and often fulminant course of the disease. Additionally, HCV patients may be at a higher than an average risk of acquiring hepatitis B because of the similar routes of transmission of both viruses. HBV infection can be prevented by the administration of a safe and immunogenic vaccine. Insufficient immune response to hepatitis B virus (HBV) vaccine in patients with chronic hepatitis C virus is frequently encountered and anti-HBs levels may persist for a shorter time than among immune competent persons. The purpose of present study was to determine long-term persistence of anti-HBs among Egyptian patients with chronic hepatitis C infection. It also assesses the need and response to a subsequent challenge with vaccine booster doses. METHODS: 200 individuals were enrolled; (GI) 100 patients suffered from chronic HCV infection and 100 healthy individuals as a control (GII). Both groups were matched in regard to age and sex. Each individual received a standard 3-dose series of HBV vaccine; 20µg recombinant DNA vaccine of HBV(Euvax-B LG Life science, Korea) administered by IM injection into deltoid muscle at 0, 1, 6 months interval. HBs antibody titer was measured after 4 weeks. Suboptimal or Non-responders (anti-HBs titer < 10 IU/L) received a booster dose and reevaluated after 4 weeks; Suboptimal response of group I (42 patients) divided into 2 subgroups: GIa (21 patients), which received 40 µg(double dose) recombinant HBV vaccine and GIb (21 patients), received standard adult dose 20 µg HBV vaccine. 11 individuals with suboptimal response of G II received standard adult dose 20 µg HBV vaccine too. CONCLUSION: Chronic HCV patients showed lower response rate for standard doses of HBV vaccine especially with advancing age, diabetes and hypoalbuminemia. A double booster dose (40 μg) vaccine would be recommended for them which are better than revaccination with the standard 3 doses recombinant HBV vaccine.
Background: Human brucellosis, a common zoonotic disease, is major public health problem in many countries worldwide including Egypt. Objectives: To define brucellosis patients' risk-factors and to assess diagnostic lab methods of brucellosis at Assiut Fever Hospital. Patients and Methods: The study recruited 98 patients with brucellosis and an equal number of controls. All participants were subjected to interview, clinical examination, and lab investigations. Results: Older age, males, rural residence, low socioeconomic status were significant risk-factors (OR=3.76, 2.04, 2.86, 2.72; respectively). Occupations had animals' contact were significant risk-factor (OR=4.7); the most risky were butchers/ slaughter workers (OR=8.0) and farmers/dairy workers (OR=3.59). Longer occupational exposure was risk-factor (OR=15.57). The main significant presenting symptoms were fever and musucloskeletal affections. The main significant signs were high temperature and hepato-and spleno-megaly. Standard agglutination test (SAT) titer 1/320 was the cutoff point for diagnosis and significantly lies in area under the ROC curve, sensitivity=96.4% and specificity=100.0%. Blood culture was positive in 58.2% of cases with no significant differences between SAT titer and blood culture positivity. ELISA IgM and IgG results were positive in 69.4% and 65.3% of the cases with no significant differences between SAT titer and IgM and IgG results. Conclusions: Human brucellosis has many preventable risk-factors; its diagnosis depends mainly on presence of riskfactors, clinically suspected, and SAT titer ≥1/320.
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