Megan G. Hofmeister, Shaoman Yin, Philip Dokpesi, Eyasu H. Teshale, Maribeth Eckert, Neil Gupta, Hepatitis A Outbreak Investigation Group
During 2016–2023, 37 U.S. states experienced hepatitis A outbreaks associated with person-to-person transmission. We sought to describe the epidemiology of the outbreaks and characterise outbreak response efforts over time. We analysed outbreak databases from 37 states, survey responses from 33 states, and hepatitis A case reports from the National Notifiable Diseases Surveillance System for all 50 states and Washington, DC, during August 1, 2016–December 31, 2023. Among 44,930 reported outbreak-associated cases, most occurred among males (62%), non-Hispanic White persons (65%), and those aged 30–49 years (54%); 62% were hospitalised and 1% died. Commonly reported risk factors for HAV infection were drug use (53%) and homelessness or unstable housing (14%). Sixty-seven percent of adults had a documented indication for hepatitis A vaccination. In late 2017, CDC stood up a national incident management system to coordinate communication between outbreak-affected states, facilitate vaccine delivery, and provide technical assistance. States with available data reported administering more than 5.3 million adult hepatitis A vaccines collectively; most states administered vaccines in correctional facilities, local health departments and homeless shelters. Outbreak-associated cases peaked in 2019 and then declined annually. As outbreak response capacity scaled up nationwide, states with later outbreak start dates tended to experience smaller outbreaks than those with earlier start dates. Unprecedented hepatitis A outbreaks were controlled by a robust vaccine response in 37 states. Continued vigilance and providing access to vaccination for recommended populations will be critical to preventing similar outbreaks in the future.
{"title":"Epidemiology and Control of Widespread Community Hepatitis A Outbreaks in 37 U.S. States, 2016–2023","authors":"Megan G. Hofmeister, Shaoman Yin, Philip Dokpesi, Eyasu H. Teshale, Maribeth Eckert, Neil Gupta, Hepatitis A Outbreak Investigation Group","doi":"10.1111/jvh.70137","DOIUrl":"10.1111/jvh.70137","url":null,"abstract":"<div>\u0000 \u0000 <p>During 2016–2023, 37 U.S. states experienced hepatitis A outbreaks associated with person-to-person transmission. We sought to describe the epidemiology of the outbreaks and characterise outbreak response efforts over time. We analysed outbreak databases from 37 states, survey responses from 33 states, and hepatitis A case reports from the National Notifiable Diseases Surveillance System for all 50 states and Washington, DC, during August 1, 2016–December 31, 2023. Among 44,930 reported outbreak-associated cases, most occurred among males (62%), non-Hispanic White persons (65%), and those aged 30–49 years (54%); 62% were hospitalised and 1% died. Commonly reported risk factors for HAV infection were drug use (53%) and homelessness or unstable housing (14%). Sixty-seven percent of adults had a documented indication for hepatitis A vaccination. In late 2017, CDC stood up a national incident management system to coordinate communication between outbreak-affected states, facilitate vaccine delivery, and provide technical assistance. States with available data reported administering more than 5.3 million adult hepatitis A vaccines collectively; most states administered vaccines in correctional facilities, local health departments and homeless shelters. Outbreak-associated cases peaked in 2019 and then declined annually. As outbreak response capacity scaled up nationwide, states with later outbreak start dates tended to experience smaller outbreaks than those with earlier start dates. Unprecedented hepatitis A outbreaks were controlled by a robust vaccine response in 37 states. Continued vigilance and providing access to vaccination for recommended populations will be critical to preventing similar outbreaks in the future.</p>\u0000 </div>","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sorcha Daly, Leila Reid, Ryan Buchanan, Peter McCulloch, Paul Flowers, Jamie Frankis, Gabriele Vojt
Services delivered by peer workers (people with lived/living experience) are recommended to find, test, and treat those at risk of hepatitis C (HCV). However, there is a lack of knowledge around the characteristics and underlying mechanisms of existing HCV peer interventions and how these drive effectiveness and impact. This systematic scoping review aimed to identify the activities of peer interventions, their reported outcomes, and mechanisms of change. We systematically searched five databases (Scopus, PubMed, Embase, PsycINFO and Web of Science) for peer-reviewed papers which described HCV peer interventions in OECD countries published between 2012 and 2022, informed and structured by the PRISMA extension for scoping reviews and scoping review reporting guidance. All identified studies were double screened at title and abstract and full text stage. Twenty-nine studies met our inclusion criteria. In 23 studies, peer workers delivered interventions, mostly focused on outcomes for intervention recipients. Peer workers improved HCV care linkage, testing, treatment and SVR12 rates. Peer workers themselves reported increased confidence, job satisfaction, improved mental wellbeing, employability and social integration into communities. Key activities and peer intervention elements were occasionally documented, but more often omitted. None of the included studies explicitly documented or theorised underlying mechanisms, that is, how or why peer interventions work. The lack of details and mechanistic descriptions of peer interventions negatively impact the ability to optimise and enhance peer-led HCV care. This potentially undermines the elimination of HCV at population level.
