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Background and Purpose : The prevalence of Hepatitis B in ÜSÂ was reported 0.5- 0.1 % while in Ïran is 1.6- 6.5 %. Ït was reported that the titer of antibody three days after vaccination was 79-90 %. The titer of antibody decreases with the pass of time, and age has a significant role in the respones to vaccination. This study was performed in order to evaluate the HBS titer after vaccination against hepatitis and the rate of its decline as time passes in the nursing staff of Gaemshahr Razi Hospital.
Materials and Methods: This was a Çross- sectional study, done on 183 nursing staff. 4cc blood was collected from each person at the same time vaccination was repeated. The history of vaccination was reported in a questionnaire paper by the same candidate. HBSÂg and HBSÂb were measured quantitatively with using Ëuro kit by ËLÏSÂ method.
Results: 1.6 % of staff were HBSÂg positive. 54.1%, 13.1% and 10.9% staff received vaccine three times, two times and once and 86%, 71% and, 55% of them had antibody titer more than 10 mu/ml respectively. 21.9% of them were not vaccinated, but 12.5% of them had antibody titer more than 10 mu/ml as time pass there was a decline in antibody titer. So that 94.1% of them in the first year declined to 67.8% in the next fifth year and the age above 40 years had a negative effect on antibody formation.
Çonclusion: Ôld age and numbers of vaccinations has a significant role in the responses to vaccine, and with time the titer of HBS antibody declines, so a booster dose should be considered.

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Background and purpose: Hepatitis B infection (HBV) is a world wide health problem, and about 2-10% of the infected persons will be prone to permanent liver conditions, of which, one third will have chronic liver disease and get cirrhosis, liver Çarcinoma. Some people such as permanent blood products receivers, health services staff, addicts, neonates from chronic carrier mothers etc more in risk of being infected. Hepatitis B vaccine is one of the safest and effective vaccine which can prevent hepatitis B infection. The question is that, the acquired immunity due to a complete series of vaccination, lasts for how long and whether booster doses are required. The purpose of this study was to determine the immunity status of vaccinated above mentioned cases, six years after vaccination.
Materials and Methods: This research was a descriptive- analytical study done in the above mentioned high risk groups individuals who received a complete series of HBV vaccination six years ahead. Ântibody against HBV was essayed by ËLÏSÂ method quantitatively.
Results: Total of 81 health services staff and 98 thalassemic patients were undertaken for the study. Six (7.4%) persons of the health staff and 22(22%) of the thalassemic patients had infection. There was statistically a significant difference by X2 method. P<0.01, DF=1, Xz= 7.58.
Çonclusion: Ôn the basis of the results of this study and determination of previous studies, the methods of prevention of hepatitis B infection in the previously vaccinated individuals, varies in different high risk groups. Ïn the health services staff due to long lasting of absolute immunity in more than 90%, there is no need of routine assay of antibody after complete vaccination of HBV or administration of booster dose each five year interval. Ïn the thalassemic patient inspite of reduction in the number of persons with absolute immunity, but due to its presence in more than three- fourth of the patients and partial immunity in the others, screening of transfused blood products for HBV and reduction of the HB infection cases due to transfusion, assay of antibody or booster dose in less than 10 years is not recommended in this group. Vaccination of above mentioned high risk group is compulsory infection.

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Background and purpose : Hepatitis B viral infection (NBÏ) and its sequelae are a major worldwide health problem. The most effective way to contral and prevent HBÏ is univerral immunization with hepatitis B vaccine (HBÏ). But the most limitation of it is inadequate resource. The aim of this study is to evaluate the immunogenitity of low dose immtradermal (ÏD) HBV, according to routine intramuscular (ÏM) route.
Materials and Methods : Â clinical trial study on 113 fullterm neonates from HBSÂg. Negative mothers in two case and control groups was conduted. Çase group received 2 μg ÏD HBV, and contral group recived 10 μg ÏM HBV at 0, 105 and 6 moths of age. 4 wks after last dose serum Ânti HBSÂg Ântibody titer was quantitied by ËLÏSÂ.
Results : The results showed 19 out of 23 (82.6%) in case and 27 out of 28 (96.4%) in control group had complete response (10 ÏÜ/ml ≤). The difference by X2 was not significant. The mean geometelic titer (GMT) in case was 447 ± 336 and in contral 658 ± 378, the difference by X2 was significant,
Çonclusion : Âccording to obtained data, low dose ÏD HBV can induce comparable immunologic response. But funther studies with larger sample size and detection of durability of protection isneeded.

