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Jaho J, Kamberi F, Mechili EA, Bicaj A, Carnì P, Baiocchi L. Review of Albanian studies suggests the need for further efforts to counteract significant hepatitis B virus prevalence. World J Virol 2024; 13:93721. [PMID: 39722761 PMCID: PMC11551693 DOI: 10.5501/wjv.v13.i4.93721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 08/05/2024] [Accepted: 09/03/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) is categorized as one of the smallest enveloped DNA viruses and is the prototypical virus of the Hepatoviridae family. It is usually transmitted through body fluids such as blood, semen, and vaginal secretions. The majority (more than 95%) of immunocompetent adults infected with HBV spontaneously clear the infection. In the context of the high prevalence of HBV infection in Albania, the research gap is characterized by the lack of studies aimed at advancing the current understanding and improving the prevailing situation. The main objective of this study was to address the low rate of HBV diagnosis and the lack of a comprehensive national program to facilitate widespread diagnosis. AIM To analyze the prevalence of HBV infection in Albania and elucidate the persistently high prevalence despite efforts and measures implemented. METHODS Using a systematic literature review, we collected existing research on the epidemiology of HBV in Albania from PubMed, Cochrane Library, Google Scholar, and Albanian Medical Journals, focusing on studies published after the 1980s and conducted solely in the Albanian population. RESULTS The findings reveal a dynamic shift in HBV prevalence in Albania over several decades. Initially high, the prevalence gradually declined following the implementation of screening and vaccination programs. However, the prevalence rates have remained notably high, exceeding 8% in recent years. Contributing factors include vertical transmission, inadequate healthcare infrastructure, and challenges in screening and diagnosis. Studies among Albanian refugees in neighboring countries also reported high prevalence rates, emphasizing the need for transnational interventions. Despite advancements in screening, vaccination, and healthcare infrastructure, Albania continues to face a substantial burden of HBV infection. CONCLUSION The persistence of high prevalence underscores the complexity of the issue, requiring ongoing efforts to ensure a comprehensive understanding and effective mitigation. Addressing gaps in vaccination coverage, improving access to screening and diagnosis, and enhancing public awareness are crucial steps toward reducing HBV prevalence in Albania.
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Affiliation(s)
- Jerina Jaho
- Faculty of Health, University of Vlore “Ismail Qemali”, Vlore 9400, Albania
| | - Fatjona Kamberi
- Faculty of Health, University of Vlore “Ismail Qemali”, Vlore 9400, Albania
| | | | - Agreta Bicaj
- Department of Hepatology, University of Tor Vergata, Rome 00133, Italy
- Postgraduate School in Gastroenterology, Our Lady of Good Counsel University, Tirana 1001, Albania
| | - Paola Carnì
- Department of Hepatology, University of Tor Vergata, Rome 00133, Italy
- Postgraduate School in Gastroenterology, Our Lady of Good Counsel University, Tirana 1001, Albania
| | - Leonardo Baiocchi
- Department of Hepatology, University of Tor Vergata, Rome 00133, Italy
- Faculty of Medicine, Our Lady of Good Counsel University, Tirana 1001, Albania
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Ioannidou C, Galanis P, Voulgari-Kokota A, Dikalioti SK, Papachristidou S, Bozas E, Mentis A, Tsoumakas K, Pavlopoulou ID. Suboptimal Serologic Immunity Against Poliomyelitis Among New Migrant Children in Greece Calls for Organized Action. J Immigr Minor Health 2023; 25:96-103. [PMID: 35441972 DOI: 10.1007/s10903-022-01363-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 01/10/2022] [Accepted: 03/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Migration-flows pose the risk of poliovirus reintroduction from endemic countries to Greece. This study aims to evaluate serologic-immunity/vaccination against poliomyelitis in newly-arriving migrant children. METHODS Demographic-immunisation data and blood-serum were obtained from migrants 1-14years-old, referred to a hospital-clinic in Athens-Greece within three months from arrival. Immunity to polioviruses-1-3 was determined by serum-neutralizing-antibodies(WHO guidelines). Titers ≥ 1:8 were considered positive. RESULTS From 9/2010 to 9/2013, 274 children(150 refugees/124 immigrants), mean age 7.1years-old, were enrolled. Only 57(20.8%) of them presented with vaccination-records. Children originated mainly from Asia(n = 198), Eastern Europe(n = 28), Middle East(n = 24) and Africa(n = 24) with 160(58.4%) from polio-endemic-countries(Afghanistan-112(40.8%), Pakistan-24(8.8%) and India-24(8.8%)). Seropositivity against polio-1-2&3 was 84.3%, 86.1% and 74.5%, respectively. Immigrants, had higher seroprotective rates against polioviruses-1-2&3 than refugees(polio-1:p = 0.002;polio-2:p = 0.004,polio-3:p < 0.001). Seronegativity to 1PVs-2PVs and all three polio serotypes was found in 37(13.5%),12 (4.4%), and 30 children(10.9%) respectively. Increasing number of vaccine-doses, and younger-age, were positively-associated with seropositivity. DISCUSSION A remarkable fraction of newly-arrived migrant-children were seronegative to one or more polioviruses.
