17 Jun 2019
In 2017, the majority (58%) of the almost 27 000 newly reported hepatitis B cases in the European Union and European Economic Area were classified as chronic infections. This follows a consistent upward trend in reported chronic hepatitis B cases since 2008.
There is evidence of on-going transmission of hepatitis B and continued the importation of cases to many European countries according to the available surveillance data for countries of the European Union and the European Economic Area (EU/EEA) for 2017. Incomplete data, as well as varying national surveillance systems and practices, however impair more detailed epidemiological analysis of reported data.
The majority of EU/EEA countries consistently reporting experienced a steady decline in newly reported acute hepatitis B infections from 1.1 per 100 000 population in 2008 to 0.6 in 2017. This reflects overall global trends and is most likely a result of successful national vaccination programs: in these countries, the proportion of acute hepatitis B infections among people below 25 years of age declined from 20% in 2008 to 12% in 2017. The proportion of chronic cases under 25 declined from 21% in 2008 to 10% in 2017.
However, during the same time period notifications of chronic hepatitis B overall increased from 6.7 per 100 000 population to 10.2 in 2017 with the highest rates reported among the 25–34-year-olds. Overall, the reported data on chronic hepatitis B seems to mirror the intensity of local testing and screening policies – thus countries with comprehensive testing programs in place appear to have the highest notification rates. The high number of chronic infections from northern Europe has a strong influence on trends with e.g. 62% of chronic hepatitis B cases in 2017 notified by the United Kingdom.
Incomplete data affects interpretation
Transmission data are key to understanding the epidemiology of hepatitis B. However, information on the transmission mode was only complete for roughly a third (29%) of the reported acute cases in 2017 and only 13% of the notified chronic cases. Hence, data are unlikely to be fully representative, and observed trends and differences between countries are hard to interpret.
For the 718 acute cases with complete information, the heterosexual transmission was most commonly reported (27%), followed by nosocomial transmission (16%), sex between men (13%), non-occupational injuries (10%) and injecting drug use (10%). Italy, Poland, and Romania accounted for 74% of the acute cases attributed to healthcare-associated hepatitis B infections in 2017.
Where this information was available, transmission from mother to child and in healthcare settings were the most commonly reported routes for chronic hepatitis B infection (41% and 28% respectively). Poland reported 90% of chronic cases related to nosocomial transmission.
Of the 12 018 cases (45%) with information on importation status, 3 778 (31%) were reported as imported. The influence of migration on hepatitis B epidemiology highlights the need for countries to develop evidence-based screening interventions that target the most affected migrant communities. It also highlights the importance of monitoring routine surveillance indicators of migration, such as importation status.
The relatively high number of 26 907 reported hepatitis B infections in 2017and especially chronic cases, in combination with the diversity in reported transmission routes across Europe suggest that countries need to maintain and strengthen local hepatitis prevention and control programs.
The World Health Organization’s European Action plan for the health sector response to viral hepatitis outlines ways to do this. Based on the information from the ECDC prevalence database, authorities can identify the key population groups and areas of high hepatitis prevalence for targeted efforts.
ECDC rolled out a monitoring framework to support EU/EEA countries in their efforts to implement hepatitis B and C control programs. This system will provide a comprehensive and much-needed overview of the progress in tackling these infections and allows for a clearer picture of the actual burden of disease.
July 12, 2019
Among a cohort of patients with Enterococcus faecalis bacteremia who underwent echocardiography, more than one-quarter had infective endocarditis, according to data published in the Journal of the American College of Cardiology.
The researchers conducted a prospective multicenter study of 344 patients (mean age, 74 years; 74% men) with E. faecalis to determine the prevalence of infective endocarditis and to identify predictors of it. All patients underwent echocardiography and 74% had transesophageal echocardiography.
Among the cohort, 90 patients had definite infective endocarditis, for a prevalence of 26.1%, Anders Dahl, MD, PhD, a cardiologist at Herlev Gentofte University Hospital and Bispebjerg Hospital in Copenhagen, Denmark, and colleagues wrote.
