Reuters Health Information (2004-10-14): Widespread dissemination of single HBV variant in England
Widespread dissemination of single HBV variant in England
Last Updated: 2004-10-14 15:01:22 -0400 (Reuters Health)
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
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
Clin Infect Dis 2004;39:945-954.