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Background and purpose: The aim of the present study was to identify the true extent of non-responsiveness in children vaccinated against Hepatitis B virus (HBV) ten years ago at birth whom were serologically susceptible to HBV,and had poor antibody response to booster HBV vaccine.
Materials and Methods: Twenty low-and non-responding 11.5 years old children recuited in by another study received three additional doeses of HB vaccine 4-6 weeks apart. Anti-HbS antibody titers were assessed before and 4-6 weeks after each dose of vaccine by using ELISA method.
Results: All children showed anamnestic antibody responses after receiving the first additional dose of vaccine. There was no significant differences between the mean concentration of antibody after the first, second and third doses of vaccine.
Conclusion: Study results showed that those children who did not respond to booster does of the HB vaccine may not be real non-responder.HB vaccine at infancy induces long-time immunologic memory which provides seroprotection by exposure to HBs-Ag.

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Background and purpose: Vaccination is the most effeetive method of prophylaxy in high risk group of hepatitis B. Some individuals faile to respond to triple doses of vaccine which is potentially dangerous. Therefore, immunogenecity of triple doses recombinant hepatitis B vaccine was evaluated in a high risk group (medical sciences students).
Materials and Methods: 193 healthy medical sciences students immunized with triple doses of recombinant hepatitis B vaccine (0,1,6 months). 1-2 months after the last dose, serum anti HBS antibody was determined by ELISA method. According to the antibody titer of the vaccinees (IU/L) they were classified into none responder, low, intermediate and high responder. The none responders were recommended for re-vaccination.
Results: Three students (1.6%) were detected as non responder. (<10 Iu/L anti HBS antibody), 23 (11/4%) as low responder, 141 (73%) as intermediate responder and 26 (13.5%) as high responder.
Conclusion: The prevolence of non responders to triple doses of recombinant hepatitis B vaccine in medical sciences students was very low.

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Background and purpose: Hepatitis Delta Virus (HDV) agent, or HDV, is a defective RNA virus that infects with HBV (Hepatitis B Virus). 15 millions people around the world are infected to HDV. There are different statistics in Iran and other countries about HDV incidence, according to accomplished studies. This study was done for determining HDV incidence in sari and considering its correlative factors.
Materials and methods: This study was done in a descriptive procedure on 167 patients. Correlative factors like demographic data and the ways of receiving disorder, history of tattoo, blood transfusion, were multi partner and IV drug abusers were considered. Diagnosing of blood Anti HDV in patients was by ELISA (Enzyme-Linked ImmunoSorbent Assay) way.
Results: We couldn’t find any evidences of advantage of HDV in patients. Among 167 HBS-Ag positive subject (63 (%37.7) women and 104 (%62.3) men) were included. Average age of participants was 35.52±14.036. 2 subject had an addiction history (%1.7), 15 subject (%9) had a blood transfusion history, 4 (%2.4) were multipart and 1 (%0.6) had tattoo history and 2 (%1.2) were Prisoners previously.
Conclusion: There wasn’t any positive Anti-HDV Ab (Anti- Hepatitis Delta Virus Antibody) in studied patients. It shows that HDV is not endemic in sari.

