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Studies Find Hepatitis B Vaccine Protection May Wane in Late Adolescence
Two studies in Hong Kong, where universal hepatitis B immunization began in late 1983, suggest that hepatitis B vaccination protection may weaken as teens reach late adolescence.
According to a report in the journal Epidemiology and Infection, researchers monitored HBsAg status of teenage mothers treated between 1998 and 2008. All of the women should have been immunized at birth.
They found the following HBsAg-positive rates:
Between 2 to 5% in those age 16
Between 2 to 7% in those age 17
And about 8% in those ages 18 and 19.
This shows that as the young women aged, their risk of hepatitis B infection increased, suggesting, "... the protective effect of the vaccine declined in late adolescence."
A second study from Hong Kong, published in the journal Infection, found that first-year university students in that city also had higher HBV infection rates as they aged. Of 2,688 students enrolled in the study, 2.9 % were HBsAg-positive.
What is significant is the infection rates increased significantly from 0.9% in students under age 18 to 5.5 % in those age 21 or older.
"Among the university students enrolled in our study, the overall prevalence of HBV infection before and after the introduction of HBV vaccination was lower than the 10 % found in the general population," researchers noted. "There was, however, a significant progressive increase with age at testing from 18 to 21 years, suggesting a previously overlooked contribution of horizontal transmission to the high prevalence of HBV infection found in our adult population."
研究发现,B型肝炎疫苗的保护可能减弱在青春期后期
,普及乙肝疫苗在1983年下半年开始,香港的两项研究表明,接种乙肝疫苗的保护可能会削弱青少年达到青春期后期。
根据杂志的流行病学和感染的一份报告中,研究人员观察了1998年至2008年间收治的十几岁的母亲HBsAg状态。所有的妇女都应该在出生时已经有免疫力。
他们发现下面的乙肝表面抗原阳性率:
在那些年满16岁2至5%
在那些17岁2年至7%
而那些年龄在18岁和19 8%左右。
这表明岁的年轻女性,他们的B型肝炎感染的风险增加,这表明,“该疫苗的保护作用下降在青春期后期。”
大学一年级的学生,在这个城市的另一项研究发现,来自香港,发表在杂志上的感染,也有较高的HBV感染率随着年龄。的2,688名学生参加了这项研究中,2.9%为HBsAg阳性。
什么是重要的感染率从0.9%大幅上升至5.5%,在18岁以下的学生,在那些21岁或以上。
“在大学的学生参加在我们的研究中,HBV感染乙肝疫苗接种前和出台后的总患病率明显低于在总人口中10%的人认为,”研究人员指出。 “,然而,有一个显着的逐步增加,年龄从18岁至21岁的测试,我们的成人人口中发现HBV感染的高患病率的水平传播提出了以前被忽视的贡献。”
Silymarin Appears Beneficial in Drug Combinations
Silymarin, derived from the milk thistle plant, is an herbal supplement that is believed to help protect the liver from infection and other diseases, but researchers do not know in detail how effective this herb is and at what dose.
A recent Chinese study, published in the European Journal of Clinical Microbiology and Infectious Diseases, examined 12 studies that involved placebo, control groups that examined the effectiveness of silymarin when combined with antiviral treatments.
"Silymarin was equivalent to antiviral drug or protection liver drugs in serum transaminases, viral load and hepatic fibrosis markers," they found. "But silymarin combined with antiviral drug or antiviral drug and protection liver drugs significantly reduced the level of serum transaminases, hepatic fibrosis markers and serum TGF-β1, TNF-α, IL-6 versus antiviral drug or protection liver drugs."
They concluded that the herbal supplement, when combined with antiviral drug or antiviral drug and protection liver drugs, "may have potential therapeutic value." But they added that the data is still too limited to result in a full recommendation of the herbal supplement until additional trials and studies are conducted.
