the receptor for HBV on leucocytes may differ from the hepatocyte receptor(s), based on synthetic peptide inhibition assays of HBV binding. Furthermore, it was observed that glycosaminoglycans influence the HBV-liver and leucocyte interactions, providing evidence that HBV attachment may be a multi-stage process.

Characterisation of duck lymphoid all populations and their role in immunity to duck hepatitis B virus / Edward M. Bertram.

Bertram, Edward M.
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado Formato: 345072 bytes; application/pdf
Publicado em //1997 Português
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The research in this thesis describes the development and use of assays to detect cellular immune responses in ducks with application to duck hepatitis B virus (DHBV) infections. This animal model is used to provide an additional area of research which complements the study of hepadnaviruses. The introduction contains an outline of the significance of hepadnavirus research, including hepatitis B virus (HBV) epidemiology, structure, replication and clinical manifestations of the diseases caused by the virus.; Thesis (Ph.D.)--University of Adelaide, Dept. of Microbiology and Immunology, 1997; Bibliography: leaves 184-218.; xx, 218, [135] leaves, [15] leaves of plates : ill. (chiefly col.) ; 30 cm.; Title page, contents and abstract only. The complete thesis in print form is available from the University Library.

Ion-exchange chromatography of hepatitis B virus surface antigen from a recombinant Chinese hamster ovary cell line

Zhou, W.; Bi, J.; Janson, J.; Dong, A.; Li, Y.; Zhang, Y.; Huang, Y.; Su, Z.
Fonte: Elsevier Science BV Publicador: Elsevier Science BV
Tipo: Artigo de Revista Científica
Publicado em //2005 Português
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About 10% of the Chinese population are chronic carriers of hepatitis B virus (HBV). Thus, the development of a highly efficient process for the preparation of a vaccine based on a recombinant hepatitis B surface antigen (HBsAg) is very important to the Chinese national immunization program. To this end, the ion exchange chromatography recovery of CHO-HBsAg from a recombinant Chinese hamster ovary cell line was shown to increase from about 55 to 80% by the addition of 1% poly(ethylene glycol) (PEG 10,000) to the mobile phase. Furthermore, based on analysis by sodium dodecyl sulphate–polyacrylamide gel electrophoresis (SDS-PAGE), the intact glycoprotein form of CHO-HBsAg was completely preserved by the addition of PEG. In the absence of PEG the glycoprotein form of CHO-HBsAg was also spread out into the high salt elution fraction. High-performance size-exclusion chromatography with on-line multiangle-laser-light scattering (HPSEC-MALLS) analysis was performed to monitor the status of the CHO-HBsAg aggregate structure assembly, particle size and molecular weight distribution after each purification step, and the results showed further that the presence of PEG facilitated the separation and recovery of intact glycoprotein form of CHO-HBsAg and promoted their assembly to proper virus-like particles...

The persistence in the liver of residual duck hepatitis B virus covalently closed circular DNA is not dependent upon new viral DNA synthesis

Reaiche-Miller, G.; Le Mire, M.; Mason, W.; Jilbert, A.
Fonte: Academic Press Inc Publicador: Academic Press Inc
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
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Residual hepatitis B virus (HBV) DNA can be detected following the resolution of acute HBV infection. Our previous work using duck hepatitis B virus (DHBV) infected ducks, indicated that ~80% of residual DHBV DNA in the liver is in the covalently closed circular DNA (cccDNA) form, suggesting that viral DNA synthesis is suppressed. The current study asked more directly if maintenance of residual DHBV cccDNA is dependent upon ongoing viral DNA synthesis. Ducks that recovered from acute DHBV infection were divided into 2 groups and treated with the antiviral drug, Entecavir (ETV), or placebo. No major differences in the stability of cccDNA or levels of residual cccDNA were observed in liver biopsy tissues taken 95 days apart from ETV treated and placebo control ducks. The data suggest that residual DHBV cccDNA is highly stable and present in a cell population with a rate of turnover similar to normal, uninfected hepatocytes.; http://www.elsevier.com/wps/find/journaldescription.cws_home/622952/description#description; Georget Y. Reaiche, Marc F. Le Mire, William S. Mason, Allison R. Jilbert

Cost-effectiveness of universal hepatitis B virus screening in patients beginning chemotherapy for solid tumors

Day, F.; Karnon, J.; Rischin, D.
Fonte: Amer Soc Clinical Oncology Publicador: Amer Soc Clinical Oncology
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
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Purpose: Universal screening for chronic hepatitis B virus (HBV) infection before chemotherapy has been recommended. We evaluated the cost-effectiveness of HBV screening before chemotherapy given for nonhematopoietic solid tumors (STs). Methods: A decision-analytic model was used to compare the cost-effectiveness of universal screening conducted per professional guidelines versus no screening in hypothetical patient cohorts beginning adjuvant chemotherapy for early breast cancer or palliative chemotherapy for advanced non–small-cell lung cancer. Survival times were extrapolated using Markov models. Probabilities were derived from published studies and costs estimated from the perspective of the Australian health care system. One-way and probabilistic sensitivity analyses were performed, including with the application of an alternative HBV screening strategy. Results: Using an incremental cost-effectiveness ratio threshold of $50,000 (Australian dollars) per life-year (LY) saved, universal HBV screening was not cost-effective for adjuvant patients ($88,224/LY, 13% probability of being cost-effective), palliative patients ($1,344,251/LY, 0%), or pooled (all) patients ($149,857/LY, 1%). Sensitivity analyses found that screening approached cost-effectiveness among adjuvant patients with the highest reported rates of undiagnosed chronic HBV (65%...

