Public Health

Widespread dissemination of single HBV variant in England

Last Updated: 2004-10-14 15:01:22 -0400 (Reuters Health)

By Megan Rauscher

NEW YORK (Reuters Health) - Over a 10-year period in England, an "unexpectedly high proportion" of cases of acute hepatitis B infections were caused by a single variant, UK epidemiologists have discovered.

Molecular typing revealed this particular variant in 20 of 24 case patients. These individuals were inmates of six prisons in three regions of northern England, according to the report in the October 1st issue of Clinical Infectious Diseases.

An investigation into 266 sporadic cases of acute hepatitis B turned up the so-called "HBV prison variant" in 117 (41%). And the same variant was implicated in 11 of 51 (22%) instances of transmission occurring in England from 1997 through 2002. Transmission occurred primarily via injection drug use.

The team notes that "the finding of a single, genetically identical variant (600 bp sequenced) occupying a large niche among the circulating viruses was unexpected."

Lead investigator Dr. Rachel L. Hallett from the Health Protection Agency Colindale and the London School of Hygiene and Tropical Medicine told Reuters Health this study highlights the importance of molecular surveillance of HBV in England.

"When investigating possible transmission incidents, it is not sufficient to rely solely on DNA sequence data to implicate the source," she warned, noting that "this variant has been detected in many unrelated infections."

"The public health-related message of the study is that the current selective hepatitis B vaccination strategy adopted in Britain is failing to reach target groups of the population at risk from hepatitis B infection, and allowing this preventable disease to find an increasing niche in the community," she concluded.

In an editorial Dr. Bernhard Zollner from University Hospital Hamburg-Eppendorf in Germany warns that industrialized nations that rely on selective rather than universal HBV vaccination should "vaccinate at-risk groups consistently, such as injection drug users and prison inmates."

"The experience in Germany, however, has been that selective vaccination of at-risk groups does not lead to an eradication of HBV infection," Dr. Zollner notes. "This goal seems to be achievable only by mass vaccination of the entire population, as has been proposed by the WHO."

Clin Infect Dis 2004;39:945-954.