建议由同行工作者（有生活经验的人）提供服务，以发现、检测和治疗有丙型肝炎（HCV）风险的人。然而，对于现有的HCV同伴干预措施的特点和潜在机制以及这些措施如何推动有效性和影响，人们缺乏了解。这项系统的范围审查旨在确定同伴干预的活动，其报告的结果和变化机制。我们系统地检索了五个数据库（Scopus、PubMed、Embase、PsycINFO和Web of Science），检索了2012年至2022年间发表在经合组织国家中描述HCV同伴干预措施的同行评议论文，这些论文由PRISMA扩展范围审查和范围审查报告指南提供信息和结构。所有确定的研究都在标题、摘要和全文阶段进行了双重筛选。29项研究符合我们的纳入标准。在23项研究中，同伴工作者提供干预，主要关注干预接受者的结果。同行工作者改善了丙型肝炎病毒护理联系、检测、治疗和SVR12率。同辈员工自己报告说，他们的信心、工作满意度、心理健康、就业能力和社会融入程度都有所提高。关键活动和同伴干预要素偶尔被记录下来，但更经常被忽略。没有一项纳入的研究明确记录或理论化潜在机制，即同伴干预如何或为什么起作用。缺乏同伴干预的细节和机制描述对优化和加强同伴主导的HCV护理的能力产生了负面影响。这可能会破坏在人群水平上消除丙型肝炎病毒。
{"title":"Peer Interventions for Hepatitis C Testing and Treatment in OECD Countries: A Systematic Scoping Review","authors":"Sorcha Daly, Leila Reid, Ryan Buchanan, Peter McCulloch, Paul Flowers, Jamie Frankis, Gabriele Vojt","doi":"10.1111/jvh.70130","DOIUrl":"10.1111/jvh.70130","url":null,"abstract":"<p>Services delivered by peer workers (people with lived/living experience) are recommended to find, test, and treat those at risk of hepatitis C (HCV). However, there is a lack of knowledge around the characteristics and underlying mechanisms of existing HCV peer interventions and how these drive effectiveness and impact. This systematic scoping review aimed to identify the activities of peer interventions, their reported outcomes, and mechanisms of change. We systematically searched five databases (Scopus, PubMed, Embase, PsycINFO and Web of Science) for peer-reviewed papers which described HCV peer interventions in OECD countries published between 2012 and 2022, informed and structured by the PRISMA extension for scoping reviews and scoping review reporting guidance. All identified studies were double screened at title and abstract and full text stage. Twenty-nine studies met our inclusion criteria. In 23 studies, peer workers delivered interventions, mostly focused on outcomes for intervention recipients. Peer workers improved HCV care linkage, testing, treatment and SVR12 rates. Peer workers themselves reported increased confidence, job satisfaction, improved mental wellbeing, employability and social integration into communities. Key activities and peer intervention elements were occasionally documented, but more often omitted. None of the included studies explicitly documented or theorised underlying mechanisms, that is, how or why peer interventions work. The lack of details and mechanistic descriptions of peer interventions negatively impact the ability to optimise and enhance peer-led HCV care. This potentially undermines the elimination of HCV at population level.</p>","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12831103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cori Campbell, Tingyan Wang, Eleanor Barnes, Philippa C. Matthews, the UK Health Informatics Collaborative for Viral Hepatitis and Liver Disease
<p>Thank you for the opportunity to respond to the letter from Katkuri et al. [<span>1</span>]. We thank this group for providing positive feedback on our report of treatment eligibility for adults living with Hepatitis B virus (HBV) infection in the UK [<span>2</span>], which was undertaken by the Health Informatics Collaborative (HIC) for viral hepatitis and liver disease [<span>3</span>].</p><p>First, we address the feedback about the HIC approach of using a single positive HBV test as a marker of chronic infection. We recognise that this approach deviates from the gold standard of two tests over a period of at least 6 months, and may therefore (in theory) misassign some cases of acute infection as chronic. However, the decision to adopt this relaxed approach to case definition was taken and ratified by an expert board with clinical and data experts from all the HIC sites and has been previously justified, published and peer reviewed [<span>4</span>]. In England, the incidence of acute HBV infection has been declining over time, and is low (< 300 cases/year since 2020 [<span>5</span>]). The potential for acute infection to influence any analytical conclusions based on analysis of the population under chronic care clinics is therefore negligible. Based on the longitudinal follow-up in this dataset, the chances of including acute cases is further reduced (those with acute infection will not have data points for inclusion beyond 6 months under observation). By removing those with only one diagnostic test, we would risk excluding valuable data from people with true chronic infection.