Serological and Vaccination Profile of Hemodialysis Patients during an Outbreak of Hepatitis B Virus Infection

Abstract

During an outbreak of hepatitis B virus (HBV) infection in a hemodialysis unit, patients were assessed for serological viral markers and vaccination status. HBV infection was identified in 26 patients. Twenty of these were positive for hepatitis B surface antigen (HBsAg), and 6 were negative for HBsAg but positive for IgM antibody to hepatitis B core (anti-HBc) and HBV DNA. The primary source of infection was not clearly identified, although 2 patients were suspected to be the index cases. A multiple logistic regression analysis revealed low anti-HBs titers and vaccination status to be independently associated with the risk of acquiring HBV infection. Both the high prevalence of HBV infection (31%) detected in this unit and the low vaccine response (53%) observed reinforce the importance of universal and preventive measures in controlling HBV infection. The detection of HBV DNA in HBsAg-negative/IgM anti-HBc-positive patients emphasizes the value of anti-HBc testing in the routine screening of HBV in hemodialysis units.

Hepatitis C and hepatitis B virus infection in different hemodialysis units in Belo Horizonte, Minas Gerais, Brazil

“…Another possibility is the absence, in the serology kits used, of an antigenic variant that is present in the geographic area studied (Dow et al 1996). Other studies also detected HCV or HBV nucleic acids in anti-HCV negative or HBsAg-negative/IgM anti-HBc-positive hemodialysis patients, respectively (Carneiro et al 2001, Lewis-Ximenez et al 2001. The potential problem of a high prevalence of HCV RNA positive patients in an HCV seronegative group deserves to be studied in depth, due to the possible consequences to HCV transmission in hemodialysis centers.…”

“…Nosocomial transmission of HCV and HBV also appears to be an important contributing factor to the spread of these viruses (Castro-Figueiredo et al 1986, Teles et al 1998, Wreghitt 1999, Carneiro et al 2001. The prevalence of the HBV has drastically reduced with control practices, but outbreaks are still frequent and routine screening necessary (Wreghitt 1999, Lewis-Ximenez et al 2001.…”

Hepatitis B virus infection profile in hemodialysis patients in Central Brazil: prevalence, risk factors, and genotypes

“…However, for others, HBV infection is still an important problem to patients (Vladutiu et al 2000, Otedo et al 2003, Kumar et al 2005. Nevertheless, HBV infection outbreaks are still seen when failures in infection control procedures occur (De Castro et al 2000, Lewis-Ximenez et al 2001.…”

Hepatitis B Virus (HBV) Variants in Hemodialysis Patients

“…These data suggest that genotype D would be more likely to disseminate in the hemodialysis environment. In fact, although genotype A is the most prevalent genotype in Brazil, HBV genotype D strains have been involved frequently in hepatitis B outbreaks in dialysis units (Castro-Figueiredo et al, 1986;De Castro et al, 2000;Lewis-Ximenez et al, 2001;Roll et al, 1995), and in some of these cases they were probably more efficiently transmitted than genotype A (Castro-Figueiredo et al, 1986;De Castro et al, 2000;Teles et al, 2002). Additionally, several studies have shown a significant association of HBV genotype D and injection drug use (Fisker et al, 2004;Panessa et al, 2009;Swenson et al, 2001), reinforcing the idea that genotype D could be a blood-borne genotype.…”