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Background and purpose:Occult hepatitis B infection (OBI) is a form of hepatitis in which despite the absence of detectable HBsAg, HBV-DNA is present in peripheral blood of patients. Investigators believed that the genetics and immunological parameters may be different in resistant individuals and patients. Cytokines, such as IL-12, could be leading to alteration in viral immune response. The main aim of this study was to investigate the serum level of IL12 in OBI patients.
Materials and methods:In this study, the plasma samples of 3700 HBsAg negative blood donors were tested for anti-HBs by ELISA. The HBsAg negative and anti-HBc positive samples were selected and screened for HBV-DNA by PCR. HBV-DNA positive samples were assigned as OBI cases and ELISA technique were performed to examine the serum level of IL-12 in OBI and 100 healthy controls.
Results:Our results showed that there was no significant difference in serum level of IL-12 between OBI patients and controls.
Conclusion:In order to be clear of viruses, L-12 is increased in viral infection. Based on the results of this study, it is concluded that OBI patients can not produce enough IL-12 to clear HBV.

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Background and purpose: Hepatitis B virus (HBV) is a major global health problem. The prevalence of HBV infection varies throughout regions of the world. More than 350 million people live with chronic HBV infection and many different clinical symptoms are associated with it. Long-term complications of HBV infection lead to cirrhosis of the liver and hepatocellular carcinoma. Consequently, 0.5-1.2 million death occurs every year. However, early diagnosis and appropriate treatment could reduce such complications. This study intended to investigate the correlation of serum concentrations of HBV-DNA and HBeAg with liver enzymes. Materials and methods: In this cross-sectional study, serum samples of 146 chronic hepatitis B patients were studied. They referred to RaziTeaching Hospital, Qaemshahr, from 2007 to 2009. The subjects were assessed regarding HBV-DNA, HBeAg and ALT enzymes. The patients’ serum was extracted and Real Time PCR test was performed using HBV RG Kit (Nov in Gene). Afterwards, the patients’ medical records were studied and the data was analyzed using Pearson correlation coefficient and t-test in SPSS. Results: From the total of 146 patients, 94 were found negative HBeAg and 52 were HBeAg positive. No correlation was seen between HBV-DNA level and AST enzyme, while there was a significant relationship between HBV-DNA level and ALT enzyme. Conclusion: ALT enzyme is a reliable indicator for severity of liver involvement even in negative HBeAg stages and hidden period of the disease. Hence, the serum levels of HBV-DNA and ALT should be measured in such individuals before developing liver cirrhosis and thereby starting immediate antiviral therapy.

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Background and purpose: Vaccination against hepatitis B is one of the most important ways to prevent this viral disease. However, some individuals vaccinated against hepatitis B do not show adequate defense. This study was designed to investigate the immune response towards this disease by assessing the level of hepatitis B antibody in vaccinated health care workers (HCWs) in north of Iran . Material and Methods: This descriptive– cross sectional study was carried out in 2013 in which 117 HCWs of Amol 17 Shahrivar Hospital were studied. Levels of hepatitis B surface antibody were measured in serum samples using ELISA kit. The results were analyzed considering elapsed time of vaccination, and age and gender of the subjects. Results: Among the studied HCWs 79 (67.5%) had complete vaccination while 38 (32.5%) had incomplete vaccination. Immune response was found in safe level in 98 (83.3%) and non-safe in19 (16.2%) (titer below 10mlu/ml). There was a significant correlation between hepatitis B surface antibody levels and elapsed time of vaccination (p<0.05). The antibody titers was higher in women and individuals younger than 40 years of age, however, this difference was not significant (p>0.05). Conclusion: Findings suggest that vaccination against hepatitis B does not guarantee a complete immunity and the level of immunity is very much affected by elapsed time of vaccination. Although women were found with higher antibody titers in this study.