</p><p>Second, in considering our statistical methods and presentation of results, we agree there is a potential problem of reverse causality. On these grounds we analysed data and presented conclusions carefully, deliberately avoiding characterisation of any associations as causal. On these grounds, we simply present ‘factors associated with treatment’ without any statements on either temporality or causality, which we are indeed unable to assign in this analysis. Note that figure 1 in our paper [<span>2</span>] presents an odds ratio for ‘ever receiving’ treatment which does not imply any direction of association.</p><p>Many factors associated with treatment status (such as sex, chronic co-infection, ethnicity, and IMD quintile) are not subject to temporality. However, we recognise that the lack of significant association between viral load and treatment is likely explained by a temporality issue (viral load is lower in those receiving treatment and therefore—despite being a major part of eligibility assessment—does not emerge as a significant signal predicting treatment. This point is addressed in the paper's discussion [<span>2</span>]). We agree and acknowledge that there are limitations associated with gaps in recording of treatment start date; this is explicitly included in the original paper (section 4.5 in the discussion expands on this challenge in some de
感谢您给我机会回复Katkuri et al. b[1]的来信。我们感谢该小组对我们的报告提供了积极的反馈，该报告是由健康信息学协作组织（HIC）对病毒性肝炎和肝脏疾病[3]进行的，针对英国[3]的成人乙型肝炎病毒（HBV）感染的治疗资格。首先，我们解决了关于HIC方法的反馈，即使用单一阳性HBV检测作为慢性感染的标记。我们认识到，这种方法偏离了在至少6个月的时间内进行两次检测的黄金标准，因此（理论上）可能会将一些急性感染病例误认为是慢性感染。然而，采用这种宽松的病例定义方法的决定是由一个由来自所有卫生保健中心的临床和数据专家组成的专家委员会做出并批准的，并且此前已得到证明、发表和同行评议。在英国，随着时间的推移，急性HBV感染的发病率一直在下降，并且很低（自2020年以来每年300例）。因此，急性感染对基于慢性护理诊所人口分析的任何分析结论的潜在影响可以忽略不计。根据该数据集中的纵向随访，纳入急性病例的机会进一步降低（急性感染患者在观察6个月后将没有纳入的数据点）。通过排除那些只有一种诊断测试的人，我们可能会排除来自真正慢性感染患者的有价值数据。其次，在考虑我们的统计方法和结果的呈现时，我们同意存在反向因果关系的潜在问题。基于这些理由，我们仔细分析了数据并提出了结论，故意避免将任何关联描述为因果关系。基于这些理由，我们只是简单地提出“与治疗有关的因素”，而不作任何关于时间性或因果性的说明，因为在这种分析中，我们确实不能确定因果性。请注意，我们的论文[2]中的图1给出了“曾经接受”治疗的比值比，这并不意味着任何关联方向。许多与治疗状况相关的因素（如性别、慢性合并感染、种族和IMD五分位数）不受时间性的影响。然而，我们认识到病毒载量与治疗之间缺乏显著相关性可能是由于暂时性问题（接受治疗的患者的病毒载量较低，因此尽管是资格评估的主要部分，但并不作为预测治疗的重要信号）。这一点在本文的讨论中得到了解决。我们同意并承认在治疗开始日期的记录中存在与空白相关的限制；这在原始论文中明确包含（讨论的第4.5节对这一挑战进行了一些详细的扩展）。第三，在基于HIC数据评估治疗资格方面，确实采取了简化的方法。我们在论文中解释了原因：这一国家合作过程捕获了人口统计、成像和实验室数据，因为使用电子系统[2]稳健地捕获了定量变量。其他变量，如家族史、合并症或个人偏好，在现实世界的临床实践中通常应用于决策，但不幸的是，电子记录尚未始终如一地捕获。我们题为“注意事项和限制”的一节描述了这个问题，我们继续详细说明这些缺失参数的含义，这可能导致对个性化评估后接受治疗的比例的低估或高估。Katkuri和合著者提出了一种敏感性分析方法来调查这些缺失数据的影响。然而，当这些参数没有在整个数据集中收集时，这样的工作就不能应用（只有当队列的一个子集缺少数据时，才能进行敏感性分析，这些数据可以被定义和删除，以便进行更细粒度的重新分析）。我们在论文的未来愿望部分中进一步探索了缺失参数的方法，其中描述了对增强数据的需求。其中一些参数，如用于诊断的ICD-10代码，将允许将来扩展。其他数据，如个人偏好，在人口水平上仍然不太容易记录，因为这是患者与其护理提供者之间的微妙讨论，而现有的电子平台无法捕获。我们清楚地认识到这些注意事项，因此将我们的工作作为“初步”描述性分析。 我们同意Katkuri的观点，即这些差异在数字上很小，不会改变治疗结果的幅度或趋势，也不会影响定性结论（基于这些理由，期刊编辑团队建议不需要发表正式的勘误）。总的来说，我们非常感谢对我们的出版物的周到和详细的反馈。这次对话是一个有趣的机会，可以反思、讨论并从使用现实世界临床数据的机遇和挑战中学习。尽管存在这些警告，但我们报告的分析是建立与在人口水平上应对HBV的规划政策和服务相关的模式的垫脚石。作为一个临床和研究界，我们无疑必须继续推进和改进常规卫生服务数据的保密整理和查询方式，以了解人口水平的特征和需求。这些愿望被强调为英国国家卫生服务战略的一部分，作为推动从模拟到数字医疗的一部分。随着国际社会致力于更广泛地推广HBV治疗，将其作为推动我们到2030年消除作为公共卫生威胁的病毒性肝炎战略的组成部分，在获取高质量人口数据方面进行持续投资是一项基本愿望。弗朗西斯克里克研究所得到了英国癌症研究中心、英国医学研究理事会和威康信托基金会的核心资金支持（参考CC2223）。她还获得了伦敦大学学院医院NIHR生物医学研究中心（BRC）的资助。获得葛兰素史克公司博士奖学金资助，由P.C.M.和E.B.指导（2019-2023）。英国病毒性肝炎和肝脏疾病健康信息学合作组织承认来自NIHR和GSK的资助。P.C.M.是英国病毒性肝炎国家战略小组（NSGVH）的联合主席，从牛津大学出版社获得图书出版的版税，并从强生公司获得一次教育活动的演讲费（2025年）。E.B.拥有HBV疫苗专利，并已获得GSK和Barinthus在HBV领域的研究资金。关于“乙型肝炎病毒（HBV）在英国的治疗资格：回顾性纵向队列数据探讨临床指南变化的影响”https://doi.org/10.1111/jvh.70132.Data的评论，分享不适用于本文，因为在目前的研究中没有生成或分析数据集。
{"title":"Response to Comments on ‘Hepatitis B Virus (HBV) Treatment Eligibility in the UK: Retrospective Longitudinal Cohort Data to Explore the Impact of Changes in Clinical Guidelines’","authors":"Cori Campbell, Tingyan Wang, Eleanor Barnes, Philippa C. Matthews, the UK Health Informatics Collaborative for Viral Hepatitis and Liver Disease","doi":"10.1111/jvh.70133","DOIUrl":"10.1111/jvh.70133","url":null,"abstract":"<p>Thank you for the opportunity to respond to the letter from Katkuri et al. [<span>1</span>]. We thank this group for providing positive feedback on our report of treatment eligibility for adults living with Hepatitis B virus (HBV) infection in the UK [<span>2</span>], which was undertaken by the Health Informatics Collaborative (HIC) for viral hepatitis and liver disease [<span>3</span>].