Hepatitis B virus transmission in Brazilian hemodialysis units: Serological and molecular follow‐up

Abstract

A serological and molecular study of hepatitis B virus (HBV) infection was carried out in dialysis units in Central Brazil. Between 1995 and 1999, serum samples from all HBsAg-positive hemodialysis patients (n = 43) were tested for HBeAg/anti-HBe and subtyping by monoclonal ELISA. HBV DNA was detected by PCR and positive samples were genotyped by restriction fragment polymorphism pattern (RFLP) methodology. TheHBsAg prevalence declined in this population during the survey period (12-5.8%). HBeAg and anti-HBe were detected in 23 (53.5%) and 18 (41.9%) sera, respectively. Thirty-six samples could be HBsAg subtyped: 21 were subtype ayw(3), 14 belonged to adw(2) and one was identified as adw(4). HBV DNA was present in 30 serum samples. Of these, 20 (66.7%) were genotype D, 9 (30%) genotype A, and 1 (3.3%) genotype F. In addition, the RFLP pattern could be determined in samples from 18/20 genotype D patients: D3 (10 strains), D7 (7 strains) and D4 (1 strain); from 8/9 genotype A patients: A1 (6 strains) and A3 (2 strains); and from the patient infected with genotype F: F1. Patterns D3 and D7 were associated closely with HBV infection in the two largest hemodialysis units studied. These findings confirm the value of the RFLP method as an effective molecular epidemiological tool for elucidating HBV transmission in hemodialysis units.

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

“…One HBeAg/anti-HBe-negative patient also had HBV DNA detectable in his serum. These data were similar to those previously found by Teles et al (2002), which emphasize the need for rapid recognition and isolation of HBsAg-positive patients regardless of their HBeAg/anti-HBe status.…”

“…These genotypes have been found in other Brazilian hemodialysis populations (De Castro et al 2000, Teles et al 2002, Souza et al 2003 reflecting the HBV genotypes circulating in our country (Moraes et al 1996, Araujo et al 2004, Sitnik et al 2004. Genotype D was predominant in this hemodialysis patients (61.5%), as observed by others (De Castro et al 2000, Teles et al 2002). In addition, HBV isolates from genotype D have been involved in outbreak in dialysis units (De Castro et al 2000).…”

“…Nevertheless, a significant decline (12 to 5.8%) was observed in the hemodialysis population of Goiânia city between 1995 and 1999 (Teles et al 2002). Also, in this study, the prevalence declined to 2.4% in 2002 (data not shown).…”

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“…However, this rate was lower than those observed in other studies conduced before the implementation of improved methods for prevention and control of infection in Brazilian hemodialysis units (Cenderoglo Neto et al 1995, Vanderborght et al 1995. In fact, recently Teles et al (2002) reported a decline of the HBsAg prevalence from 12%, in 1995, to 5.8%, in 1999, among hemodialysis patients from Goiânia city.…”

“…In developed countries where these measures have been implemented, HBV infection declined significantly, reaching hepatitis B surface antigen (HBsAg) rates lower than 1%, as observed in the US (Alter et al 1986, Tokars et al 2002. In Brazil, investigations have shown prevalence rates ranging from 4.4% to 15.1% (Cenderoglo Neto et al 1995, Busek et al 2002, Teles et al 2002.…”