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Affiliation(s)
- Christina Ioannidou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, P.O. 11527, Goudi, Athens, Greece
| | - Petros Galanis
- Department of Public Health Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, 11527, Goudi, Athens, Greece
| | - Androniki Voulgari-Kokota
- The National Polio- Enteroviruses Laboratory, Hellenic Pasteur Institute, 127 Vasilissis Sophias Ave, 11521, Athens, Greece
| | - Stavroula K Dikalioti
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, P.O. 11527, Goudi, Athens, Greece. .,Faculty of Nursing, Pediatric Clinic, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian National and Kapodistrian University of Athens, Thivon & Levadeias str, 11527, Athens, Greece.
| | - Smaragda Papachristidou
- Faculty of Nursing, Pediatric Clinic, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian National and Kapodistrian University of Athens, Thivon & Levadeias str, 11527, Athens, Greece
| | - Evangelos Bozas
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, P.O. 11527, Goudi, Athens, Greece
| | - Andreas Mentis
- The National Polio- Enteroviruses Laboratory, Hellenic Pasteur Institute, 127 Vasilissis Sophias Ave, 11521, Athens, Greece
| | - Konstantinos Tsoumakas
- Faculty of Nursing, Pediatric Clinic, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian National and Kapodistrian University of Athens, Thivon & Levadeias str, 11527, Athens, Greece
| | - Ioanna D Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Papadiamantopoulou 123, P.O. 11527, Goudi, Athens, Greece.,Faculty of Nursing, Pediatric Clinic, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian National and Kapodistrian University of Athens, Thivon & Levadeias str, 11527, Athens, Greece
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Rigopoulou EI, Gatselis NK, Galanis K, Lygoura V, Gabeta S, Zachou K, Dalekos GN. The changing epidemiology of hepatitis B in Greece. Ann Gastroenterol 2021; 34:431-437. [PMID: 33948070 PMCID: PMC8079866 DOI: 10.20524/aog.2021.0614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022] Open
Abstract
Background The epidemiology of hepatitis B virus (HBV) infection has changed in recent years as a result of various factors. Our aim was to assess the epidemiological characteristics and the evolution of the HBV infection in a well-defined area of Greece. Method Prospectively collected data from 1910 consecutive patients (60.8% male, age: 50.1 years) with chronic hepatitis B (CHB) followed from 1999-2016 were analyzed. Results Of the patients evaluated, 90.6% were of Greek and 8% of Albanian origin. Vertical/intrafamilial transmission during early childhood (56.8%) and traditional practices (17.2%) were the most common infection sources. Several areas with higher rates of CHB were identified. At first evaluation, 68.8% had chronic infection, 21.7% chronic hepatitis, 6.1% cirrhosis and 3.4% hepatocellular carcinoma (HCC). Comparison between 2 periods (1999-2010 and 2011-2016) revealed older age and longer disease duration at first presentation (P<0.001 for both) to be more common during 2011-2016, while patients of foreign nationality doubled during this period. There was a trend towards more advanced disease stage at first assessment during 2011-2016. Patients after 2011 had lower rates of virological and biochemical breakthrough (P<0.001 for both) during treatment with new antivirals. In addition, fewer patients progressed to cirrhosis (P=0.02) and HCC (P=0.04). Conclusions CHB continues to be a major health problem in Central Greece, as highlighted by the preservation of high prevalence areas and a tendency towards an increase of chronic liver disease burden longitudinally. Our data highlight the need for scaling-up prevention and treatment strategies, especially in at-risk populations.
