Evaluation of Hepatitis B Infection Prevalence in Institutionalized Intellectually Disabled Children

Background: Hepatitis B virus (HBV) infection causes chronic infection in human population, with high mortality. One of the high risk communities is mentally retarded children, who are institutionalized. Special conditions in these centers predispose children for HBV infection and transmission to healthy people. In this study our objective was to determine the prevalence of HBV infection among institutionalized mentally retarded children and study its associated risk factors.Materials and Methods: In this study, 250 mentally retarded children (younger than 14 years old) were included. They were living in 5 nursing institutions, located in different parts of Tehran. Hepatitis B surface antigen (HBsAg) was measured in the sera of these patients by ELISA method.Results: Among 250 children, 20 children (8%) were HBsAg positive. HBV infection in girls was more than boys (11% to 5.6%). Among the types of mental retardation, children with cerebral palsy had the highest positive result for HBsAg. The most HBV infection (28.5%) was seen in children with longest duration of being institutionalized (10 to 11 years). Vaccinated children were more HBsAg positive (8.7%) than non-vaccinated children (5.3%). However, no significant relationship was observed between any of these factors and HBsAg positivity.Conclusion: Despite improvement of people’s health condition and implementation of HBV vaccination, the prevalence of HBV infection is increased in institutionalized mentally retarded children, which highlights the need for active measures to reduce this infection among this high risk populatio

A review on Quarantine during COVID-19 Outbreak: Lessons Learned from Previous Epidemics

Background: Since the emergence in December 2019, the novel coronavirus disease 2019 (COVID-19) has caused a global pandemic that has infected so many people all around the world. As there are no vaccination or antiviral treatment available yet, public health measures play a substantial role in the management of this pandemic. Governments of affected countries have imposed different quarantine policies and travel bans. As quarantine can have many controversial aspects, this review intends to clarify its role in disease control and other aspects of human everyday life with due attention to a couple of epidemics in the past (SARS, MERS, and flu) and ongoing COVID-19 outbreak.   Methods: We conducted a thorough search in PubMed, Research Gate, Google Scholar, Excerpta Media Database (EMBASE), and Web of Science databases and collected all relevant articles to Quarantine in the past epidemics (SARS, MERS, and flu) as well as ongoing COVID-19 pandemic.     Results:  A total of 176 articles were extracted in our primary search process. Primarily, 53 articles have been excluded because of duplication. The other 44 articles have been excluded due to different reasons (Lack of useful information and eligibility of data). Finally, 79 articles were selected for more evaluation (published until April 2020).   Conclusion: By having previous epidemics, including SARS, MERS, and flu, in mind, quarantine and isolation seem to be proper choices for this situation. But, as this epidemy is bigger than former ones, stricter public health measurements, such as serious social distancing and community-wide containment, are recommended

Investigation of Relative Risk Factors of Hepatitis B Virus Core Antibody Positivity among Intravenous Drug Users in Tehran, 2013

Background: Hepatitis B virus (HBV) still continues to infect many people worldwide despite the availability of an effective vaccine for more than three decades. The high prevalence of HBV may exist in high risk groups, particularly among intravenous drug users (IDUs). This group is among groups with a higher risk of infection due to their hazardous behaviors such as sharing needles for drug injection. This cross sectional study included 229 intravenous drug users in Tehran, in 2013 to investigate the prevalence of HBc Ab positivity and its associated risk factors among IDUs.Materials and Methods: Socio-demographic characteristics and associated risk factors were recorded during sample collection. Their serum samples were tested for the presence of total hepatitis B virus core antibody (HBc Ab) by Enzyme-linked Immunosorbent Assay (ELISA).Results: HBc Ab was detected in 64 of 229 participants, giving an overall prevalence of 28%. History of imprisonment, injecting drugs and age has a significant correlation with HBc Ab positivity.Conclusion: Expansion of new preventive strategies through the national health system could be beneficial for decreasing the risk of acquiring HBV among high risk groups such as IDUs.</p

Prevalence of YMDD mutations in patients with chronic hepatitis B and renal transplant recipient patients after prolonged using of lamivudine

