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      Prevalence of Hepatitis B Virus Seromarkers in Young Adults Vaccinated at Birth; Impact on the Epidemiology of Hepatitis B Infection in Iran

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          Abstract

          Background:

          The epidemiological impact and the duration of protection provided by infant hepatitis B (HB) vaccination are unknown.

          Objectives:

          This study was designed to determine the hepatitis B virus (HBV) infection seromarkers in young adults who have been vaccinated against HBV as the first group of Iranian neonates during 1993 and 1994.

          Patients and Methods:

          We recruited 510 young adults with a history of complete HB vaccination at birth. HBV seromarkers (HB surface antigen (HBs Ag), antibody against HBs Ag (Anti-HBs), and antibody against HB core antigen (Anti-HBc) were measured using ELISA method. Anti-HBs titers ≥ 10 IU/L were considered protective and titers more than 300 IU/L were indicative of a natural boosting. Positive results for Anti-HBc and HBs Ag were considered as breakthrough infection and possible vaccine failure, respectively. The history of acute symptomatic clinical hepatitis was also investigated.

          Results:

          Anti-HBs seropositivity rate was detected in 224 of 510 [95% CI: 39-47] young adults. Breakthrough infection (positive sera for Anti-HBc without chronic infection) was observed in 18 [95% CI: 2.5-3.5] subjects. There were neither HBs Ag positive results nor symptomatic hepatitis cases.

          Conclusions:

          The study results indicated that the neonatal HBV immunization induced a long-term protection against HBV and was very efficacious in reducing chronic HBV infection rate in vaccinated young adults in Iran.

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          Most cited references 44

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          The changing epidemiology of viral hepatitis B in Iran.

          Hepatitis B virus (HBV) prevalence has decreased dramatically in Iranian population during the last decade, and now our country is classified as having low endemicity for hepatitis B infection. Improvement of the people's knowledge about HBV risk factors, national vaccination program since 1993 for all neonates, and vaccination of high risk groups might justify this decrease. The HBV vaccination started in infants in two provinces (Zanjan and Semnan) in 1989, and in 1993 the vaccination was included in the Expanded Program on Immunization (EPI) countrywide. After 13 years of implementation, the coverage has reached an appropriate level from 62% in 1993 to 94% in 2005. Evaluation of risk factors in HBV infected people is important for designing the strategies to control the disease. Intensifying HB vaccination of high risk groups, surveillance of hepatitis B infected subjects, and control on health state of refugees will further decrease the frequency of the disease in our country. Considering all possible routes of transmission in subjects without risk factors for infection is necessary. Changes in the pattern of transmission of new cases of hepatitis B, inform us of changes in the epidemiology of viral hepatitis B infection.
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            Risks of chronicity following acute hepatitis B virus infection: a review.

             K C Hyams (1995)
            A bibliographic search was conducted of English-language articles dealing with chronic hepatitis B virus (HBV) infection to evaluate the risk of chronicity following acute infection. Chronic HBV infection was defined as carriage of hepatitis B surface antigen (HBsAg) for at least 6 months. On the basis of incidence studies employing standard serological test methods, the highest risk (80%-90%) of chronic infection was found to be among infected neonates born to hepatitis B e antigen-positive carrier mothers. Of children infected before 6 years of age, chronic infection was reported to develop in approximately 30%. A relatively wide range of risks (< 1%-12%) was found among diverse populations of older children and adults. However, most of the 10 identified incidence studies of generally healthy adults indicated that the risk of chronicity is very low: < or = 5% in eight studies. In addition, the pooled incidence of chronicity was < 5% among two different adult population groups: initially uninfected subjects, who usually experienced asymptomatic infection, and patients presenting with acute hepatitis B. In addition to the primary influence of age, the studies revealed a higher risk of chronic HBV infection among males and among patients with impaired immunity due to various causes.
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              The global impact of vaccination against hepatitis B: a historical overview.

              Hepatitis B virus (HBV) infection is a world wide public health problem of major concern. HBV infection may lead to chronic liver disease, including cirrhosis and hepatocellular carcinoma (HCC). Vaccination is the most effective measure to control and prevent hepatitis B and its long-term serious sequelae on global scale, both in terms of cost-effectiveness and benefit-cost ratios. According to the WHO recommendations, universal vaccination has been currently implemented in 168 countries world wide with an outstanding record of safety and efficacy. The effective implementation of such programmes of vaccination has resulted in a substantial decrease in disease burden, in the carrier rate and in hepatitis B-related morbidity and mortality. A future challenge is to overcome the social and economic hurdles which still hamper the introduction of hepatitis B vaccination on a global scale.
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                Author and article information

                Affiliations
                [1 ]Department of Pathology, Shariaty Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
                [2 ]Department of Immunology, Mazandaran University of Medical Sciences, Sari, IR Iran
                [3 ]Pediatric Infectious Diseases Ward, Boali-Cina Hospital, Mazandaran University of Medical Sciences, Sari, IR Iran
                [4 ]Provincial Center for Diseases Control and Prevention, Mazandaran University of Medical Sciences, Sari, IR Iran
                [5 ]Department of Statistics, Mazandaran University of Medical Sciences, Sari, IR Iran
                Author notes
                [* ]Corresponding Author: Mohammed Jafar Saffar, Pediatric Infectious Diseases Ward, Boali-Cina Hospital, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel: +98-1512233018, Fax: +98-1512234506, E-mail: saffar@ 123456softhome.net
                Journal
                Hepat Mon
                Hepat Mon
                10.5812/hepatmon
                Kowsar
                Hepatitis Monthly
                Kowsar
                1735-143X
                1735-3408
                01 May 2014
                May 2014
                : 14
                : 5
                4013494 10.5812/hepatmon.17263
                Copyright © 2014, Kowsar Corp.; Published by Kowsar Corp.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Research Article

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