An estimated 41,200 people were newly infected with hepatitis C virus (HCV) in 2016 in the United States. Screening tests for antibodies to HCV may generate up to 32% false positivity in low-risk populations.
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In Sub-Saharan Africa, prevalence estimates of hepatitis C virus (HCV) vary widely.
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Objectives: The number of SARS-CoV-2 infections is underestimated in surveillance data. Various approaches to assess the seroprevalence of antibodies to SARS-CoV-2 have different resource requirements and generalizability. We estimated... more
Objectives: The number of SARS-CoV-2 infections is underestimated in surveillance data. Various approaches to assess the seroprevalence of antibodies to SARS-CoV-2 have different resource requirements and generalizability. We estimated the seroprevalence of antibodies to SARS-CoV-2 in Denver County, Colorado, via a cluster-sampled community survey. Methods: We estimated the overall seroprevalence of antibodies to SARS-CoV-2 via a community seroprevalence survey in Denver County in July 2020, described patterns associated with seroprevalence, and compared results with cumulative COVID-19 incidence as reported to the health department during the same period. In addition, we compared seroprevalence as assessed with a temporally and geographically concordant convenience sample of residual clinical specimens from a commercial laboratory. Results: Based on 404 specimens collected through the community survey, 8.0% (95% CI, 3.9%-15.7%) of Denver County residents had antibodies to SARS-CoV-...
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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China, in December 2019, with subsequent worldwide spread. The first US... more
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China, in December 2019, with subsequent worldwide spread. The first US cases were identified in January 2020. Methods To determine if SARS-CoV-2–reactive antibodies were present in sera prior to the first identified case in the United States on 19 January 2020, residual archived samples from 7389 routine blood donations collected by the American Red Cross from 13 December 2019 to 17 January 2020 from donors resident in 9 states (California, Connecticut, Iowa, Massachusetts, Michigan, Oregon, Rhode Island, Washington, and Wisconsin) were tested at the Centers for Disease Control and Prevention for anti–SARS-CoV-2 antibodies. Specimens reactive by pan-immunoglobulin (pan-Ig) enzyme-linked immunosorbent assay (ELISA) against the full spike protein were tested by IgG and IgM ELISAs, microneutralization test, Ortho total Ig S1...
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In March 2013, public health authorities were notified of a new hepatitis B virus (HBV) infection in a patient receiving hemodialysis. We investigated to identify the source and prevent additional infections. We reviewed medical records,... more
In March 2013, public health authorities were notified of a new hepatitis B virus (HBV) infection in a patient receiving hemodialysis. We investigated to identify the source and prevent additional infections. We reviewed medical records, interviewed the index patient regarding hepatitis B risk factors, performed HBV molecular analysis, and observed infection control practices at the outpatient hemodialysis facility where she received care. The index patient's only identified hepatitis B risk factor was hemodialysis treatment. The facility had no other patients with known active HBV infection. One patient had evidence of a resolved HBV infection. Investigation of this individual, who was identified as the source patient, indicated that HBV reverse seroconversion and reactivation had occurred in the setting of HIV (human immunodeficiency virus) infection and a failed kidney transplant. HBV whole genome sequences analysis from the index and source patients indicated 99.9% genetic h...
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Background: Hepatitis C virus (HCV) infection is a major cause of liver disease in the United States. Rates of newly reported HCV infection to the Massachusetts disease surveillance system from 2002−2009 among cases aged 15−24 years... more
Background: Hepatitis C virus (HCV) infection is a major cause of liver disease in the United States. Rates of newly reported HCV infection to the Massachusetts disease surveillance system from 2002−2009 among cases aged 15−24 years increased from 65 to 113 cases per 100,000 population. To better understand the increase in HCV infection in youth, we investigated a subset of reported cases for detailed demographic, clinical, and risk characteristics, and use of healthcare services. Methods: Of the 394 hepatitis C cases aged 18-24 years reported between July 1−December 31, 2010, we contacted 193 to request an interview. We also interviewed 5 persons with hepatitis C diagnosed in a correctional facility but not yet reported to the surveillance system. Blood specimens were tested for evidence of hepatitis B and C. Genotyping and phylogenetic testing were performed when feasible. Results: A total of 28 young persons participated. Of these, 18% reported symptoms of acute hepatitis at the ...
