A review of chronic hepatitis B epidemiology and management issues in selected countries in the Middle East

Abstract

Experts from seven countries convened as a Specialist Panel for the Middle East to share information on practical issues relating to the epidemiology, diagnosis and management of chronic hepatitis B (CHB) infection. The Middle East is regarded as a region of high-to-intermediate epidemicity; however, infant vaccination programmes have successfully lowered the prevalence of hepatitis B infection in most countries to that of low-to-intermediate endemicity. Vaccine issues still to be addressed included improving coverage in some rural/poor communities, instituting hepatitis B vaccine at birth and providing vaccines for high-risk population groups. Hepatitis B infection in the Middle East primarily occurs as a result of perinatal infection, horizontal transmission between family members and transmission from injections. Blood transfusion services have broadly efficient screening programmes, but immunocompromised and haemodialysis patients are at risk. The cost of screening, monitoring and treating CHB influences practice in a number of Middle East countries, and there is a need for information on the most cost-effective options.

The persistence of anti-HBs antibody and anamnestic response 20 years after primary vaccination with recombinant hepatitis B vaccine at infancy

“…The seroprotection rate after booster vaccination is similar to the results reported in studies from Malaysia (94.0%), Thailand (98.6%) and Germany (97.2%-99.6%). 14,16,25 Moreover, 90.6% of the re-vaccinated subjects showed an anamnestic response to booster vaccination. Similar anamnestic response has been reported at 23 years after primary vaccination in a study from China.…”

“…These findings are in accordance with results reported in other studies. 25 It has been shown that vaccine induces active production of anti-HBs antibody accompanied by HBsAg-specific immunological memory that provide continuous protection in the absence of antibody. 17,18 The persistence of immunological memory over 5 years after primary vaccination is apparent from rapid increases in antibody level following booster vaccination, even in subjects who have lost antibodies.…”

“…In regions of intermediate endemicity, the patterns of the disease transmission is mixed and disease occurs at all ages, but again the predominant period of transmission seems to be at younger ages. 2 Effective control of HBV transmission in regions with high and intermediate endemicity, therefore, would not be possible without vaccination of the vulnerable groups of the population. 3 The WHO (World Health Organization) strategy for effective control of HBV infection and its complications is the mass vaccination of neonates and children within the framework of Expanded Program on Immunization (EPI).…”

“…2 Effective control of HBV transmission in regions with high and intermediate endemicity, therefore, would not be possible without vaccination of the vulnerable groups of the population. 3 The WHO (World Health Organization) strategy for effective control of HBV infection and its complications is the mass vaccination of neonates and children within the framework of Expanded Program on Immunization (EPI). In 1991, the Global Advisory Group to the WHO recommended that all countries integrate hepatitis B vaccine into national immunization by 1997.…”

“…11 We have also demonstrated that intramuscularly administration of a single supplementary low dose of HB vaccine induced high seroprotection rate in the non-responder neonates to primary course of vaccination. 12 Although, vaccination with the HBsAg induces protection in the majority of vaccines, however, it has been shown that the anti-HBs level diminishes after vaccination. The results of the studies reported from different regions with varied hepatitis B endemicity have demonstrated the persistence of protection for at least 10-15 years after primary vaccination despite diminishing antibody levels.…”