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Background and purpose: Infection caused by hepatitis B virus is a major health problem and the most common known chronic infection. It has an important role in developing cirrhosis and hepatic cancer. Glutathione-s-transferase enzyme is one of the most important metabolic enzymes in cellular protection mechanisms such as: xenobiotic detoxification and metabolism and cells protection against harms caused by oxidative stress which prevents different diseases. This study aimed at determining the frequencies of GSTT1 polymorphisms in chronic hepatitis B infection. Material and methods: In this case-control study, 100 chronic hepatitis B patients and 100 normal subjects from Mazandaran province were evaluated for GST T1 polymorphism. Both patient’s and control’s Genomic DNA was extracted from peri pheral white blood cells according to Salting out method. Multiplex-PCR was done for detection of GST T1 gene polymorphism in both groups. Data was analyzed using SPSS V.18 and P<0.05 was considered significant. Results: In present study, 200 people including 94 men and 106 women were examined. All subjects were from the same race and geographic area. Results showed an increase in the number of null GST T1 allele in patients (0.95% CL: 1.724 - 5.974, OR: 3.209, P ≤ 0.001). Conclusion: GST T1 null allele was a factor leading to chronic hepatitis B and hepatic injuries in studied population in Mazandaran province.

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Background and purpose: Cytokines are a group of endogenous proteins which play an influential role in regulating the inflammatory responses and defeating infectious diseases. Elevated levels of proinflammatory cytokines and their receptors are usually observed in association with immune responses against viral infections such as hepatitis B virus (HBV) infection. IL 12 and its receptor play an important role in the clearance of viral infections, especially HBV. The aim of this study was to investigate the association between interleukin 12 receptor B1 gene single nucleotide polymorphism (rs3746190 A/G) and chronic HBV infection susceptibility.

Materials and methods: In a case control study, genomic DNA of 150 chronic HBV infected patients and 150 healthy controls was extracted by salting out method and single nucleotide polymorphism (rs3746190 A/G) was genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

Results: A total of 300 individuals were studied. The frequency of rs3746190 A/G gene for CC, CT, TT genotypes was 40.7%, 46%, and 13.3% in chronic patients and 38%, 49.3%, and 12.7% in control group, respectively. After genotyping and statistical analysis, no significant difference was seen between the cases and controls (P=0.845).

Conclusion: This study did not find any significant association between rs3746190 A/G single nucleotide polymorphism of the IL12RB1 gene and susceptibility to chronic hepatitis B virus infection. Therefore, polymorphism in gene IL12RB1 is not an effective factor for susceptibility to chronic HBV.

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Background and purpose: Personality disorders may lead to addiction and viral diseases. On the other hand, addiction and viral infections also cause mental and personality disorders. This research aimed at comparing personality disorders and clinical symptoms between male prisoners.

Materials and methods: A cross–sectional study was conducted in male prisoners in Quchan, Iran, 2014. Three groups (healthy, addict, and viral infection) including 200 prisoners were selected using systematic sampling. Millon Clinical Multiaxial Inventory (MCMI-III) was administered. The multivariate analysis (MANOVA) was applied in SPSS V. 11.5.

Results: There was significant differences between the three groups in schizoid, dependent, histrionic, narcissistic, antisocial, sadistic, and masochistic personality disorders (P<0.001). Significant differences were found between patients and addicts, and healthy prisoners in avoidance, OCD, passive- aggressive, schizotypal and borderline disorders (P<0.001), but this difference were not significant between patients and addicts (P>0.001). In paranoid scale, there was a significant difference between addicts and healthy prisoners (P<0.001), but the difference between other groups was not significant (P>0.001).

Conclusion: Mental disorders were found to be more prevalent in addict prisoners and those with viral infections, therefore, effective psychological interventions are highly recommended for prisoners.

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Background and purpose: Recently, use of enzyme-linked immunosorbent assay (ELISA) and rapid Immunochromatographic test (ICT) in diagnosis and screening of patients with hepatitis B reduced the risk of hepatitis during blood transfusion. However, the incidence of hepatitis B is very high in high-risk patients such as hemodialysis, thalassemia and hemophilia which receive a lot of blood transfusions. Also, due to the infection with mutant type of hepatitis B virus (HBV) and false negative results, using molecular tests such as polymerase chain reaction (PCR) are necessary for detection of HBV. In this study we aimed to compare the efficacy of ELISA and rapid ICT kits with gold standard real time PCR for the detection of HBV in high risk patients.

