Hepatitis B vaccine: Immunity, efficacy and types

Current issues that are associated with the development of hepatitis B vaccine, combination vaccines, modes of administration, immunogenicity, and efficacy of different types of hepatitis B vaccines are reviewed. Hepatitis B viral mutants can emerge as a result of either immune response or treatment options. Several studies are in progress on treatment of chronic hepatitis B infection by immunization with multiple antigenic components; DNA vaccines alone or with DNA encoded immunomodulatory cytokines; combination of vaccine with antiviral drugs and cytokines; and genetic manipulation of antigen presenting cells. Integrating hepatitis B vaccine doses into the global infant immunization program is not sufficient for hepatitis B virus (HBV) infection eradication. Implementing HBV schedule to high risk groups such as injection drug users, inmates of correctional centers, and persons at risk for sexually transmitted diseases, surveillance of hepatitis B infected subjects and refugees, access to immunization services and treatment is necessary. Further investigation is needed to assess factors that can impede an adequate antibody response, HBV variants, and the need for booster doses to preserve vaccine-induced immunity, vaccinating schedule for older children, evaluation of those vaccinated but in persistent contact in HBV-endemic areas. Copyright © 2010, Shiraz E Medical Journal. All rights reserved

Comparison of callus induction and somatic embryogenesis of some Iranian cottons (Gossypium Spp.) with Coker 312 and histology of somatic embryogenesis

Callus induction and somatic embryogenesis from hypocotyl explants of some Iranian cottons spp. (Hashem abad, Kerman, Termez and Sepid) were compared with Coker 312 through induction and formation of embryogenic calli on medium of Murashige and Skoog (MS) with Gamborg vitamins (B5) supplemented with the following compositions: MSB1 (0.5 mg/l zeatin), MSB2 (1 mg/l zeatin), MSB3 (0.5 mg/l 2,4-dichlorophenoxyacetic acid, 0.1 mg/l kinetin), MSB4 (1 mg/l 2,4-D, 0.5 mg/l kinetin, 0.5 mg/l zeatin) and MSB5 (2 mg/l α-naphtalene-3-acetic acid, 1 mg/l kinetin, 0.75 mg/l MgCl2). The optimum medium for the proliferation of embryogenic calli was MS medium containing B5 vitamins, 1 mg/l 2,4-D, 0.5 mg/l kinetin and 0.5 mg/l zeatin and the optimum medium for the development of somatic embryos was MS medium (NH4NO3 was removed and KNO3 amount doubled) containing B5 vitamins, 40 g/l sucrose and without hormone. Media MSB1, MSB2 and MSB4 gave the highest percentage (100%) of calli induction in Coker 312 but the lowest induction (46.66%) was observed when Hashem abad explants were cultured in the MSB3 medium. Embryogenesis percentage of Termez (2.22  to 24.40%), Hashemabad (1.85 to 9.73%) and Sepid (9.06 to 22.28%) genotypes were significantly lower than that of Coker 312 (66.66 to 94.33%). The Kerman genotype did not show embryogenesis. In the histological studies, the different development stages of the embryos (globular, heart, torpedo and cotyledonary) together with callus cells were showed.Key words: Hypocotyl explants, somatic embryo, in vitro regeneration, germination, somatic embryogenesis histology

Lamivudine resistance in Iranian chronic hepatitis B patients

Background and objectives: Lamivudine therapy for chronic hepatitis B (CHB) is associated with resistance. This study aimed to analyze the response, the incidence of LAM resistance, and different viral mutational patterns of Lamivudine therapy. Study design: CHB patients (n=31) who had not previously received interferon or a nucleoside analogue, received Lamivudine once daily for a minimum of E12 months and followed. All patients were tested for presence of mutation in YMDD motif of viral polymerase gene at the end of the first year of treatment, and if indicated in rising alanine aminotransferase (ALT) or HBVDNA titer. Polymerase chain reaction along with restriction fragment length polymorphism (PCR-RFLP) method was used to detect mutations in YMDD motif. Results: The mean age of patients was 45.2 (SD 13.5) years. The mean follow-up period of patients was 45.5 (21.9) months. Seventeen patients (54.8) had mutations, and 45.2 of subjects were sensitive to LAM. Mean time of mutation detection after treatment was 45.5 (SD 25.3) months. The distribution of YMDD status was: 32.3 YIDD, 3.2 YSDD, 12.9 YVDD, and 6.5 YVDD/ YIDD. The mean age, pretreatment HBeAg negativity, and high HBVDNA titer at time of mutation had significant statistical association with occurrence of YMDD mutants (PV= 0.009, 0.032, 0.049), respectively. Conclusions: Lamivudine-resistant mutation is common in CHB patients. Regarding different mutant strains as identified in this study, is necessary for develop more useful treatment strategies, especially in patients without YMDD mutation and high HBVDNA titer, analysis for possible new mutants should be performed. Copyright © 2010, Shiraz E Medical Journal. All rights reserved