Research Interests: Immunology, Adolescent, Medicine, Biological Sciences, Hepatitis B, and 15 moreHumans, Immunity, Female, Male, Infant, Vaccine, Vaccination, Newborn Infant, Immune system, Hepatitis B virus, Hepatitis B Vaccine, Hepatitis A Vaccine, Hepatitis B Vaccines, Child preschool, and Medical and Health Sciences
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Background: Hepatitis C virus (HCV) infection is endemic in Mongolia, with reported prevalence of HCV antibody (anti-HCV) positivity of 11%–16% in the adult population. Healthcare-related risk factors associated with development of acute... more
Background: Hepatitis C virus (HCV) infection is endemic in Mongolia, with reported prevalence of HCV antibody (anti-HCV) positivity of 11%–16% in the adult population. Healthcare-related risk factors associated with development of acute HCV infection have not been evaluated in this population. Methods:We conducted a prospective, matched case-control study to identify risk factors associated with acute HCV infection in Ulaanbaatar, Mongolia. Cases were aged 18 years with discrete onset of symptoms consistent with acute viral hepatitis as well as jaundice or elevated serum alanine aminotransferase (ALT) levels who were admitted to the National Center for Communicable Diseases during January–October, 2019. Cases were both anti-HCV and HCV RNA positive and tested negative for acute hepatitis A, B, and E. Controls were randomly selected from the Population and Household Database, a national registry of all citizens, and were matched by age and gender. Data collection covered healthcare-...
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Background All African countries recommend 3 doses of hepatitis B vaccine (HepB3), most at 6, 10, and 14 weeks of age, but few recommend a HepB birth dose (HepB-BD). To evaluate the role of mother to child transmission (MTCT) of hepatitis... more
Background All African countries recommend 3 doses of hepatitis B vaccine (HepB3), most at 6, 10, and 14 weeks of age, but few recommend a HepB birth dose (HepB-BD). To evaluate the role of mother to child transmission (MTCT) of hepatitis B virus (HBV) with the 3 dose HepB schedule, we conducted a serosurvey in Sierra Leone among 4–30 month old children and their mothers, and 5–9 year old children. Methods We conducted a multi-stage cluster survey in 3 districts. Enumeration areas (EA) were selected by probability proportional to size, followed by random selection of eligible households to identify 1901 children per age group. We tested all participants for HBV surface antigen (HBsAg) by rapid test and collected children’s HepB vaccination history. Serum from all HBsAg+ mothers and 1 HBsAg- mother per EA was tested for total antibodies to HBV core antigen (anti-HBc), HBsAg, HBV e antigen (HBeAg), and HBV DNA. We assessed the association of HBsAg prevalence with HepB vaccination and ...
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We determined the prevalence of IgG antibodies to hepatitis E virus (anti-HEV IgG) among travelers attending Boston-area travel health clinics from 2009 to 2010. Pre-travel samples were available for 1,356 travelers, with paired pre- and... more
We determined the prevalence of IgG antibodies to hepatitis E virus (anti-HEV IgG) among travelers attending Boston-area travel health clinics from 2009 to 2010. Pre-travel samples were available for 1,356 travelers, with paired pre- and post-travel samples for 450 (33%). Eighty of 1,356 (6%) pre-travel samples were positive for anti-HEV IgG. Compared with participants who had never lived in nor traveled to a highly endemic country, the pre-travel prevalence odds ratio (POR) of anti-HEV IgG among participants born in or with a history of previous travel to a highly endemic country was increased (POR = 4.8, 95% CI = 2.3-10.3 and POR = 2.6, 95% CI = 1.4-5.0, respectively). Among participants with previous travel to a highly endemic country, anti-HEV IgG was associated with age > 40 years (POR = 3.7, 95% CI = 1.3-10.2) and travel history to ≥ 3 highly endemic countries (POR = 2.7, 95% CI = 1.2-5.9). Two participants may have contracted HEV infection during their 2009-2010 trip.