Materials and methods: In a cross-sectional study, 100 patients consisting of hemodialysis, thalassemia and hemophilia were assessed by real time PCR as the gold standard for detection of HBV DNA, fourth-generation ELISA kits including Dia-pro®, Pishtazteb®, Pasteur® and ICT Ecotest® were applied for detection of HBSAg.

Results: Compared with real time PCR, sensitivity and specificity of fourth generation ELISA kits was 100% and positive predictive value (PPV) and negative predictive value (NPV) were 100%.

Conclusion: Recent improvements in the monoclonal antibody production against mutant hepatitis B virus and their application in fourth-generation ELISA and rapid ICT kits resulted in significant increase in sensitivity and specificity of these methods. Thus, in emergency cases or lack of real-time PCR instruments, rapid ICT and ELISA kits could be suggest for detection of HBsAg.

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Background and purpose: Viral hepatitis is a systemic infection that mainly affects the liver. We studied the prevalence of skin lesions and infectious diseases including hepatitis A and B virus infection in patients attending Qaemshahr Razi Teaching Hospital, Iran 2013-2015.

Materials and methods: In this retrospective descriptive study, records of patients diagnosed with hepatitis were investigated for skin lesions and other simultaneous infectious diseases.

Results: There were 188 patients with viral hepatitis in whom skin lesions were observed in 16 and 35 were diagnosed with other simultaneous infections.

Conclusion: In current study, the incidence of skin lesions in patients with hepatitis B was higher than that of other hepatitis. High rate of infections such as pneumonia and bronchitis among patients with viral hepatitis indicates a decreased ability of their immune system in protecting against other infectious agents.

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Background and purpose: Hepatitis B virus (HBV) is considered to be one of the most important etiological factors of liver complication around the world. Interactions of host immune responses with HBV have a crucial role in the outcome of the infection. IL12 is an important pro-inflammatory cytokine that stimulates natural killer cells and T-lymphocytes to produce IFN-γ, promotes T-helper 1 responses, and expands CD8+cytotoxic T-cell activity. These unique properties of IL12 indicate that it might play an important role in control and clearance of HBV. In addition, single nucleotide polymorphisms (SNPs) are presumed to be linked to differential production of cytokines levels. This study investigated the association of IL12B rs6887695 G/C polymorphism with chronic HBV infection.
Materials and methods: Genotypes distribution of IL12B rs6887695 was determined in 120 chronic HBV infected patients and 120 healthy controls using polymerase chain restriction fragment length polymorphism (PCR-RFLP) method between 2013 and 2015.
Results: The frequencies of rs6887695 GG, GC and CC genotypes in the patients with chronic infection were 56.7%, 36.7% and 6.6%, respectively and in healthy controls were 51.7%, 42.5%, and 5.8%, respectively. No statistically significant difference was detected in IL12B rs6887695 genotypes between the patients and controls (P =0.65).
Conclusion: IL12 plays an essential role in immune response against HBV infection; however, present findings suggest that IL12B rs6887695 SNP was not associated with chronic HBV in the Iranian population studied.

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Background and purpose: Beta-thalassemia major is a genetic disorder with known globin defect that leads to chronic hemolytic anemia. Due to the need for recurrent blood transfusion, the risk of infectious diseases such as hepatitis is higher in these patients.
Materials and methods: This cross-sectional study recruited 518 patients with thalassemia major in Amirkola Thalassemia Center, 2013-2014 who were selected via census sampling. Patients' blood samples were analyzed for HBsAb, HBsAg, and HCVAb by ELISA test. Data were analyzed in
SPSS V22.
Results: The patients included 268 (51.7%) females and 250 (48.3%) males with the mean age of 27.93±9.88 years. The study showed that 5.79% of patients with thalassemia major were infected with HCV, including 11 (4.4%) males and 19 (7.1%) females and only one male patient was found to be HBsAg positive.
Conclusion: The study showed lower incidence of hepatitis C compared to previous reports from Amirkola Thalassemia Center. In current study the prevalence of HBsAg was also found to be low.
 