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Affiliation(s)
- Eirini I Rigopoulou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece
| | - Konstantinos Galanis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece
| | - Vasiliki Lygoura
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece
| | - Stella Gabeta
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece
| | - Kalliopi Zachou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Greece
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Ahmad AA, Falla AM, Duffell E, Noori T, Bechini A, Reintjes R, Veldhuijzen IK. Estimating the scale of chronic hepatitis B virus infection among migrants in EU/EEA countries. BMC Infect Dis 2018; 18:34. [PMID: 29325525 PMCID: PMC5765695 DOI: 10.1186/s12879-017-2921-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/14/2017] [Indexed: 12/23/2022] Open
Affiliation(s)
- Amena A Ahmad
- Faculty Life Sciences, Department of Health Sciences, Hamburg University of Applied Sciences, Ulmenliet 20, 21033, Hamburg, Germany. .,Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Abby M Falla
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015, Rotterdam, CN, Netherlands.,Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Schiedamsedijk 95, 3011, Rotterdam, EN, Netherlands
| | - Erika Duffell
- European Centre for Disease Prevention and Control, Granits väg 8, 171 65 Solna, Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Granits väg 8, 171 65 Solna, Stockholm, Sweden
| | - Angela Bechini
- Department of Health Sciences, University of Florence, Viale G.B. Morgagni, 48, 50134, Florence, Italy
| | - Ralf Reintjes
- Faculty Life Sciences, Department of Health Sciences, Hamburg University of Applied Sciences, Ulmenliet 20, 21033, Hamburg, Germany
| | - Irene K Veldhuijzen
- Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Schiedamsedijk 95, 3011, Rotterdam, EN, Netherlands.,Center for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721, Bilthoven, MA, Netherlands
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Lazarus JV, Sperle I, Spina A, Rockstroh JK. Are the testing needs of key European populations affected by hepatitis B and hepatitis C being addressed? A scoping review of testing studies in Europe. Croat Med J 2016; 57:442-456. [PMID: 27815935 PMCID: PMC5141462 DOI: 10.3325/cmj.2016.57.442] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 09/18/2016] [Indexed: 01/14/2023] Open
Abstract
AIM To investigate whether or not key populations affected by hepatitis B and hepatitis C are being tested sufficiently for these diseases throughout the European region. METHODS We searched MEDLINE and EMBASE for studies on HBV and HCV testing in the 53 Member States of the World Health Organization European Region following PRISMA criteria. RESULTS 136 English-language studies from 24 countries published between January 2007 and June 2013 were found. Most studies took place in 6 countries: France, Germany, Italy, the Netherlands, Turkey, and the United Kingdom. 37 studies (27%) addressed HBV, 46 (34%) HCV, and 53 (39%) both diseases. The largest categories of study populations were people who use drugs (18%) and health care patient populations (17%). Far fewer studies focused on migrants, prison inmates, or men who have sex with men. CONCLUSIONS The overall evidence base on HBV and HCV testing has considerable gaps in terms of the countries and populations represented and validity of testing uptake data. More research is needed throughout Europe to guide efforts to provide testing to certain key populations.