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Background: In 2009, 5 older adults with hepatitis B virus (HBV) infection were reported to the local health department. Four had resided and 1 worked at the same assisted living facility in Virginia; none reported HBV-related risk... more
Background: In 2009, 5 older adults with hepatitis B virus (HBV) infection were reported to the local health department. Four had resided and 1 worked at the same assisted living facility in Virginia; none reported HBV-related risk behaviors or exposures. Objective: To investigate and determine the source, magnitude and mode of HBV transmission and prevent further infections. Methods: A public health response team was organized to coordinate the outbreak investigation. A facility inspection was made to assess resident care and staff infection control (IC) practices. Blood was drawn from current residents and facility staff to determine HBV infection status. Data on resident demographics and potential HBV exposures were collected and compared using odds ratios or the Kruskal-Wallis rank test. Results: Among 47 current residents, median age was 83 years (range 59-95), 19% were male, and 83% were black. HBV status was determined for 44 (94%) residents, and 15 (88%) of 17 staff. Among r...
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In May 2012, the New Hampshire (NH) Division of Public Health Services (DPHS) was notified of 4 persons with newly diagnosed hepatitis C virus (HCV) infection at hospital X. Initial investigation suggested a common link to the hospital... more
In May 2012, the New Hampshire (NH) Division of Public Health Services (DPHS) was notified of 4 persons with newly diagnosed hepatitis C virus (HCV) infection at hospital X. Initial investigation suggested a common link to the hospital cardiac catheterization laboratory (CCL) because the infected persons included 3 CCL patients and a CCL technician. NH DPHS initiated an investigation to determine the source and control the outbreak. NH DPHS conducted site visits, case patient and employee interviews, medical record and medication use review, and employee and patient HCV testing using enzyme immunoassay for anti-HCV, reverse-transcription polymerase chain reaction for HCV RNA, nonstructural 5B (NS5B) and hypervariable region 1 (HVR1) sequencing, and quasispecies analysis. HCV HVR1 analysis of the first 4 cases confirmed a common source of infection. HCV testing identified 32 of 1074 CCL patients infected with the outbreak strain, including 3 patients coinfected with >1 HCV strain....
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ABSTRACT Background: The epidemiology of hepatitis E in non-endemic countries remains unclear. Four U.S. cases among persons who did not travel to endemic regions have been previously reported. We describe the investigation of the 5th... more
ABSTRACT Background: The epidemiology of hepatitis E in non-endemic countries remains unclear. Four U.S. cases among persons who did not travel to endemic regions have been previously reported. We describe the investigation of the 5th such U.S. case, and the results of active surveillance to identify additional cases. Methods: We conducted a clinical, molecular and environmental investigation of a case of hepatitis E in Pensacola, Florida. To identify additional cases, we implemented active case finding and hospital chart review. Included patients had unexplained acute hepatitis between 06/01/05 and 12/31/05, with acutely elevated liver enzymes > 2.5 times the upper limit of normal, and negative for acute HAV and HBV infection. These patients were interviewed and a blood specimen collected. Results: The index case, a 61 year old male, had illness onset on 9/12/05, and was hospitalized for 3 days with fever, abdominal pain, jaundice, and elevated liver enzymes (peak ALT 1913 IU/L). HEV isolated from this patient was genotype 3 and 93% similar to previous U.S. swine isolates. He reported no contact with pigs or pig products or any other risk factors and had not traveled outside the southeast U.S. Case finding at 7 hospitals identified 53 patients with unexplained hepatitis; 24 were interviewed and tested for HEV. Their median age was 44 years (range 18-74); 67% were female. 24% were jaundiced; the median (range) ALT and AST were 259 IU/L (103_3002), and 189 IU/L (50_891), respectively. Three individuals tested IgG anti-HEV positive, but IgM anti-HEV and HEV RNA negative. Conclusions: An apparently single isolated hepatitis E case occurred in a Florida man. No infection source was identified, and active surveillance failed to detect additional cases. The high homology of U.S. human and swine HEV strains suggests zoonotic transmission, but direct molecular and epidemiological links remain to be established.
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Nucleic acid testing (NAT) for hepatitis C virus (HCV) is recommended for screening of organ donors, yet not all donor infections may be detected. We describe three US clusters of HCV transmission from donors at increased risk for HCV... more
Nucleic acid testing (NAT) for hepatitis C virus (HCV) is recommended for screening of organ donors, yet not all donor infections may be detected. We describe three US clusters of HCV transmission from donors at increased risk for HCV infection. Donor's and recipients' medical records were reviewed. Newly infected recipients were interviewed. Donor-derived HCV infection was considered when infection was newly detected after transplantation in recipients of organs from increased risk donors. Stored donor sera and tissue samples were tested for HCV RNA with high-sensitivity quantitative PCR. Posttransplant and pretransplant recipient sera were tested for HCV RNA. Quasispecies analysis of hypervariable region-1 was used to establish genetic relatedness of recipient HCV variants. Each donor had evidence of injection drug use preceding death. Of 12 recipients, 8 were HCV-infected-6 were newly diagnosed posttransplant. HCV RNA was retrospectively detected in stored samples from donor immunologic tissue collected at organ procurement. Phylogenetic analysis showed two clusters of closely related HCV variants from recipients. These investigations identified the first known HCV transmissions from increased risk organ donors with negative NAT screening, indicating very recent donor infection. Recipient informed consent and posttransplant screening for blood-borne pathogens are essential when considering increased risk donors.