水飞蓟素出现有益的药物组合
水飞蓟素,水飞蓟厂来自,是一种草药补充,被认为有助于保护肝脏免受感染等疾病,但研究人员并不知道这种草药是如何有效详细,在什么剂量。
中国最近的研究,发表在欧洲临床微生物学和传染病杂志,审查了12项研究,涉及的安慰剂,对照组检查的有效性时,水飞蓟素与抗病毒治疗相结合。
“水飞蓟素是相当于抗病毒药物或血清转氨酶,病毒载量和肝纤维化标志物的保护肝脏的药物,他们发现了。” “但是,水飞蓟素具有抗病毒的药物或抗病毒药物和保护肝脏的药物相结合能显着降低血清转氨酶,肝纤维化标志物及血清TGF-β1,TNF-α,IL-6与抗病毒药物或保护肝脏的药物水平。”
他们的结论是,草药补充,结合抗病毒的药物或抗病毒药物和保护肝脏的药物,“可能有潜在的治疗价值。”但他们补充说,这些数据仍然太有限,导致在一个完整的草药补充剂的建议,直到进行额外的试验和研究。
U.S. Doctors Play Key Role in Screening Asian Immigrants for Hepatitis B
Asian immigrants and their offspring have high rates of chronic hepatitis B in the United States—reaching up to 10%. So what's the best way to promote screening, immunization, and treatment in this culturally diverse, at-risk population?
The family doctor is the most powerful influence in this group, according to a report published in the Journal of Immigrant Minority Health. Researchers from Johns Hopkins Bloomberg School of Public Health in Baltimore and the Maryland Asian American Liver Cancer Education Program surveyed 877 Asian immigrants to help identify the most powerful source who could most influence screening and treatment.
Those surveyed were almost evenly split among Korean, Chinese and Vietnamese immigrants. The average age was 44, most were women, 58% were college-educated (only 34.9% claimed to speak English well) and 59.2% had lived more than 25% of their lives in the U.S. Sixty-two percent were employed, 60.1% regularly saw a physician and 67.8% had health insurance.
美国医生筛查B型肝炎的亚洲移民中发挥关键作用
亚洲移民和他们的后代有慢性B型肝炎的高利率,在美国达到10%。那么,什么是最好的方式,以促进在这个多元文化的筛选,免疫和治疗,高危人群吗?
家庭医生是本组中最强大的影响力根据在移民少数民族健康杂志公布的一份报告。从约翰霍普金斯大学彭博公共卫生学院在巴尔的摩,马里兰州亚裔美国人肝癌教育计划的研究人员调查了877亚洲移民,以帮助确定谁最能影响筛查和治疗的最强大的源。
受访者几乎各占一半在韩国,中国和越南的移民。平均年龄为44岁,大多数是妇女,58%受过大学教育的(只有34.9%的人声称自己英语说得很好),59.2%的人居住超过25%,他们的生活在美国,61%,60.1%经常看到医生和67.8%的健康保险。
Despite their education and access to health care, only 16.4% knew of a family history of HBV infection.
The most commonly reported sources for hepatitis B information among those surveyed were newspapers (especially among older respondents), physicians, friends, television, and the Internet (among younger, college-educated respondents). About 80% of respondents had heard of HBV from one of these sources.
Interestingly, among Vietnamese immigrants, community health fairs were the third most popular source of HBV information.
Across all groups, physicians were the most important sources of hepatitis B information and had the strongest impact on whether patients were screened. But unfortunately, health care providers often fail to screen Asian-American clients for hepatitis B despite clear practice guidelines on this topic that call for screening.
This study is the first of its kind and is expected to affect how experts develop a national HBV education campaign spear-headed by the U.S. Department of Health and Human Services in 2013.
尽管他们的教育和医疗保健的访问中,只有16.4%的人知道乙肝病毒感染的家族病史。
最常见的B型肝炎的受访者之间的信息来源是报纸(尤其是年龄较大的受访),医生,朋友,电视,互联网(其中包括年轻的,受过大学教育的受访者)。从这些来源之一,大约有80%的受访者听说过HBV。
有趣的是,在越南移民,社区卫生服务交易会是第三个最流行的的HBV信息来源。
在所有的群体,医生是最重要的B型肝炎信息来源和患者是否进行了筛选,有强烈的影响。但不幸的是,卫生保健提供者往往不能筛选亚洲和美国的B型肝炎的客户,尽管这个主题明确的实践指南,筛选的要求。
这项研究是首开先河,预计将影响一个国家HBV教育活动矛在2013年由美国卫生和人类服务部专家如何发展。
Hepatitis and Alcohol Abuse Contribute to Increase in Liver Deaths Among Addicts
An Australian study published in the journal Drug, Alcohol Dependence finds that death from liver disease—often resulting from viral hepatitis and alcohol abuse—is increasing among heroin-addicted people.
In their study, they found deaths from liver disease occurred at 9.8-times the rate in heroin-addicted people than among the general population and have been increasing over time. Viral hepatitis contributes to 76% of these deaths, and alcohol plays a role in 43% of them.