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Affiliation(s)
- Jeffrey V Lazarus
- Jeffrey V Lazarus, CHIP, Rigshospitalet, University of Copenhagen, Oster Allé 56, 5th floor, DK-2100 Copenhagen O, Denmark,
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Coppola N, Alessio L, Pisaturo M, Macera M, Sagnelli C, Zampino R, Sagnelli E. Hepatitis B virus infection in immigrant populations. World J Hepatol 2015; 7:2955-2961. [PMID: 26730274 PMCID: PMC4691698 DOI: 10.4254/wjh.v7.i30.2955] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/16/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) is the most common cause of hepatitis worldwide, with nearly 350 million people chronically infected and 600000 deaths per year due to acute liver failure occurring during acute hepatitis or, more frequently, in HBV-related liver cirrhosis or hepatocellular carcinoma. Ongoing immigration from countries with a high HBV endemicity to those with a low HBV endemicity warrants particular attention to prevent the spread of HBV infection to the native population. This review article analyzes the epidemiology and virological and clinical characteristics of HBV infection in immigrant populations and in their host countries, and suggests prophylactic measures to prevent the spread of this infection. Among the immigrants from different geographical areas, those from South East Asia and sub-Saharan Africa show the highest prevalences of hepatitis B surface antigen (HBsAg) carriers, in accordance with the high endemicity of the countries of origin. The molecular characteristics of HBV infection in immigrants reflect those of the geographical areas of origin: HBV genotype A and D predominate in immigrants from Eastern Europe, B and C in those from Asia and genotype E in those from Africa. The literature data on the clinical course and treatment of HBsAg-positive immigrants are scanty. The management of HBV infection in immigrant populations is difficult and requires expert personnel and dedicated structures for their assistance. The social services, voluntary operators and cultural mediators are essential to achieve optimized psychological and clinical intervention.
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Zampino R, Boemio A, Sagnelli C, Alessio L, Adinolfi LE, Sagnelli E, Coppola N. Hepatitis B virus burden in developing countries. World J Gastroenterol 2015; 21:11941-11953. [PMID: 26576083 PMCID: PMC4641116 DOI: 10.3748/wjg.v21.i42.11941] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/23/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) infection has shown an intermediate or high endemicity level in low-income countries over the last five decades. In recent years, however, the incidence of acute hepatitis B and the prevalence of hepatitis B surface antigen chronic carriers have decreased in several countries because of the HBV universal vaccination programs started in the nineties. Some countries, however, are still unable to implement these programs, particularly in their hyperendemic rural areas. The diffusion of HBV infection is still wide in several low-income countries where the prevention, management and treatment of HBV infection are a heavy burden for the governments and healthcare authorities. Of note, the information on the HBV epidemiology is scanty in numerous eastern European and Latin-American countries. The studies on molecular epidemiology performed in some countries provide an important contribution for a more comprehensive knowledge of HBV epidemiology, and phylogenetic studies provide information on the impact of recent and older migratory flows.
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Greenaway C, Thu Ma A, Kloda LA, Klein M, Cnossen S, Schwarzer G, Shrier I. The Seroprevalence of Hepatitis C Antibodies in Immigrants and Refugees from Intermediate and High Endemic Countries: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0141715. [PMID: 26558905 PMCID: PMC4641717 DOI: 10.1371/journal.pone.0141715] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/12/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & AIMS Hepatitis C virus (HCV) infection is a significant global health issue that leads to 350,000 preventable deaths annually due to associated cirrhosis and hepatocellular carcinoma (HCC). Immigrants and refugees (migrants) originating from intermediate/high HCV endemic countries are likely at increased risk for HCV infection due to HCV exposure in their countries of origin. The aim of this study was to estimate the HCV seroprevalence of the migrant population living in low HCV prevalence countries. METHODS Four electronic databases were searched from database inception until June 17, 2014 for studies reporting the prevalence of HCV antibodies among migrants. Seroprevalence estimates were pooled with a random-effect model and were stratified by age group, region of origin and migration status and a meta-regression was modeled to explore heterogeneity. RESULTS Data from 50 studies representing 38,635 migrants from all world regions were included. The overall anti-HCV prevalence (representing previous and current infections) was 1.9% (95% CI, 1.4-2.7%, I2 96.1). Older age and region of origin, particularly Sub-Saharan Africa, Asia, and Eastern Europe were the strongest predictors of HCV seroprevalence. The estimated HCV seroprevalence of migrants from these regions was >2% and is higher than that reported for most host populations. CONCLUSION Adult migrants originating from Asia, Sub-Saharan Africa and Eastern Europe are at increased risk for HCV and may benefit from targeted HCV screening.