</p><p>First, we address the feedback about the HIC approach of using a single positive HBV test as a marker of chronic infection. We recognise that this approach deviates from the gold standard of two tests over a period of at least 6 months, and may therefore (in theory) misassign some cases of acute infection as chronic. However, the decision to adopt this relaxed approach to case definition was taken and ratified by an expert board with clinical and data experts from all the HIC sites and has been previously justified, published and peer reviewed [<span>4</span>]. In England, the incidence of acute HBV infection has been declining over time, and is low (< 300 cases/year since 2020 [<span>5</span>]). The potential for acute infection to influence any analytical conclusions based on analysis of the population under chronic care clinics is therefore negligible. Based on the longitudinal follow-up in this dataset, the chances of including acute cases is further reduced (those with acute infection will not have data points for inclusion beyond 6 months under observation). By removing those with only one diagnostic test, we would risk excluding valuable data from people with true chronic infection.</p><p>Second, in considering our statistical methods and presentation of results, we agree there is a potential problem of reverse causality. On these grounds we analysed data and presented conclusions carefully, deliberately avoiding characterisation of any associations as causal. On these grounds, we simply present ‘factors associated with treatment’ without any statements on either temporality or causality, which we are indeed unable to assign in this analysis. Note that figure 1 in our paper [<span>2</span>] presents an odds ratio for ‘ever receiving’ treatment which does not imply any direction of association.</p><p>Many factors associated with treatment status (such as sex, chronic co-infection, ethnicity, and IMD quintile) are not subject to temporality. However, we recognise that the lack of significant association between viral load and treatment is likely explained by a temporality issue (viral load is lower in those receiving treatment and therefore—despite being a major part of eligibility assessment—does not emerge as a significant signal predicting treatment. This point is addressed in the paper's discussion [<span>2</span>]). We agree and acknowledge that there are limitations associated with gaps in recording of treatment start date; this is explicitly included in the original paper (section 4.5 in the discussion expands on this challenge in some de","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The World Health Organisation targeted the Hepatitis B virus (HBV) for elimination as a public health threat by 2030. To achieve this goal, equitable access to HBV testing and treatment services is critical. Migrants usually experience multiple barriers to accessing HBV services. Understanding HBV prevalence among this population can support planning for HBV elimination. This systematic review aimed to estimate HBV prevalence among migrants in high-income countries with low/intermediate HBV prevalence. PubMed, Scopus, PsycINFO and Cochrane Library were searched for peer-reviewed studies published between 2015 and 2025 in English. The Joanna Briggs Institute (JBI) Critical Appraisal Tools were used for methodological quality assessment. A proportional meta-analysis was used to estimate HBV prevalence. We also estimated the prevalence of HBV surface antibody (anti-HBs) positive from the included studies. Forty-four studies were included in this review. The pooled HBV surface antigen (HBsAg) and anti-HBs prevalence were 4.4% (95% CI: 3.4%–5.5%) and 35.2% (95% CI: 26.9%–44.0%), respectively. HBsAg prevalence was higher in males (5.8%) than in females (2.4%). Migrants aged 18 years and over had higher HBsAg prevalence than those aged less than 18 years (3.5% vs. 2.1%). Among refugees and asylum seekers, HBsAg and anti-HBs prevalence were 4.2% and 31.2%, respectively. The HBV prevalence among migrants was comparable to the global level, but higher than that in the general population of countries included in this study. To improve equity in HBV elimination strategies, migrants, especially refugees and asylum seekers' access to HBV information, testing, and treatment should be facilitated.
