Clinical Infectious Diseases 2004;39:945-952

liver411

Clinical Infectious Diseases    2004;39:945-952
© 2004 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2004/3907-0007$15.00

MAJOR ARTICLE

Widespread Dissemination in England of a Stable and Persistent Hepatitis B
Virus Variant

Rachel L. Hallett,1,* Siew Lin Ngui,1 Rolf E. Meigh,2 Ken J. Mutton,3
Elizabeth H. Boxall,4 and Chong Gee Teo1

1Sexually Transmitted and Blood Borne Virus Laboratory, Health Protection
Agency Colindale, London, 2Virology/Microbiology Laboratory, Castle Hill
Hospital, Cottingham, 3Health Protection Agency Manchester Medical
Microbiology Partnership, Manchester Royal Infirmary, Manchester, and
4Health Protection Agency West Midlands, Birmingham Heartlands Hospital,
Birmingham, United Kingdom

(See the editorial commentary by Zöllner on pages 9534)

Background.     Outbreaks of acute hepatitis B among inmates of 6 prisons in
3 regions of northern England occurring from 1992 through 1994 were found to
be associated with a single hepatitis B virus (HBV) variant, which was
carried by 20 of the 24 case patients. We instigated a study of cases of
acute hepatitis B to trace the spread and prevalence of this variant.

    Methods.     A denaturing gradient gel electrophoresis assay was
optimized to detect the HBV variant, and cases of acute HBV infection in 3
regions in England occurring from 1990 through 1996 were screened for its
presence. Samples from HBV-transmission incidents that were received for
molecular investigation were also tested.

    Results.     The variant was identified in 117 (41%) of the 266 cases
of acute hepatitis examined in representative regions in England. In North
Humberside, but not in southeast England or the West Midlands, a trend
toward an increase in the prevalence of the variant was observed.
Furthermore, the same variant was identified in the case patients or the
individuals implicated in transmission in 11 (22%) of 51 transmission
incidents occurring in England from 1997 through 2002. The spread of the
variant was primarily associated with injection drug use.

    Conclusions.     The finding of a single, genetically identical variant
(over the 600 bp sequenced) occupying a large niche among the circulating
viruses was unexpected. This finding has major implications for the use of
DNA sequencing analysis in the investigation of chains of transmission. The
study also highlights the need for better protection of at-risk groups
through vaccination against HBV, a strategy that currently achieves poor
coverage.