Immunogenicity of Hepatitis B Vaccine in Patients Infected with Schistosoma mansoni

Bassily, S.; Kc, Hyams; Nm, el-Ghorab; Mansour, Malek; Na, el-Masry; Ma, Dunn

doi:10.4269/ajtmh.1987.36.549

Cited by 30 publications

(25 citation statements)

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“…34 The relationship between HBV and hepatosplenic schistosomiasis was initially reported from Brazil, Egypt, and the Philippines. [35][36][37][38] Ghaffar and colleagues 39 reported a 12-month follow-up of adults from an area endemic for schistosomiasis mansoni admitted to a fever hospital with acute viral hepatitis. 39 Among the 126 patients who had acute HBV infections, 19% having coinfections with S. mansoni were positive for hepatitis B surface antigen at 12 months, and many also had persistent splenomegaly.…”

Section: Concomitant Schistosomiasis and Hepatitis C Infectionsmentioning

confidence: 99%

Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors

2006

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In Egypt, schistosomiasis was traditionally the most important public health problem and infection with Schistosoma mansoni the major cause of liver disease. From the 1950s until the 1980s, the Egyptian Ministry of Health (MOH) undertook large control campaigns using intravenous tartar emetic, the standard treatment for schistosomiasis, as community-wide therapy. This commendable effort to control a major health problem unfortunately established a very large reservoir of hepatitis C virus (HCV) in the country. By the mid-1980s, the effective oral drug, praziquantel, replaced tartar emetic as treatment for schistosomiasis in the entire country. This both reduced schistosomal transmission and disease and interrupted the "occult" HCV epidemic. It was evident when diagnostic serology became available in the 1990s that HCV had replaced schistosomiasis as the predominant cause of chronic liver disease. Epidemiological studies reported a high prevalence and incidence of HCV, particularly within families in rural areas endemic for schistosomiasis. Clinical studies showed 70% to 90% of patients with chronic hepatitis, cirrhosis, or hepatocellular carcinoma had HCV infections. Co-infections with schistosomiasis caused more severe liver disease than infection with HCV alone. Schistosomiasis was reported to cause an imbalance in HCV-specific T-cell responses leading to increased viral load, a higher probability of HCV chronicity, and more rapid progression of complications in co-infected persons. As complications of HCV usually occur after 20 years of infection, the peak impact of the Egyptian outbreak has not yet occurred. Efforts have been initiated by the Egyptian MOH to prevent new infections and complications of HCV in the estimated 6 million infected persons. (HEPATOLOGY 2006;43:915-922.)

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Section: Concomitant Schistosomiasis and Hepatitis C Infectionsmentioning

confidence: 99%

Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors

2006

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“…It was also proposed that these patients had an impaired immune response that enhanced their susceptibility to becoming chronic carriers [27] . Concomitant infection with both schistosomiasis and hepatitis B or C causes more severe liver disease than infection with schistosomiasis alone [28] . The prognosis for this group of patients was worse than that…”

Section: Concomitant Infections With Schistosomiasismentioning

confidence: 99%

Curse of schistosomiasis on Egyptian liver

El-Zayadi¹

2004

WJG

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“…4,5 This is also biologically plausible since Schistosoma mansoni infections affect the immune response in two ways that might delay clearance of viral infections. Anti-idiotype antibodies produced in patients with chronic schistosomiasis can down-regulate specific immune responses and suppress nonspecific immune responses.…”

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Prevalence of Hepatitis B Surface Antigenemia Among Patients withSchistosoma mansoni

1994

Annals of Saudi Medicine

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Prevalence of hepatitis B surface antigenemia among patients with Schistosoma mansoni" with interest, 1 and congratulate him for using epidemiological methods, that is, the case-control study, for investigating endemic diseases.However, I believe his conclusion, "...patients with Schistosoma mansoni are exposed to a higher risk of acquiring HBV infection and ..." is reversed. It is true that farmers and males have more exposure to either infection than city dwellers and females in the Middle East; and when parenteral therapy was used to treat schistosomiasis, some patients may have been infected with HBV through contaminated needles.2 However, a recent study in Egypt, in which subjects were selected because they had acute viral hepatitis, showed that patients having concomitant Schistosoma mansoni, which was usually asymptomatic, were much more likely to become chronic HBsAg carriers than other subjects with acute viral hepatitis who did not have active S. mansoni infections.3 Among the 95 patients with acute HBV hepatitis, the HBsAg carrier rate was 25% in those with -and 9% in those without -concomitant Schistosoma mansoni, a significant (P<0.038) difference. In addition, patients with Schistosoma mansoni having acute viral hepatitis -caused by HBV, hepatitis delta virus on top of HBV infection and (probably) hepatitis C virus infection (which is prevalent in Egypt) -had greater prevalence of, and more prolonged, splenomegaly and morbidity (graded by clinical outcome and liver function tests) than others with acute viral hepatitis not having active schistosomiasis.I am unaware of any study proving patients with Schistosoma mansoni have a greater risk of HBV infection, as Dr. Al-Freihi concluded, 1 although two others have shown that HBsAg carriage is prolonged in patients with both infections. 4,5 This is also biologically plausible since Schistosoma mansoni infections affect the immune response in two ways that might delay clearance of viral infections. Anti-idiotype antibodies produced in patients with chronic schistosomiasis can down-regulate specific immune responses and suppress nonspecific immune responses. 6 In addition, recent very interesting studies in mice and humans have shown that S. mansoni egg antigens modify subpopulations of thymus helper cells. Th2 activity and the cytokines involved with eosinophilia and IgE secretion are stimulated while Th1 activity and the cytokines, interleukin 2 and gamma interferon, as well as CD8 + cytotoxic T cells, components of the immune system that help clear viral infections, are down-regulated in BALB/c mice infected with S. mansoni.7 The immunosuppression appears specific, possibly organ (liver) associated, since schistosomiasis has not been reported to increase the prevalence of HIV infection or decrease the time from initial infection to the development of AIDS.

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Immunogenicity of Hepatitis B Vaccine in Patients Infected with Schistosoma mansoni

Cited by 30 publications

References 0 publications

Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors

Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors

Curse of schistosomiasis on Egyptian liver

Prevalence of Hepatitis B Surface Antigenemia Among Patients withSchistosoma mansoni

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