{"title":"Prevalence of Hepatitis B Among Migrants Living in High-Income Countries With Low/Intermediate HBV Prevalence–A Systematic Review and Meta-Analysis","authors":"Jiajun Sun, Davoud Pourmarzi","doi":"10.1111/jvh.70106","DOIUrl":"10.1111/jvh.70106","url":null,"abstract":"<div>\u0000 \u0000 <p>The World Health Organisation targeted the Hepatitis B virus (HBV) for elimination as a public health threat by 2030. To achieve this goal, equitable access to HBV testing and treatment services is critical. Migrants usually experience multiple barriers to accessing HBV services. Understanding HBV prevalence among this population can support planning for HBV elimination. This systematic review aimed to estimate HBV prevalence among migrants in high-income countries with low/intermediate HBV prevalence. PubMed, Scopus, PsycINFO and Cochrane Library were searched for peer-reviewed studies published between 2015 and 2025 in English. The Joanna Briggs Institute (JBI) Critical Appraisal Tools were used for methodological quality assessment. A proportional meta-analysis was used to estimate HBV prevalence. We also estimated the prevalence of HBV surface antibody (anti-HBs) positive from the included studies. Forty-four studies were included in this review. The pooled HBV surface antigen (HBsAg) and anti-HBs prevalence were 4.4% (95% CI: 3.4%–5.5%) and 35.2% (95% CI: 26.9%–44.0%), respectively. HBsAg prevalence was higher in males (5.8%) than in females (2.4%). Migrants aged 18 years and over had higher HBsAg prevalence than those aged less than 18 years (3.5% vs. 2.1%). Among refugees and asylum seekers, HBsAg and anti-HBs prevalence were 4.2% and 31.2%, respectively. The HBV prevalence among migrants was comparable to the global level, but higher than that in the general population of countries included in this study. To improve equity in HBV elimination strategies, migrants, especially refugees and asylum seekers' access to HBV information, testing, and treatment should be facilitated.</p>\u0000 </div>","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatitis B virus (HBV) infection remains a significant public health challenge in Florida despite advancements in prevention and treatment. This review analyses the current epidemiology, disease burden and management strategies for hepatitis B in Florida as of 2025, drawing on state surveillance data and recent public health reports. Florida continues to experience higher rates of both acute and chronic hepatitis B compared to national averages, with pronounced racial, ethnic and geographic disparities. Rural areas face disproportionately high rates of acute infections, while chronic infections are more concentrated in urban centres. Despite established prevention strategies—including vaccination, perinatal prevention programs and adult testing initiatives—critical gaps persist in service delivery and care engagement. This review also highlights the growing challenges posed by declining childhood immunisation rates and limited harm reduction services in high-burden areas. Finally, we examine Florida's progress toward the World Health Organization's 2030 hepatitis elimination targets, underscoring the urgent need for expanded screening, improved linkage to care and strategies that address the social determinants driving transmission.
{"title":"The State of Hepatitis B in Florida in 2025: Current Challenges and Health Disparities","authors":"Cameron Nejat","doi":"10.1111/jvh.70136","DOIUrl":"10.1111/jvh.70136","url":null,"abstract":"<p>Hepatitis B virus (HBV) infection remains a significant public health challenge in Florida despite advancements in prevention and treatment. This review analyses the current epidemiology, disease burden and management strategies for hepatitis B in Florida as of 2025, drawing on state surveillance data and recent public health reports. Florida continues to experience higher rates of both acute and chronic hepatitis B compared to national averages, with pronounced racial, ethnic and geographic disparities. Rural areas face disproportionately high rates of acute infections, while chronic infections are more concentrated in urban centres. Despite established prevention strategies—including vaccination, perinatal prevention programs and adult testing initiatives—critical gaps persist in service delivery and care engagement. This review also highlights the growing challenges posed by declining childhood immunisation rates and limited harm reduction services in high-burden areas. Finally, we examine Florida's progress toward the World Health Organization's 2030 hepatitis elimination targets, underscoring the urgent need for expanded screening, improved linkage to care and strategies that address the social determinants driving transmission.</p>","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12813733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hee Yeon Kim, Hae Lim Lee, Heechul Nam, Soon Kyu Lee, Ji won Han, Hyun Yang, Ahlim Lee, Pil Soo Sung, Seok-Hwan Kim, Jihye Lim, Do Seon Song, Myeong Jun Song, Jeong Won Jang, U Im Chang, Chang Wook Kim, Soon Woo Nam, Si Hyun Bae, Seung Kew Yoon, Jung Hyun Kwon, Sung Won Lee
Despite advances in hepatitis C virus (HCV) treatments, diagnostic gaps and linkage-to-care hinder elimination efforts. We evaluated an electronic medical record (EMR)-based automated alert system to improve HCV care at tertiary referral centers. We have screened 1,303,578 patients who were tested for anti-HCV, and analyzed 8291 patients positive for anti-HCV antibody (Ab) across four tertiary hospitals between July 2009 and December 2023. The EMR alert system, implemented in June 2021, identified patients with positive anti-HCV antibody results who had not undergone HCV ribonucleic acid (RNA) testing. We compared HCV RNA testing rates, linkage-to-care and time intervals between testing before and after system implementation. The HCV RNA test prescription rate increased from 60.5% in the pre-alert period to 66.9% in the post-alert period. In non-hepatology departments, the prescription rate increased from 47.1% to 60.5%. The interval between HCV Ab positivity to HCV RNA test prescription in patients without initial HCV RNA order decreased significantly from 1208.9 to 244.5 days. Among 732 previously HCV RNA untested patients who were followed up after alert implementation, 43.4% received HCV RNA testing, leading to 62 new HCV diagnoses. The referral rate to hepatology departments remained stable (83.3% pre-alert vs. 80.9% post-alert). In conclusion, implementation of an EMR-based alert system effectively improved HCV diagnostic rates and reduced testing delays, particularly in non-hepatology departments. This system represents a promising strategy for hospital-based HCV micro-elimination, but additional interventions might be needed to achieve optimal testing rates and linkage-to-care.