Background: The long-term protection from hepatitis B vaccination is unknown. We report evidence of 15 year persistent protection against hepatitis B virus (HBV) infection among vaccinated adolescents from Palau, a Pacific island nation... more
Background: The long-term protection from hepatitis B vaccination is unknown. We report evidence of 15 year persistent protection against hepatitis B virus (HBV) infection among vaccinated adolescents from Palau, a Pacific island nation where HBV is highly endemic. Methods: Study participants were Palauan children vaccinated beginning at birth between 1991 and 1993; all completed the three-dose series by 1 year of age. Participants received Recombivax® 5 mcg at birth and 2.5 mcg at ages 1 and 6 months. We tested participants for anti-HBs and anti-HBc 6 months after completion of the primary vaccine series, and again 15 years later in 2008. To assess immunity (anamnestic response) participants received a single pediatric booster dose of hepatitis B vaccine in 2008 and were retested 14 days later. Anamnestic response to the booster dose was defined as a 4-fold increase in anti-HBs concentration, with a peak titer of anti-HBs ≥10 mIU/mL. Results: Of 67 participants, 61 (91.0%) had prot...
Hepatitis C virus (HCV) infects an estimated 130-150 million persons globally and results in an estimated 700,000 deaths annually from hepatocellular carcinoma or cirrhosis. Georgia, a middle-income Eurasian country, has one of the... more
Hepatitis C virus (HCV) infects an estimated 130-150 million persons globally and results in an estimated 700,000 deaths annually from hepatocellular carcinoma or cirrhosis. Georgia, a middle-income Eurasian country, has one of the highest estimated HCV prevalences in the world. In 2011, Georgia began offering treatment to a limited number of HCV-infected persons. Beginning in 2013, when new oral medications that can cure >90% of HCV infections were licensed, Georgia engaged partners to develop a comprehensive HCV prevention and control plan, during which the concept of elimination of HCV transmission and disease emerged. To prepare for the launch of an HCV elimination program, Georgia requested CDC's assistance to describe HCV epidemiology, evaluate laboratory and health care capacity, and conduct program monitoring and evaluation. This report describes the activities undertaken to prepare for the program, launched in April 2015, and early results of its initial phase, focus...
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Background: Hepatitis E virus (HEV) typically causes asymptomatic infection, but rarely severe illness particularly in pregnancy. Human-to-human transmission is primarily fecal-oral. Zoonotic transmission from swine has also been... more
Background: Hepatitis E virus (HEV) typically causes asymptomatic infection, but rarely severe illness particularly in pregnancy. Human-to-human transmission is primarily fecal-oral. Zoonotic transmission from swine has also been described. An outbreak investigation into a novel illness, Progressive Inflammatory Neuropathy (PIN) in swine abattoir workers at Plant A, Minnesota, in December 2007 afforded an opportunity to investigate exposure to HEV. Methods: The investigation included an interview in the worker’s preferred language including PIN cases and controls. Following consent, serum was evaluated by commercially available (MP Diagnostics) and in-house enzyme immunoassays using recombinant ORF-2 and ORF-3 proteins as antigens. Stools from three PIN cases were evaluated for HEV RNA by RT PCR. Results: Of 135 interviewees, 99 (73%) consented to blood testing. All were HEV IgM negative. 21 (21%) were HEV IgG positive. There were 15 PIN cases and 84 controls with no significant dif...