Background and Aim: In hepatitis B Virus, one of major problem associate lamivudine therapy is the emergence of YMDD motif mutation in Polymerase gene leading to lamivudine resistance mutations. The aim of this study was evaluation of the incidence of the YMDD mutants among patients with chronic hepatitis B and Renal transplant recipients (RTRs). Materials & Methods: In this study, 80 chronic hepatitis B patients who received renal transplants at Tehran city were selected. The patients serum samples were collected for molecular evaluation by nested PCR assays were used for the direct identification of hepatitis B Virus surface antigen (HBsAg). After laboratory tests the results were analyzed by using molecular software. Results: In this study, of the 80 patients, 30 patients were positive for HBV DNA.  They were between 28 to 74 years old with the mean of 23 ± 51.The frequency of lamivudine resistance mutations in YMDD region was detected in 12 (40%) of chronic hepatitis B patients. Conclusion: Much is still unknown about Lamivudine therapy among chronic hepatitis B RTR patients. But most studies have confirmed Lamivudine therapy in these patients is safe and it is better to use it before renal transplantation. It is suggested to follow up patients in terms of immunosuppressive therapy and HBV molecular analysis in different status of disease. Therefore, it will be possible to investigate the effect of these mutations in chronic hepatitis B RTR patients who receive immunosuppressive drugs

Persons with Intellectual Disability: A Potential Reservoir of Invasive Strains of Hepatitis B Virus

Background: A higher prevalence of hepatitis B virus (HBV) infection has been reported in persons with intellectual disability as well as the nurses working in closed institutions compared to the general population. Objectives: In the present study, the serological and molecular markers of HBV infection in individuals with intellectual disability of closed institutions were investigated. Methods: Blood samples were derived from 400 persons with intellectual disability living in six institutions in Tehran and tested for HBsAg and HBcAb. Nested PCR, direct sequencing, and phylogenetic analysis were performed to determine the HBV genotypes and mutational patterns of HBsAg. Also, HBsAb was tested for HBV DNA positive cases. Results: Twenty-eight (7.0%) patients were positive for the HBsAg serological test. Furthermore, six HBV occult cases were identified. In total, out of 41 patients with HBV infection markers, 26 cases were positive for HBV DNA. Of these patients, 15 full-length HBsAg were successfully amplified and sequenced. All strains belonged to genotype D and subtypes ayw2 and ayw3. These 15 isolated strains carried several immune escape mutants in the S genes. Surprisingly, mutations related to antiviral resistance were detected in the overlapped pol genes of strains isolated from naïve-treatment patients. Conclusions: The observed frequency of HBV infection in individuals with intellectual disability was higher than the reported estimation of HBV infection in Iranian blood donors and the general population. All HBV isolates from these patients represented a homogenous genotype and corresponded with other reported strains from Mediterranean countries. The high frequency of immune escape strains, despite vaccination and detection of identical mutational patterns in different genes, might indicate that persons with intellectual disability have shared vaccine-escape and drug-resistant HBV strains.status: Published onlin

Urinary viral shedding of COVID-19 and its clinical associations: A systematic review and meta-analysis of observational studies

Objectives: To review the current literature on the presence of COVID-19 virus in the urine of infected patients and to explore the clinical features that can predict the presence of COVID-19 in urine.Materials and Methods: A systematic review of published literature between 30th December 2019 and 21st June 2020 was conducted on Pubmed, Google Scholar, Ovid, Scopus, and ISI web of science. Studies investigating urinary viral shedding of COVID-19 in infected patients were included. Two reviewers selected relative studies and performed quality assessment of individual studies. Meta-analysis was performed on the pooled case reports and cohort with a sample size of >= 9.Results: Thirty-nine studies were finally included in the systematic review; 12 case reports, 26 case series, and one cohort study. Urinary samples from 533 patients were investigated. Fourteen studies reported the presence of COVID-19 in the urinary samples from 24 patients. The crude overall rate of COVID-19 detection in urinary samples was 4.5%. Considering case series and cohorts with a sample size of >= 9, the estimated viral shedding frequency was 1.18 % (CI 95%: 0.14 - 2.87) in the meta-analysis. Urinary viral load in most reports were lower than rectal or oropharyngeal samples. In adult patients, urinary shedding of COVID-19 was commonly detected in patients with moderate to severe disease (16 adult patients with moderate or severe disease versus two adult patients with mild disease). In children, urinary viral shedding of COVID-19 was reported in 4 children who all suffered from mild disease. Urinary viral shedding of COVID-19 was detected from day 1 to day 52 after disease onset. The pathogenicity of virus isolated from urine has been demonstrated in cell culture media in one study while another study failed to reveal replication of isolated viral RNA in cell cultures. Urinary symptoms were not attributed to urinary viral shedding.Conclusion: While COVID-19 is rarely detected in urine of infected individuals, infection transmission through urine still remains possible. In adult patients, infected urine is more likely in the presence of moderate or severe disease. Therefore, caution should be exerted when dealing with COVID-19 infected patients during medical interventions like endoscopy and urethral catheterization especially in symptomatic adult patients while in children caution should be exerted regardless of symptoms