{"title":"Challenges of an EMR-Based Hospital Alert Program for Micro-Elimination of Hepatitis C in Tertiary Referral Hospitals","authors":"Hee Yeon Kim, Hae Lim Lee, Heechul Nam, Soon Kyu Lee, Ji won Han, Hyun Yang, Ahlim Lee, Pil Soo Sung, Seok-Hwan Kim, Jihye Lim, Do Seon Song, Myeong Jun Song, Jeong Won Jang, U Im Chang, Chang Wook Kim, Soon Woo Nam, Si Hyun Bae, Seung Kew Yoon, Jung Hyun Kwon, Sung Won Lee","doi":"10.1111/jvh.70134","DOIUrl":"10.1111/jvh.70134","url":null,"abstract":"<div>\u0000 \u0000 <p>Despite advances in hepatitis C virus (HCV) treatments, diagnostic gaps and linkage-to-care hinder elimination efforts. We evaluated an electronic medical record (EMR)-based automated alert system to improve HCV care at tertiary referral centers. We have screened 1,303,578 patients who were tested for anti-HCV, and analyzed 8291 patients positive for anti-HCV antibody (Ab) across four tertiary hospitals between July 2009 and December 2023. The EMR alert system, implemented in June 2021, identified patients with positive anti-HCV antibody results who had not undergone HCV ribonucleic acid (RNA) testing. We compared HCV RNA testing rates, linkage-to-care and time intervals between testing before and after system implementation. The HCV RNA test prescription rate increased from 60.5% in the pre-alert period to 66.9% in the post-alert period. In non-hepatology departments, the prescription rate increased from 47.1% to 60.5%. The interval between HCV Ab positivity to HCV RNA test prescription in patients without initial HCV RNA order decreased significantly from 1208.9 to 244.5 days. Among 732 previously HCV RNA untested patients who were followed up after alert implementation, 43.4% received HCV RNA testing, leading to 62 new HCV diagnoses. The referral rate to hepatology departments remained stable (83.3% pre-alert vs. 80.9% post-alert). In conclusion, implementation of an EMR-based alert system effectively improved HCV diagnostic rates and reduced testing delays, particularly in non-hepatology departments. This system represents a promising strategy for hospital-based HCV micro-elimination, but additional interventions might be needed to achieve optimal testing rates and linkage-to-care.</p>\u0000 </div>","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2015, Georgia launched a hepatitis C elimination programme with free screening and treatment. However, a large number of persons were lost to follow up after screening for, or diagnosis with, hepatitis C virus (HCV) infection. During February 2023–September 2024, we conducted active outreach to reengage persons who were lost to follow-up in care and assess barriers to hepatitis C care and treatment through questionnaires covering pre- and post-outreach perceptions. Among 18,034 persons who tested HCV antibody (anti-HCV) reactive but were not tested for HCV viremia and had valid contact information, 14,252 (79%) could be reached, among whom 64% were unaware of their test result. After outreach, 4593 (32%) completed HCV viremia testing, among whom 2440 (53%) tested positive and 1577 (65%) initiated treatment. Main reasons for not seeking care after active outreach were having another chronic illness (33%) and being unaware they were screened for anti-HCV (23%). Among 13,151 persons diagnosed with HCV infection who did not initiate treatment and had valid contact information, 6982 (53%) were reached, among whom 2267 (33%) initiated treatment. The main reason for not initiating treatment before outreach was lack of information (62%) and after outreach was distrust in the hepatitis C elimination programme (79%). Treatment initiation was more common among those first tested in recent years. Active outreach successfully identified new infections and nearly 40% of those diagnosed initiated treatment. Educating patients about their test results and promptly linking them to care and treatment is essential to achieve hepatitis C elimination.
{"title":"Identifying and Linking to Care and Treatment Persons With Hepatitis C Who Were Lost to Follow-Up, Georgia 2023–2024","authors":"Vladimer Getia, Paata Imnadze, Eka Adamia, Maia Tsereteli, Maia Alkhazashvili, Sophia Surguladze, Irina Tskhomelidze Schumacher, Nancy Glass, Shaun Shadaker, Rania A. Tohme","doi":"10.1111/jvh.70135","DOIUrl":"10.1111/jvh.70135","url":null,"abstract":"<div>\u0000 \u0000 <p>In 2015, Georgia launched a hepatitis C elimination programme with free screening and treatment. However, a large number of persons were lost to follow up after screening for, or diagnosis with, hepatitis C virus (HCV) infection. During February 2023–September 2024, we conducted active outreach to reengage persons who were lost to follow-up in care and assess barriers to hepatitis C care and treatment through questionnaires covering pre- and post-outreach perceptions. Among 18,034 persons who tested HCV antibody (anti-HCV) reactive but were not tested for HCV viremia and had valid contact information, 14,252 (79%) could be reached, among whom 64% were unaware of their test result. After outreach, 4593 (32%) completed HCV viremia testing, among whom 2440 (53%) tested positive and 1577 (65%) initiated treatment. Main reasons for