HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:
- Studies Find Hepatitis B Virus Can Mutate and Infect Even Immunized People
- Hepatitis B Patients Appear to Be At Risk of Other Diseases
- Experts: Do Not Rush to Treat HBV-Infected Children
- Primary Care Doctors Essential in Treating Immigrants at Risk of Liver Cancer
- Relapse Rate Low in Those Who Respond Well to Entecavir
- Only 64% of U.S. Health Care Providers Are Immunized Against Hepatitis B
- Studies Reveal Important Information about Hepatitis B in Women
- Hepatitis B Risk in African Immigrants and African-Americans Studied
HBV Journal Review
December 1, 2013
Vol 10, no 12
by Christine M. Kukka
Studies Find Hepatitis B Virus Can Mutate and Infect Even Immunized People
A growing number of studies are finding that the hepatitis B virus (HBV) is so adept at mutating that in some cases it is able to infect people who have been immunized against hepatitis B.
The hepatitis B vaccine contains only one particle (antigen) of the virus—the hepatitis B surface antigen (HBsAg)—which makes up the outer layer of the virus. When immunized with this antigen, the body’s immune system creates the hepatitis B surface antibody to specifically target and eradicate HBsAg if a person comes in contact with the virus. To date, the vaccine has effectively protected millions against hepatitis B.
However, researchers are finding some people who were immunized and then exposed to the virus are now infected with HBV that is able to replicate without HBsAg. Scientists say these vaccinated people have “occult” or a “vaccine escape” version of the infection. They have HBV DNA in their bodies, but they test negative for normal HBsAg.
A new study published in the November issue of the Journal of Virology finds that the number of vaccinated Chinese children with mutated HBV has increased from 6.5% in 1992 to 15% in 2005.(1) And, as these vaccinated children age and become adults, the rate of mutations increases. Researchers also fear these mutated virus may cause more severe liver disease in patients than regular HBV.
“The vaccine has been successful in protecting millions of children from HBV, but there is concern that use of the vaccine puts selective pressure on the virus to develop ‘breakout’ mutations that could render the vaccine less effective,” wrote M. J. Friedrich in an editorial citing the study, entitled, “Hepatitis B vaccination spurs virus mutation rise,” in the November issue of the Journal of the American Medical Association.(2)
In the investigation, researchers from the U.S. and China compared blood samples taken from vaccinated children and unvaccinated adults before and after universal HBV immunization began in China in 1992. “They found that the prevalence of HBV mutants in children increased from 6.5% in 1992 to almost 15% in 2005, whereas in the adults, little difference was seen in HBV mutation prevalence from 1992 to 2005—as would be expected because the adults did not receive vaccines.
“Although the vaccine remains effective, this study indicates that HBV mutations should be monitored so that additional vaccination strategies can be implemented when necessary,” Friedrich cautioned.
In another study, published in the November issue of the Journal of Viral Hepatitis, researchers compared outcomes in babies born to HBV-infected mothers who were given only the vaccine or a combination of the vaccine and HBIG, which is composed of hepatitis B surface antibodies derived from humans. They found occult hepatitis B, with HBsAg mutations, in 42% of 222 babies two years after their births.(3) The occult infection rate was higher in infants treated with both the vaccine and HBIG, and whose mothers had high rates of HBV DNA when they were born.
1. Source: www.ncbi.nlm.nih.gov/pubmed/24006443
2. Source: http://jama.jamanetwork.com/data/Journals/JAMA/929168/jwm130041.pdf.gif
3. Source: www.ncbi.nlm.nih.gov/pubmed/24168259
Hepatitis B Patients Appear to Be At Risk of Other Diseases
Several new studies report that people with chronic hepatitis B appear to be at higher risk of heart disease, eye problems and fibromyalgia.
Continue reading about this study and others