E-selectin gene polymorphisms in Iranian chronic hepatitis B patients

Background and Aims: The aim of this study was to detect the substitutions Ser128Arg (A128C) and Leu554Phe (T554C) which are responsible for E-selectin polymorphisms in patients with chronic hepatitis B and healthy controls. We investigated possible association of the Ser128Arg and Leu554Phe gene polymorphisms in the E-selectin gene with susceptibility to chronic hepatitis B. Methods: Sixty-three patients with chronic hepatitis B virus infection and 150 healthy subjects were recruited sequentially as they presented to clinic. Classification of chronic hepatitis B virus (HBV)-infected patients was as asymptomatic carrier state (34 patients) and chronic hepatitis B (29 patients). Genomic DNA was isolated from anticoagulated peripheral blood Buffy coat using Miller�s salting-out method. The presence of the E-selectin gene polymorphisms was determined by using polymerase chain reaction amplification refractory mutation system (ARMS). Results: Distribution of E-selectin 128 (A+C-, A+C+, A-C+) genotypes and E-selectin 554 (C+T-, T+C-, C+T+) genotypes were not statistically different in chronic hepatitis B patients and controls (P=0.41 and 0.96, respectively). Also, two groups had no significant difference in distribution of frequencies of allele 128A (P=0.41), 128C (P=0.15), allele 554C (P=0.85), and allele 554T (P=0.76). Carrying of allele 128A (OR=0.58, 95 CI=0.16-2.12), 128C (OR=1.52, 95 CI=0.84-2.74), 554C (OR=1.24, 95 CI=0.12-12.08), and allele 554T (OR=0.88, 95 CI=0.38-2.01) were not risk factors for susceptibility to chronic hepatitis B infection. Conclusions: Carrying E-selectin gene polymorphisms of Ser128Arg and Leu554Phe is not considered risk factor for susceptibility to chronic hepatitis B infection. © 2007, Kowsar Medical Publishing Company. All rights reserved

Assessment of human cytomegalovirus co-infection in Egyptian chronic HCV patients

Human cytomegalovirus (HCMV) is the most common cause of severe morbidity and mortality in immune- compromised individuals. This study was conducted to determine the incidence of HCMV infection in HCV patients who either spontaneously cleared the virus or progressed to chronic HCV infection. The study included a total of eighty four cases (48 females and 36 males) that were referred to blood banks for blood donation with an age range of 18-64 years (mean age 37.62 ± 10.03 years). Hepatitis C virus RNA and HCMV DNA were detected in sera by RT-nested PCR and nested PCR respectively in all subjects. Immunoglobulin G levels for HCV and HCMV were determined. Besides, IgM antibodies for HCMV infection were also determined in subjects' sera. Fifty three out of 84 cases (63%) were positive for HCV-RNA while 31 (37%) cases had negative HCV RNA. Forty six (87%) and 13 (25%) cases out of 53 HCV RNA positive patients were positive for HCMV IgG and IgM antibodies respectively. While 20 of 53 cases (38%) had detectable HCMV DNA. To examine the role of HCMV infection in HCV spontaneous resolution, two groups of HCV patients, group 1) chronic HCV infection (positive HCV RNA and positive IgG antibodies) vs group 2) spontaneous resolution (negative HCV RNA and positive IgG antibodies) were compared. The percentages of positive CMV IgG and IgM results is higher in chronic HCV patient than those in spontaneously cleared HCV patients and the difference is highly statistically significant (P value < 0.001). Also, there is a general trend towards elevated levels of CMV IgG antibodies in HCV chronic patients than those in spontaneously cleared HCV patients (P value < 0.02). HCMV DNA detection in group 1 was more than twice the value observed in group 2 (38% vs 14.3%, P value < 0.001). Moreover, levels of liver enzymes were significantly higher in HCV RNA positive cases co-infected with HCMV DNA than HCMV negative cases (P value < 0.001). The results indicate the role of HCMV in the liver pathogenesis. We conclude that chronic HCV patients co-infected with HCMV infection can be regarded as high risk groups for liver disease progression where they should be monitored for the long term outcome of the disease

Impact of immunosuppression and chemotherapy on reactivation of viral hepatitis.