Background: The epidemiology of hepatitis E in non-endemic countries remains unclear. Four U.S. cases among persons who did not travel to endemic regions have been previously reported. We describe the investigation of the 5th such U.S.... more
Background: The epidemiology of hepatitis E in non-endemic countries remains unclear. Four U.S. cases among persons who did not travel to endemic regions have been previously reported. We describe the investigation of the 5th such U.S. case, and the results of active surveillance to identify additional cases. Methods: We conducted a clinical, molecular and environmental investigation of a case of hepatitis E in Pensacola, Florida. To identify additional cases, we implemented active case finding and hospital chart review. Included patients had unexplained acute hepatitis between 06/01/05 and 12/31/05, with acutely elevated liver enzymes > 2.5 times the upper limit of normal, and negative for acute HAV and HBV infection. These patients were interviewed and a blood specimen collected. Results: The index case, a 61 year old male, had illness onset on 9/12/05, and was hospitalized for 3 days with fever, abdominal pain, jaundice, and elevated liver enzymes (peak ALT 1913 IU/L). HEV iso...
Background: Persistence of immunity to response from hepatitis A vaccine administered in children under 2 years of age is unknown and passively transferred maternal antibodies to hepatitis A virus (maternal anti-HAV) may lower infant... more
Background: Persistence of immunity to response from hepatitis A vaccine administered in children under 2 years of age is unknown and passively transferred maternal antibodies to hepatitis A virus (maternal anti-HAV) may lower infant immune response. Methods: Infants and young children (N=197) were recruited at the Alaska Native Medical Center in Anchorage and randomized into three groups to receive a two dose of hepatitis A vaccine (HAVRIX, GlaxoSmithKline; 720 EL.U. in 0.5 ml): group 1 at 6 and 12 months, group 2 at 12 and 18 months, and group 3 at 15 and 21 months of age; within groups, infants were randomized by maternal anti-HAV status. Anti-HAV levels were measured at 1 and 6 months, and at 3, 5, 7 and 10 years after second dose of hepatitis A vaccination. Results: Children in all groups had evidence of seroprotection (≥10mIU/mL) at 1 month after dose 2. 10 years after the 2nd dose, all children retained seroprotective anti-HAV levels except for only 6% and 9% of children in g...
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The incidence of HBs- and HBe-antigens detection in future mothers was studied in Moscow, Uzbekistan, and Moldavia, and the incidence of hepatitis B (HB) virus transmission from mothers with persisting HBs-antigenemia to their offspring.... more
The incidence of HBs- and HBe-antigens detection in future mothers was studied in Moscow, Uzbekistan, and Moldavia, and the incidence of hepatitis B (HB) virus transmission from mothers with persisting HBs-antigenemia to their offspring. In reverse passive hemagglutination test, HBsAg was detected in 1.1% of pregnancies in Moscow, in 6.3% of pregnancies in Uzbekistan, and in 5.4% of pregnancies in Moldavia. In these regions, immunofluorescence revealed HBe-antigen in HBsAg carriers in 5.2, 13.9, and 16.3%, respectively. Perinatal infection with HB virus was found in 26.1% of births to HBsAg carriers in Moscow and in 40% in Uzbekistan and Moldavia; in the latter two regions 16.0% and 13.3% of these births were found to become chronic carriers of HBsAg. In the presence of persistence of HBeAg in HSsAg carriers, from 89 to 100% births to these mothers showed the development of durable HBs-antigenemia, while in the presence of anti-HBe such outcome was noted in only 3%. Specific anti-HBs-immunoglobulin administered to infants born to HBsAg carriers exerted a protective effect by reducing the HB virus infection rate in the first 6 months of life, but failed to prevent completely the development of HB virus infection. The necessity of a wide-scale vaccination against HB in order to prevent HB virus infection of neonates is emphasized.
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Saliva tests, when used in screening for antibodies to HIV virus (anti-HIV), makes testing safer, easy-to-fulfill (even outside clinic) and acceptable for a majority of examinees. The main quality parameters of express-test for the... more
Saliva tests, when used in screening for antibodies to HIV virus (anti-HIV), makes testing safer, easy-to-fulfill (even outside clinic) and acceptable for a majority of examinees. The main quality parameters of express-test for the detection of anti-HIV in saliva were evaluated for the purpose of using the related approach in the HIV epidemiological supervision. Saliva samples and sera of 81 HIV-infected patients and of 99 presumably non-infected persons were investigated by the "OraQuick" express-test. The data obtained were compared with the results of ELISA-based serum testing. The sensitivity of "OraQuick" made 95% and its specificity was 100%. The test is appropriate for epidemiological investigations and HIV epidemiological supervision but it cannot be recommended for the blood transfusion service.