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Affiliation(s)
- Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Ann Thu Ma
- Department of Internal Medicine, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | | | - Marina Klein
- Division of Infectious Diseases, McGill University Health Center, McGill University, Montreal, Canada
| | - Sonya Cnossen
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Research Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
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Higher rates of chronic hepatitis B infection and low vaccination-induced protection rates among parturients escaping HBsAg prenatal testing in Greece: a 2-year prospective study. Eur J Gastroenterol Hepatol 2012; 24:878-83. [PMID: 22588307 DOI: 10.1097/meg.0b013e328354834f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Universal screening for the identification of hepatitis B surface antigen [HBsAg(+)] mothers is essential to prevent perinatal hepatitis B virus (HBV) infection. In Greece, although adherence to HBV prenatal testing has improved significantly, there are still pregnant women who do not receive testing, and there is concern that this group may include women with a higher disease burden. METHODS The seroprevalence of HBV markers among parturient women escaping HBsAg prenatal testing was assessed prospectively. Seropositivity rates were compared with those from a control group of women [n=1304, Greek: 1156 (88.7%), Albanian: 148 (11.3%)], with appropriate prenatal HBsAg documentation, who delivered in the same public hospital. RESULTS Between January 2007 and March 2009, 9546 women delivered at the Alexandra Hospital, Athens, Greece, and 1000 (10.6%, mean age: 26.6±6.2 years) were unable to document their HBsAg status. Among women tested for the first time in the delivery room, 70.4% were immigrants (Albanians: 41.7%, Eastern European: 14.7%, African: 7.2%, Asian: 6.9%), 15.2% were of Roma origin, and 14.4% were Greek. Overall, 53/1000 (5.3%, 95% confidence interval: 4.1-6.9%) HBsAg(+) cases were found (Albanians: 7.4%, Roma: 5.3%, Asians: 4.3%, Eastern European: 3.4%, Greeks: 2.8%, African: 2.8%, P<0.05 between Greek and Albanian women) versus 15/1304 (1.2%, 95% confidence interval: 0.7-1.9%) in the control group (P<0.0001). Greek women nonadherent to HBV maternal testing were more likely to be chronically infected with HBV (0.6 vs. 2.8%, P<0.05), whereas a similar trend was observed in Albanian women (5.4 vs. 7.4%, P=0.45). Disappointingly low vaccination-induced protection rates (mean 21.4%) were observed among women escaping HBV maternal testing. CONCLUSION Higher HBV disease burden and low vaccination-induced protection are characteristic in pregnant women nonadherent to HBsAg prenatal testing. More intense surveillance and implementation of immunization programs should be applied in these populations.
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Zehender G, Shkjezi R, Ebranati E, Gabanelli E, Abazaj Z, Tanzi E, Kraja D, Bino S, Ciccozzi M, Galli M. Reconstruction of the epidemic history of hepatitis B virus genotype D in Albania. INFECTION GENETICS AND EVOLUTION 2011; 12:291-8. [PMID: 22142487 DOI: 10.1016/j.meegid.2011.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 11/17/2011] [Accepted: 11/19/2011] [Indexed: 12/15/2022]
Abstract
Despite a recent decrease in the prevalence of HBsAg in the general population, Albania is still highly endemic for HBV infection. Genotype D is the most prevalent HBV strain in the Mediterranean area. We studied the prevalence and distribution of HBV genotypes and subgenotypes in a total of 73 HBsAg-positive patients living in Albania, and reconstructed the epidemiological history of the most prevalent HBV D subgenotype using a "phylodynamic" framework. A time-scaled genealogy of the Albanian patients' and reference P gene sequences with known sampling dates was reconstructed using an MCMC Bayesian approach that allows population growth to be estimated on the basis of coalescent theory. All of the Albanian subjects were infected with the HBV D genotype, and a percentage varying from 44.4% to 100% (depending on the ethnic or risk group) were infected with subgenotype D2, the most prevalent in the study population (72.4%). The other subgenotypes present in a minority of subjects were D1 (13.8%) and D3 (13.8%). The Bayesian skyline plot population dynamics analysis showed that genotype D2 entered the Albanian population in the late 1960s, and that the effective number of infections grew gradually until the second half of the 1980s and more rapidly until the mid-1990s, when it reached a plateau that still persists today. Our data suggest that political and socio-economic factors played an important role in determining the rapid spread of HBV infection in Albania.
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Affiliation(s)
- Gianguglielmo Zehender
- Department of Clinical Sciences Luigi Sacco, Chair of Infectious Diseases, University of Milan, Milan, Italy.
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