Chemotherapy drugs, biological medications that are used to treat cancer, may cause hepatic side effects. Patients with pre-existing viral hepatitis may be more susceptible to exacerbation of their underlying liver disease, and risk of drug-induced hepatotoxicity. We conducted a search on immunosuppression, and its impact on reactivation of viral hepatitis, using the electro-nic medical databases. Before starting chemotherapy, it is recommended to record the past history of liver disease and check for hepatitis B virus (HBV) and hepatitis C virus (HCV) serology. In immunosuppressed patients, radiation toxicity, graft versus host disease, hepatic veno-occlusive disease, acalculous cholecystitis, tumor infiltration, ischemia, other viruses such as CMV and her-pes virus, and systemic infection should also be considered. Transplant recipients with serologic evidence of previous infection with hepatitis B or C, or those who receive organs from a seropositive donor, should have viral load levels monitored before and after transplantation and, may also require treatment. We believe that there is a role for prophylactic use of antiviral treatment in patients at risk for HBV reactivation

Fluorosis

The health of habitants, living in un-fluoridated drinking water areas, can be endangered&quot;nthrough fluoride intake from food, beverages, tooth paste and dentistry products. Fluoride is used in&quot;nmouthwash, toothpaste, juice fruits, conserved foods and Teflon dishes. Water exposure to fluoride&quot;noccurs through fertilizers, aluminum industries, insecticides, pesticides, herbicides and fungicides used&quot;nfor fruits and vegetables which ultimately lead to environmental fluoride pollution. Some side effects.&quot;ncaused by chronic fluoride intake are as follows: decrease of hemoglobin concentration, gastrointestinal&quot;ndisorders, and tooth loss at young age, osteofluorosis, hip fracture among aged people, osteosclerosis,&quot;nosteoporosis, special forms of arthritis and joint ankylosis, metaphysial osteomalacia, mottling and weak&quot;nstructure of tooth, insulin secretion and glucose tolerance test disorders, decrease of urine concentration,&quot;nimmune system disorders, genetic defects and cancer, learning disabilities and IQ(intelligence quotient)&quot;ndeficits and thyroid dysfunction The present article was to investigate the side effect of excessive&quot;nfluoride intake and to discuss different preventive and diagnostic ways

Epidemiology and transmission of hepatitis G virus infection in dialysis patients.

Hepatitis G virus (HGV) or GB-virus type C (GBV-C) is distributed globally and is present in the volunteer blood donor population. For epidemiological studies, HGV is of interest in hemodialysis patients who are at risk of parenterally transmitted infections. The role of HGV in producing illness and hepatic disease has yet to be determined. A review of literature was performed in 2009 to summarize scientific reports on epidemiology and pathogenesis of the HGV infection and its exposure through hemodialysis

Immune response to hepatitis B vaccine in health-care workers.

This study was performed to study the immune response to hepatitis B virus (HBV) vaccine in health-care workers. Through a cross-sectional study, relevant information and blood samples from 151 healthcare workers at the Firuzgar hospital were studied. The age range of the study individuals was 20-59 years, with the mean and standard deviation being 35.11 and 10.06, respectively. There were 24 males (15.9) and 127 females (84.1). The mean and median of months after HBV vaccination was 63.42 and 49.00, respectively. The mean and median of anti-HBs titer in those who received HBV vaccination was 164.81 and 200 milli international units per milliliter (mIU/mL), respectively. Of the 129 HBV-vaccinated subjects, 103 (68.2) had anti-HBs titer >10 and 26 (17.2) had anti-HBs titer <10. There was no association between gender and anti-HBs titer, but vaccination and adequate completion of its courses were associated with higher anti-HBs titer (P < 0.05). Also, the logistic regression method showed that the association between duration after vaccination and age with anti-HBs titer was not statistically significant. Our study suggests that the HBV vaccine immunization program had obtained excellent efficacy. There is need for further investigation among subjects who are not vaccinated against HBV but are positive for anti-HBs as well as in HBV-vaccinated subjects with low anti-HBs titers, about possible low-level viremia and other causes of lower vaccine efficacy, particularly in health-care workers