Urinary viral shedding of COVID-19 and its clinical associations: A systematic review and meta-analysis of observational studies

Objectives: To review the current literature on the presence of COVID-19 virus in the urine of infected patients and to explore the clinical features that can predict the presence of COVID-19 in urine. Materials and Methods: A systematic review of published literature between 30th December 2019 and 21st June 2020 was conducted on Pubmed, Google Scholar, Ovid, Scopus, and ISI web of science. Studies investigating urinary viral shedding of COVID-19 in infected patients were included. Two reviewers selected relative studies and performed quality assessment of individual studies. Meta-analysis was performed on the pooled case reports and cohort with a sample size of = 9. Results: Thirty-nine studies were finally included in the systematic review; 12 case reports, 26 case series, and one cohort study. Urinary samples from 533 patients were investigated. Fourteen studies reported the presence of COVID-19 in the urinary samples from 24 patients. The crude overall rate of COVID-19 detection in urinary samples was 4.5%. Considering case series and cohorts with a sample size of ≥ 9, the estimated viral shedding frequency was 1.18 % (CI 95%: 0.14 - 2.87) in the meta-analysis. In adult patients, urinary shedding of COVID-19 was commonly detected in patients with moderate to severe disease (16 adult patients with moderate or severe disease versus two adult patients with mild disease). In children, urinary viral shedding of COVID- 19 was reported in 4 children who all suffered from mild disease. Urinary viral shedding of COVID-19 was detected from day 1 to day 52 after disease onset. The pathogenicity of virus 3 isolated from urine has been demonstrated in cell culture media in one study while another study failed to reveal replication of isolated viral RNA in cell cultures. Urinary symptoms were not attributed to urinary viral shedding. Conclusions: While COVID-19 is rarely detected in urine of infected individuals, infection transmission through urine still remains possible. In adult patients, infected urine is more likely in the presence of moderate or severe disease. Therefore, caution should be exerted when dealing with COVID-19 infected patients during medical interventions like endoscopy and urethral catheterization

COVID-19 and Influenza Co-infection: A Systematic Review and Meta-Analysis

Background and Aim: Co-infection of COVID-19 with other respiratory pathogens which may complicate the diagnosis, treatment, and prognosis of COVID-19 emerge new concern. The overlap of COVID-19 and influenza, as two epidemics at the same time can occur in the cold months of the year. The aim of current study was to evaluate the rate of such co-infection as a systematic review and meta-analysis. Methods: A systematic literature search was performed on September 28, 2019 fororiginal research articles published in Medline, Web of Science, and Embase databases from December 2019 to September 2020 using relevant keywords. Patients of all ages with simultaneous COVID-19 and influenza were included. Statistical analysis was performed using STATA 14 software. Results: Eleven prevalence studies with total of 3,070 patients with COVID-19, and 79 patients with concurrent COVID-19 and influenza were selected for final evaluation. The prevalence of influenza infection was 0.8% in patients with confirmed COVID-19. The frequency of influenza virus co-infection among patients with COVID-19 was 4.5% in Asia and 0.4% in the America. Four prevalence studies reported the sex of patients, which were 30 men and 31 women. Prevalence of co-infection with influenza in men and women with COVID-19 was 5.3 and 9.1%, respectively. Eight case reports and 7 case series with a total of 123 patients with COVID-19 were selected, 29 of them (16 men, 13 women) with mean age of 48 years had concurrent infection with influenza viruses A/B. Fever, cough, and shortness of breath were the most common clinical manifestations. Two of 29 patients died (6.9%), and 17 out of 29 patients recovered (58.6%). Oseltamivir and hydroxychloroquine were the most widely used drugs used for 41.4, and 31% of patients, respectively. Conclusion: Although a low proportion of COVID-19 patients have influenza co-infection, however, the importance of such co-infection, especially in high-risk individuals and the elderly, cannot be ignored. We were unable to report the exact rate of simultaneous influenza in COVID-19 patients worldwide due to a lack of data from several countries. Obviously, more studies are needed to evaluate the exact effect of the COVID-19 and influenza co-infection in clinical outcomes. Keywords: coronavirus, COVID-19, influenza virus, co-infection, meta-analysis, systematic revie