background
The quarterly report on enhanced molecular surveillance of acute hepatitis B is based on clinical reports of acute cases submitted to the UK Health Security Agency (british health and safety agency) is entered into HPZone and the corresponding sample is submitted british health and safety agency Bloodborne Virus Unit (BBVU) in the Virus Reference Department (virtual reality development) in Colindale.
2016, virtual reality development Reintroduction of anti-hepatitis B core affinity testing and genotyping of patient samples diagnosed with acute hepatitis B as a free service. As part of the National Enhanced Surveillance for Acute Hepatitis B, hospital microbiology and virology departments are asked to send samples to Colindale for confirmation, affinity testing, and genotyping (see Acute Hepatitis B: National Enhanced Surveillance Guidance).
Following reports of a cluster of acute hepatitis B in 2016, HPZone added the context of “acute hepatitis B” for monitoring acute cases.
method
Acute hepatitis B cases recorded in two different ways and entered into HPZone between January and June 2021 were extracted. HPZone Context “Acute Hepatitis B” data includes personally identifiable information so cases can be quickly identified and samples requested directly from the Colindale laboratory for avidity and molecular characterization.
HPZone data without personally identifiable information about acute cases (HPZone dashboard) is matched with HPZone contextual data using unique identifiers. “Acute Hepatitis B” background data matches laboratory test data from the laboratory virtual reality development Use a Microsoft Access algorithm to compare combinations of the following variables: last name, first name, date of birth, gender, and NHS number.
result
Between January and June 2021, 103 cases of acute hepatitis B (confirmed, probable and probable) were reported on the HPZone Dashboard across England.
Overall, cases imported into the HPZone have been declining since 2011: from 513 that year to 199 in 2020. Figure 1 shows the monthly number of cases in England since 2010. In 2015, there was a slight increase in cases of acute hepatitis B among men who have sex with heterosexual men (1).
Figure 1. Cumulative cases of acute hepatitis B in England entered on the HPZone dashboard: 2010 to June 2021. (Note: 2021 data are provisional)
Figure 2 shows the number of cases with personally identifiable information reported through HPZone Context each month. Additional information allows direct correspondence to be sent to the laboratory requesting residual samples for affinity and molecular characterization. Points represent the proportion of samples received from the laboratory. Figure 3 shows the distribution by region.
Figure 2. Cases from January to June 2021 enter the HPZone dashboard.Dots (right axis) show the proportion of HPZone context cases to which samples were forwarded virtual reality development
Figure 3. Cases of entering HPZone context and/or entering HPZone dashboard from January to June 2021 british health and safety agency area.Dots (right axis) show the proportion of HPZone context cases to which samples were forwarded virtual reality development
For cases reported between January and June 2021, age and gender were reported in the HPZone Context dataset and HPZone Dashboard dataset (99%). Where sexual activity was known (102 of 103 cases), sin accounted for 62.1% of cases (64 of 102 cases). The median age of patients with acute hepatitis B was 39 years (IQR: 29 to 52): 40.5 years (IQR: 31 to 54) for men and 33.5 years (IQR: 21 to 49) for women.
The age distribution by gender is shown in Table 1 . The highest proportion of cases are in the 25 to 34 and 35 to 44 age groups. The highest proportion of men is in the 35 to 44 age group, and the highest proportion of women is in the 25 to 34 age group.
Table 1. Number and proportion of acute HBV cases by gender and age group in HPZone Dashboard from January to June 2021
| age group | female | male | unknown | all |
|---|---|---|---|---|
| Under 15 years old | 3 (8%) | twenty three%) | 0(-) | 5 (5%) |
| 15 to 24 | 8 (21%) | 8 (13%) | 0(-) | 16 (16%) |
| 25 to 34 | 9 (24%) | 12 (19%) | 0(-) | 21 (20%) |
| 35 to 44 | 6 (16%) | 16 (25%) | 1(-) | 23 (22%) |
| 45 to 54 | 6 (16%) | 10 (16%) | 0(-) | 16 (16%) |
| 55 to 64 | 4 (11%) | 10 (16%) | 0(-) | 14 (14%) |
| 65 years and above | 2 (5%) | 6 (9%) | 0(-) | 8 (8%) |
| all | 38 | 64 | 1 | 103 |
Affinity testing and molecular characterization studies were performed on samples associated with the cases to confirm the diagnosis of acute hepatitis B, and additional genotyping and phylogenetic analyzes were performed to understand the diversity of circulating viruses.
Of the 30 samples submitted to virtual reality development As part of the enhanced surveillance programme, 6 samples (11%) were confirmed to be from people with chronic hepatitis B and 12 samples (89%) were confirmed to be from people with acute hepatitis B infection. Avidity testing of 3 samples was classified as undetermined and HBV infection status could not be determined with confidence, and 9 samples were not tested.
Not all cases with samples are forwarded to virtual reality development Can be matched to cases in the HPZone context; this may be because the case was not entered on HPZone or because the case was entered in the previous quarter.
A total of 12 confirmed acute cases were available for genotyping in the January to June quarter of 2021; the distribution of genotypes is shown in Table 2. Consistent with trends in 2019 and 2020, genotype A was the most commonly reported genotype, accounting for 58.3% of cases (2). Additional subgenotypic analysis of A viruses showed 100% to be A2.Distribution of genotypes seen british health and safety agency The area is shown in Figure 4.
Table 2. Genotype distribution and proportion of acute hepatitis B cases tested virtual reality development January to June 2021
| acute genotype | Number of cases | case ratio |
|---|---|---|
| arrive | 7 | 58% |
| Second | 1 | 8% |
| C | 0 | – |
| d | 3 | 25% |
| and | 1 | 8% |
| F | 0 | – |
| all | 12 | – |
Figure 4. Genotypes of acute samples sent to virtual reality development go through british health and safety agency area*
*Exclude 3 with unknown regions (genotypes A2=1, D5=1 and B3=1).
discuss
Quarterly release of enhanced molecular surveillance using matched HPZone and reference laboratory confirmation and typing data and regional segmentation enables real-time monitoring of acute hepatitis B transmission. The number of acute hepatitis B cases remained low from January to June 2021, consistent with the annual trend for the same period. Molecular analysis provides insight into currently circulating hepatitis B genotypes in England, although interpretation is limited by the small proportion of samples submitted. virtual reality development. The A2 “prisoner variant” is one of the most common strains and is already well known in the UK gay men population.
Other genotypes can indicate geographic origin, which can help understand the source of infection and transmission routes. For example, genotype D is associated with South Asia. Timely allocation of cases to the HPZone Context and improved submission of samples for molecular characterization will facilitate more comprehensive surveillance of acute hepatitis B infection in England.
refer to
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Shankar AG, Mandal S, Ijaz S (2016). “Hepatitis B outbreak among men who have sex with men but identify as heterosexual.” BMJ Sexually Transmitted Infections, Volume 92 Issue 3: Page 227.
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Public Health England (2016). ‘Acute Hepatitis B (England): Annual Report 2018’.