not seeking care after active outreach were having another chronic illness (33%) and being unaware they were screened for anti-HCV (23%). Among 13,151 persons diagnosed with HCV infection who did not initiate treatment and had valid contact information, 6982 (53%) were reached, among whom 2267 (33%) initiated treatment. The main reason for not initiating treatment before outreach was lack of information (62%) and after outreach was distrust in the hepatitis C elimination programme (79%). Treatment initiation was more common among those first tested in recent years. Active outreach successfully identified new infections and nearly 40% of those diagnosed initiated treatment. Educating patients about their test results and promptly linking them to care and treatment is essential to achieve hepatitis C elimination.</p>\u0000 </div>","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Weixi Tang, Yuanji Ma, Lingyao Du, Lang Bai, Hong Tang
This study investigates the impact of the indirect bilirubin percentage-to-albumin ratio (iBAR) on the prognosis of patients with acute-on-chronic liver failure (ACLF), as defined by the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH ACLF) criteria, who were treated with an artificial liver support system (ALSS). In a retrospective cohort of 258 eligible patients, restricted cubic splines, linear regression, and Cox proportional hazards models were used to analyse the association of iBAR with disease severity and 28-day and 90-day outcomes. The 28-day transplant-free and overall survival rates were 76.4% and 82.2%, respectively, while the 90-day rates were 58.5% and 66.3%. The iBAR was significantly lower in 28-day transplant-free survivors compared to those who underwent transplantation or died (6.47 ± 2.95 vs. 8.87 ± 2.49, p < 0.001), with similar findings for 90-day outcomes (6.09 ± 2.75 vs. 8.38 ± 2.88, p < 0.001). A positive association was observed between iBAR and COSSH ACLF score (adjusted β = 0.14, 95% CI: 0.11–0.18, p < 0.001). Furthermore, iBAR was independently associated with higher risks of 28-day transplant-free mortality (adjusted HR = 1.21, 95% CI: 1.10–1.34, p < 0.001), 28-day overall mortality (adjusted HR = 1.26, 95% CI: 1.12–1.42, p < 0.001), 90-day transplant-free mortality (adjusted HR = 1.13, 95% CI: 1.06–1.22, p < 0.001), and 90-day overall mortality (adjusted HR = 1.14, 95% CI: 1.05–1.23, p = 0.002). Patients with an iBAR > 6.13 had significantly poorer 28-day and 90-day prognoses compared to those with iBAR ≤ 6.13 (all adjusted HR > 1, p < 0.05). In conclusion, iBAR is positively associated with disease severity and adverse prognosis in COSSH ACLF patients receiving ALSS therapy, suggesting its potential as a prognostic biomarker that warrants validation in future prospective, multicenter studies.
本研究探讨了间接胆红素百分比-白蛋白比（iBAR）对急性-慢性肝衰竭（ACLF）患者预后的影响，ACLF是中国重型乙型肝炎ACLF研究小组（COSSH ACLF）标准定义的，接受人工肝支持系统（ALSS）治疗。在258例符合条件的患者的回顾性队列中，使用限制三次样条、线性回归和Cox比例风险模型来分析iBAR与疾病严重程度以及28天和90天预后的关系。28天无移植生存率和总生存率分别为76.4%和82.2%，90天生存率分别为58.5%和66.3%。与接受移植或死亡的患者相比，28天无移植幸存者的iBAR显著降低（6.47±2.95 vs. 8.87±2.49,p . 6.13），与iBAR≤6.13的患者相比，iBAR≤6.13的患者的28天和90天预后明显较差（所有调整后的HR bb1， p . 6.13）
{"title":"Association Between Indirect Bilirubin Percentage to Albumin Ratio and Outcome of Hepatitis B Related Acute on Chronic Liver Failure Treated With Artificial Liver Support System","authors":"Weixi Tang, Yuanji Ma, Lingyao Du, Lang Bai, Hong Tang","doi":"10.1111/jvh.70131","DOIUrl":"10.1111/jvh.70131","url":null,"abstract":"<div>\u0000 \u0000 <p>This study investigates the impact of the indirect bilirubin percentage-to-albumin ratio (iBAR) on the prognosis of patients with acute-on-chronic liver failure (ACLF), as defined by the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH ACLF) criteria, who were treated with an artificial liver support system (ALSS). In a retrospective cohort of 258 eligible patients, restricted cubic splines, linear regression, and Cox proportional hazards models were used to analyse the association of iBAR with disease severity and 28-day and 90-day outcomes. The 28-day transplant-free and overall survival rates were 76.4% and 82.2%, respectively, while the 90-day rates were 58.5% and 66.3%. The iBAR was significantly lower in 28-day transplant-free survivors compared to those who underwent transplantation or died (6.47 ± 2.95 vs. 8.87 ± 2.49, <i>p</i> < 0.001), with similar findings for 90-day outcomes (6.09 ± 2.75 vs. 8.38 ± 2.88, <i>p</i> < 0.001). A positive association was observed between iBAR and COSSH ACLF score (adjusted β = 0.14, 95% CI: 0.11–0.18, <i>p</i> < 0.001). Furthermore, iBAR was independently associated with higher risks of 28-day transplant-free mortality (adjusted HR = 1.21, 95% CI: 1.10–1.34, <i>p</i> < 0.001), 28-day overall mortality (adjusted HR = 1.26, 95% CI: 1.12–1.42, <i>p</i> < 0.001), 90-day transplant-free mortality (adjusted HR = 1.13, 95% CI: 1.06–1.22, <i>p</i> < 0.001), and 90-day overall mortality (adjusted HR = 1.14, 95% CI: 1.05–1.23, <i>p</i> = 0.002). Patients with an iBAR > 6.13 had significantly poorer 28-day and 90-day prognoses compared to those with iBAR ≤ 6.13 (all adjusted HR > 1, <i>p</i> < 0.05). In conclusion, iBAR is positively associated with disease severity and adverse prognosis in COSSH ACLF patients receiving ALSS therapy, suggesting its potential as a prognostic biomarker that warrants validation in future prospective, multicenter studies.