Development and assessment of novel vaccination strategies for hepatitis B virus infection.

Teoh, Devin
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2014 Português
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The current hepatitis B virus (HBV) vaccine is of no benefit in the treatment of patients with chronic HBV infection, and current antiviral therapies which inhibit the virus polymerase are not highly effective. The ultimate aim of this Ph.D. project was to develop and assess therapeutic vaccination strategies that induce immune responses that target virus infected hepatocytes and allow successful control of chronic HBV infection. To this end, a number of vaccination strategies were tested using the duck hepatitis B virus (DHBV) model. The DHBV model provides a versatile and reproducible experimental system for testing vaccination strategies as the outcomes of DHBV infection in ducks of different ages infected with different doses of virus have been well characterised. In initial studies described in Chapter 3, recombinant DHBV core antigen (rDHBcAg) expressed in E. coli, was purified and used to immunise rabbits and mice to produce specific polyclonal and monoclonal antibodies for the detection of DHBV core antigen (DHBcAg). Immuno-staining techniques using these anti-DHBcAg-specific antibodies were then optimised. Immunoperoxidase detection of DHBcAg in duck liver sections was an essential part of this analysis as it allowed comparison with detection of DHBV surface antigen (DHBsAg) and confirmation of the percentage of DHBV-infected hepatocytes. Western Blot and immunofluorescent detection of DHBcAg were also developed and optimised and then all 3 immuno-staining techniques were used in subsequent Chapters to assess the efficacy of the different vaccination strategies. As described in Chapter 4...

Hepatitis B virus infection in children

O'Gorman, Clodagh S; O'Connell, K; Broderick, A.M.; Butler, K.M.
Fonte: Irish Medical Organization Publicador: Irish Medical Organization
Tipo: info:eu-repo/semantics/article; all_ul_research; ul_published_reviewed
Português
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peer-reviewed; Recent increases in Hepatitis B virus (HBV) infection prompted us to characterize HBV-infected children in Ireland and to audit management, by reviewing prospectively gathered data. Of 46 children (29 [63%] male), median age at presentation was 8.1 years (range 0.6â 17.6), monitoring duration was 22.5 months (range 1-101), 23/46 (50%) were European (including 9 [19.6%] Irish), 15 (32.6%) African and 9 (19.6%) Asian. Acquisition was vertical (25/46 [54.3%]), horizontal (5/46 [10.9%]), unknown (16/46 [34.8%]). HBV-DNA was >100,000,000 cpm in 20/32 (62.5%) with chronic infection. Hepatitis B e antigen (HBeAg) was detected in 32/44 (72.7%). We estimate that universal neonatal vaccination (UNV-HBV) could have prevented 22% of cases, and could limit further horizontal HBV spread. This supports the recent introduction of UNV-HBV.

Seroconvertion to hepatitis B vaccine after weight reduction in obese non-responder

Dinelli,Maria Isabel Saraiva; Moraes-Pinto,Maria Isabel de
Fonte: Instituto de Medicina Tropical Publicador: Instituto de Medicina Tropical
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2008 Português
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Decreased responses to hepatitis B vaccine have been associated with some host conditions including obesity. Susceptible non-responders to a primary three-dose vaccine series should be revaccinated. Those who maintain a non-responder condition after revaccination with three vaccine doses are unlikely to develop protection using more doses. This is a description of an obese woman who received six doses of hepatitis B vaccine and persisted as a non-responder. She was submitted to a vertical banded gastroplasty Roux-en-Y gastric bypass Capellas's technique. After weight reduction, she received three additional doses of vaccine and seroconverted. Further studies should help clarify the need to evaluate antibody levels and eventually revaccinate the increasing population of individuals who undergo weight reduction.

Cost-effectiveness of entecavir versus lamivudine for the suppression of viral replication in chronic hepatitis B Patients in Brazil

Costa,Anna Maria N.; L.'Italien,Gilbert; Nita,Marcelo Eidi; Araujo,Evaldo Stanislau A.
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2008 Português
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Hepatitis B virus infection is an important public-health issue. Chronic patients have a higher risk of death due to complications, which increases health-care expenses in. Cost-effectiveness analysis of entecavir (ETV) versus lamivudine (LVD) for treatment of chronic hepatitis B, in e antigen (AgHBe)-positive and negative patients, based on two phase 3, controlled and randomized studies. A decision analysis model was developed, using the following endpoints: cost per patient with undetectable viral load and cost per quality life year (QALY) gained. Risks for complications (compensated or decompensated cirrhosis and hepatocellular carcinoma) were based on the cohort study REVEAL, published in 2006. The REVEAL parameters were applied to the results of the viral load levels obtained from the clinical assay data. The complication costs were based on a study of the disease cost conducted in Brazil, in 2005. The cost data were obtained predominantly from Sistema Único de Saúde [SUS - Brazilian public health system] payment tables and drug price lists. The utility data were obtained from literature and life expectancy information was based on IBGE data. The analysis perspective was that of SUS. A discount rate of 3% per year was used. For the horizon of time of 10 years...