"Increased uptake of treatment for hepatitis C virus infection is crucial to reducing the burden of liver-related mortality in this population," they wrote. "Hepatitis B vaccination, and screening of (addicted) patients for alcohol use disorders and delivery of brief interventions as clinically indicated may also be of benefit."
肝炎和酒精滥用,有利于增加肝脏中死亡,其中吸毒者
澳大利亚的一项研究发表在杂志药物,酒精依赖发现,死亡的肝脏疾病,往往造成病毒性肝炎和酒精滥用增加之间的海洛因成瘾的人。
在他们的研究中,他们发现肝脏疾病的死亡发生在海洛因成瘾的人的9.8倍的速度比在普通人群中,并随着时间的推移不断增加。病毒性肝炎至76%的死亡和酒精发挥了作用,43%的人。
“治疗丙型肝炎病毒感染的摄取增加,以减少肝脏相关死亡率的负担,在这个人口是至关重要的,”他们写道。 “B型肝炎疫苗接种,筛选酒精使用障碍和提供简短的干预(上瘾)患者临床指征的,也可能是有益的。”
Formula Proposed to Treat and Monitor HBV Patients When They Receive Immune-Suppressing Drugs
Japanese researchers have crafted a formula when to treat people with current or resolved hepatitis B infections with antivirals if they receive immune-suppressing drugs for diseases such as osteoarthritis or rheumatoid arthritis.
Recently, doctors have discovered that inactive hepatitis B infections can rebound and become active when people are treated with immune-suppressing drugs. As a result, medical organizations worldwide have been trying to establish an algorithm for when to test these patients for hepatitis B, and at what point to treat them with antivirals in order to prevent a dangerous rebound in HBV infection.
The proposal promoted by Japan's College of Rheumatology (in a country where HBV infection was common) and published in the journal Modern Rheumatology makes the following recommendations:
All patients starting immunosuppressive therapy should be screened for HBsAg (which indicates a current infection.)
Those negative for HBsAg should be screened for hepatitis B core antibody (HBcAb) and hepatitis B surface antibody (HBsAb) as well (which would indicate a resolved infection.)
Patients who are HBsAg-positive and have HBV DNA in their bloodstream should receive antivirals before starting immunosuppressive therapy.
If patients are HBsAg- and HBV DNA-negative with resolved infections, they should have their ALTs and HBV DNA monitored monthly during treatment and for at least 12 months after finishing immunosuppressive treatment.
If HBV DNA becomes positive, patients should immediately receive antivirals while continuing immunosuppressive therapy to avoid liver damage. "To facilitate proper management of patients with HBV infection, collaboration between rheumatologists and hepatologists is strongly encouraged," they recommended.
建议的方案进行治疗和监控乙肝患者,当他们收到的免疫抑制药物
日本的研究人员已经制作了一个公式时使用抗病毒药物治疗或解决B型肝炎感染的人,如果他们接受免疫抑制药物的疾病,如骨关节炎和类风湿关节炎。
最近,医生们发现,失活的B型肝炎感染可出现反弹,并成为积极的,当人们与免疫抑制药物治疗。因此,全球医疗机构一直在努力建立一个算法时,以测试这些病人的B型肝炎,以及在什么时候使用抗病毒药物治疗,以防止在HBV感染危险的反弹。
促进了日本的风湿病学院(在一个国家,HBV感染是常见的),并在现代风湿病学杂志发表的建议,提出以下建议:
所有开始接受免疫抑制治疗的患者应进行筛选,乙肝表面抗原(这表示目前的感染。)
这些消极的HBsAg应进行筛选,乙肝病毒核心抗体(HBcAb)和乙肝表面抗体(HBsAb阳性),以及(这表明一个解决的感染)。
谁是病人HBsAg阳性,HBV DNA在他们的血液中免疫抑制治疗开始前应接受抗病毒药物。
如果患者乙肝表面抗原和HBV DNA阴性解决感染,他们应该有其存在的低价竞标和HBV DNA监测治疗过程中,至少有12个月的每月完成后免疫抑制治疗。
如果HBV DNA变为正时,患者应立即接受抗病毒药物,同时继续接受免疫抑制治疗,以避免肝损害。 “为了方便管理与HBV感染的患者,风湿病和肝病之间的合作,大力鼓励,他们建议。”
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