</p>\u0000 </div>","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comments on “Hepatitis B Virus (HBV) Treatment Eligibility in the UK: Retrospective Longitudinal Cohort Data to Explore the Impact of Changes in Clinical Guidelines”","authors":"Sushma Narsing Katkuri, Varshini Vadhithala, Arun Kumar, Sushma Verma, Dhanya Dedeepya","doi":"10.1111/jvh.70132","DOIUrl":"10.1111/jvh.70132","url":null,"abstract":"","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Habiba Kamal, Ganbolor Jargalsaikhan, Sanjaasuren Enkhtaivan, Daniel Bruce, Karin Lindahl, Bekhbold Dashtseren, Tuvshinjargal Ulziibadrakh, Munguntsetseg Batkhuu, Purevjargal Bat-Ulzii, Sumiya Byambabaatar, Soo Aleman, Naranjargal B. Dashdorj
Chronic liver diseases cause a significant burden in Asia. This study aims to characterise the pattern and factors associated with advanced chronic liver disease (aCLD) in a large cohort from Mongolia, which has the highest rate of liver cancer globally. This is a cross-sectional analysis of HBsAg tested adults (≥ 18 years) with available liver stiffness measurement (LSM) and/or platelet count at initial visit at a hepatology centre, Ulaanbaatar, Mongolia during 2015–2023. Definition of aCLD was LSM ≥ 12.5 kPa or platelet count < 150*109 cells/L. The annual percentage change (APC) of the incidence rates and factors associated with aCLD were assessed via logistic regression models. Out of 17,711 persons identified, 2517 (14.2%) had aCLD at initial visit, with a mean age (±SD) of 50.1 (12.0) years, 23.6% below 40 years old and 53.2% were female. The prevalence of HBsAg+, anti-HDV+, HDV RNA+, and anti-HCV+ was 61.6%, 78.6%, 64.6% and 57.9% in aCLD, respectively. Among aCLD, three-fourths had an intermediate to high 5-year risk of hepatocellular carcinoma (HCC) with 25.0%, and 17.1% having previously received anti-HBV and anti-HCV therapies, respectively. The overall rate of aCLD declined (APC −7.8%), mainly due to decline in anti-HCV+ cases (APC −15.0%), while it significantly increased for anti-HDV+ over study period (APC 3.3%). In a large cohort of attendees at a hepatology centre in Mongolia, the prevalence of aCLD declined associated with decreasing HCV infection, while chronic hepatitis D constituted the majority of increasing cases. A minority received therapy, with most patients showing an intermediate to high risk of liver cancer. More efforts are needed to improve linkage to care and access to therapy, especially in middle-aged individuals at higher risk of liver disease progression.
{"title":"Trends of Advanced Chronic Liver Disease Among 17,711 Persons in Mongolia During Years 2015–2023","authors":"Habiba Kamal, Ganbolor Jargalsaikhan, Sanjaasuren Enkhtaivan, Daniel Bruce, Karin Lindahl, Bekhbold Dashtseren, Tuvshinjargal Ulziibadrakh, Munguntsetseg Batkhuu, Purevjargal Bat-Ulzii, Sumiya Byambabaatar, Soo Aleman, Naranjargal B. Dashdorj","doi":"10.1111/jvh.70129","DOIUrl":"10.1111/jvh.70129","url":null,"abstract":"<p>Chronic liver diseases cause a significant burden in Asia. This study aims to characterise the pattern and factors associated with advanced chronic liver disease (aCLD) in a large cohort from Mongolia, which has the highest rate of liver cancer globally. This is a cross-sectional analysis of HBsAg tested adults (≥ 18 years) with available liver stiffness measurement (LSM) and/or platelet count at initial visit at a hepatology centre, Ulaanbaatar, Mongolia during 2015–2023. Definition of aCLD was LSM ≥ 12.5 kPa or platelet count < 150*10<sup>9</sup> cells/L. The annual percentage change (APC) of the incidence rates and factors associated with aCLD were assessed via logistic regression models. Out of 17,711 persons identified, 2517 (14.2%) had aCLD at initial visit, with a mean age (±SD) of 50.1 (12.0) years, 23.6% below 40 years old and 53.2% were female. The prevalence of HBsAg+, anti-HDV+, HDV RNA+, and anti-HCV+ was 61.6%, 78.6%, 64.6% and 57.9% in aCLD, respectively. Among aCLD, three-fourths had an intermediate to high 5-year risk of hepatocellular carcinoma (HCC) with 25.0%, and 17.1% having previously received anti-HBV and anti-HCV therapies, respectively. The overall rate of aCLD declined (APC −7.8%), mainly due to decline in anti-HCV+ cases (APC −15.0%), while it significantly increased for anti-HDV+ over study period (APC 3.3%). In a large cohort of attendees at a hepatology centre in Mongolia, the prevalence of aCLD declined associated with decreasing HCV infection, while chronic hepatitis D constituted the majority of increasing cases. A minority received therapy, with most patients showing an intermediate to high risk of liver cancer. More efforts are needed to improve linkage to care and access to therapy, especially in middle-aged individuals at higher risk of liver disease progression.</p>","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12771268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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