Independent predictors of infective endocarditis included a prosthetic heart valve (OR = 3.93; 95% CI, 1.76-8.77), community acquisition of E. faecalis (OR = 3.35; 95% CI, 1.74-6.46), at least three positive blood culture bottles (OR = 3.69; 95% CI, 1.88-7.23), unknown portal of entry (OR = 2.36; 95% CI, 1.26-4.4), monomicrobial bacteremia (OR = 2.73; 95% CI, 1.23-6.05) and immunosuppression (OR = 2.82; 95% CI, 1.2-6.58), according to the researchers.
“It seems that the more extensively we examine using echocardiography, the higher the detection rate of [infective endocarditis],” Dahl and colleagues wrote. “This is not surprising, but the question is, do we overlook cases of [infective endocarditis] in the normal clinical routine? The discrepancy in [infective endocarditis] prevalence between our prospective study and the previous studies suggests a substantial underdiagnosis of E. faecalis endocarditis in the general everyday clinic represented by the earlier studies.”
In a related editorial, Nuria Fernández-Hidalgo, MD, PhD, from Servei de Malalties Infeccioses, Hospital Universitari Vall d’Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain, and Laura Escolà-Vergé, MD, from the Spanish Network for Research in Infectious Diseases (REIPI), Madrid, wrote that in regard to use of echocardiography, “we agree that it is better to overtreat than to fail to treat.”
Because the rates of infective endocarditis were only 3% in patients with no risk factors and 14% in patients with one or two risk factors, “similar to what occurs in Staphylococcus aureus bacteremia (in which the risk of [infective endocarditis] is elevated), an echocardiogram might not be recommended for all patients, and the decision to perform an echocardiogram should be individualized on a case-by-case basis,” they wrote. – by Erik Swain
Source: www. haelio.com
finds a new study in mice led by the Francis Crick Institute.
The research, published in Cell Reports, discovered that signals from gut bacteria help to maintain a first line of defence in the lining of the lung. When mice with healthy gut bacteria were infected with the flu, around 80% of them survived. However, only a third survived if they were given antibiotics before being infected.
“We found that antibiotics can wipe out early flu resistance, adding further evidence that they should not be taken or prescribed lightly,” explains Dr Andreas Wack, who led the research at the Francis Crick Institute. “Inappropriate use not only promotes antibiotic resistance and kills helpful gut bacteria, but may also leave us more vulnerable to viruses. This could be relevant not only in humans but also livestock animals, as many farms around the world use antibiotics prophylactically. Further research in these environments is urgently needed to see whether this makes them more susceptible to viral infections.”
The study found that type I interferon signaling, which is known to regulate immune responses, was key to early defense. Among the genes switched on by interferon is a mouse gene, Mx1, which is the equivalent of the human MxA gene. This antiviral gene produces proteins that can interfere with influenza virus replication. Although often studied in immune cells, the researchers found that microbiota-driven interferon signals also keep antiviral genes in the lung lining active, preventing the virus from gaining a foothold.
“We were surprised to discover that the cells lining the lung, rather than immune cells, were responsible for early flu resistance induced by microbiota,” says Andreas. “Previous studies have focused on immune cells, but we found that the lining cells are more important for the crucial early stages of infection. They are the only place that the virus can multiply, so they are the key battleground in the fight against flu. Gut bacteria send a signal that keeps the cells lining the lung prepared, preventing the virus from multiplying so quickly.
“It takes around two days for immune cells to mount a response, in which time the virus is multiplying in the lung lining. Two days after infection, antibiotic-treated mice had five times more virus in their lungs. To face this bigger threat, the immune response is much stronger and more damaging, leading to more severe symptoms and worse outcomes.”
To test whether the protective effect was related to gut bacteria rather than local processes in the lung, the researchers treated mice with antibiotics and then repopulated their gut bacteria through fecal transplant. This restored interferon signaling and associated flu resistance, suggesting that gut bacteria play a crucial role in maintaining defenses.
“Taken together, our findings show that gut bacteria help to keep non-immune cells elsewhere in the body prepared for the attack,” says Andreas. “They are better protected from flu because antiviral genes are already switched on when the virus arrives. So when the virus infects a prepared organism, it has almost lost before the battle starts. By contrast, without gut bacteria, the antiviral genes won’t come on until the immune response kicks in. This is sometimes too late as the virus has already multiplied many times, so a massive, damaging immune response is inevitable.”