 

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Hepatitis B and C viruses are major public health problems. These viruses can chronically lead to liver disease such as fibrosis, cirrhosis, and hepatocellular carcinoma, which often increase mortality in these patients. According to previous studies, the liver is highly affected by changes in the microbiota of gastrointestinal tract and immune system damage caused by inflammation due to viral hepatitis. Significant advances have been made in identifying gastrointestinal microbiota in cirrhotic patients associated with viral hepatitis and its use in their prognosis and treatment in recent years. Unique bacterial profiles are observed in cirrhotic patients associated with viral hepatitis, including increased numbers of Streptococcus, Prevotella, Staphylococcus, and Enterococcus, as well as decreased numbers of Clostridium and Ruminococcus. The purpose of this review was to summarize and discuss the gastrointestinal microbiota profile in patients with chronic hepatitis B and C and its role in the progression of cirrhosis.

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Background and purpose: Hepatitis B vaccination is recommended in HBsAg-positive mothers to prevent hepatitis B in infants. Mother-to-infant transmission of HBV causes many health problems and it is important to identify HBV positive mothers. This investigation aimed at studying the prevalence of HBV and the immunogenicity of HBV vaccination in pregnant women to prevent HBV at birth in Sari, Iran.
Materials and methods: This descriptive observational study was conducted in pregnant women attending Sari Birth Cohort (SBC) Center, 2018-2020. A total of 1018 samples were investigated for HBV serological markers by enzyme-linked immunosorbent assay (ELISA).
Results: The prevalence of HBV was 1.57% and 46.6% (n=474) of expectant mothers had received HBV vaccine. Immunogenicity of HBV vaccination was 51.9%. HBV prevalence was found to be significantly associated with increase in age and gestational age (P= 0.009 and P= 0.005, respectively). HBV infection in women who were not immunized was significantly associated with family history of HBV and unprotected sex (P= 0.000 and P= 0.008, respectively).
Conclusion: Family history of HBV, maternal age, gestational age, and unprotected intercourse were the risk factors for HBV infection in pregnant women in Sari.

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 Background and purpose: Hepatitis B is one of the most common viral infectious diseases of the liver, which is of particular importance due to the possibility of chronic conditions and high risk of transmission, especially during dental treatments. The best way to combat is preventing the infection. The present study was conducted to determine the level of awareness of general dentists and dental specialists in Sari about hepatitis B.
Materials and methods: In a descriptive-analytical study, 142 general dentists and dental specialists were included using census sampling in Sari, Iran 2018. The participants completed a questionnaire designed by Alavian et al. 2011. SPSS V24 was used for data analysis.
Results: The subjects were 88 (62.9%) males and 54 (38.1%) females. Findings showed that 50% of dentists had a good level of awareness, 44.37% had a moderate level of awareness and 5.63% had a low level of awareness about hepatitis B. Overall, the level of awareness was found to have no significant association with gender (P= 0.58), being a general dentist or dental specialist (P=0.66), participating in infection control courses (P= 0.50), and age (P=0.06(.
Conclusion: In this study, dentists were found to have an appropriate level of awareness about hepatitis B, but, there is still a need for retraining courses.
 

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Background and purpose: Viral hepatitis accounts for about 1.4 million deaths in the world every year. Surveillance systems and effective interventions play important roles in the management of these diseases. This study aimed to review the programs and measures done in Iran to eliminate viral hepatitis B and C.
Materials and methods: Using qualitative content analysis, the programs for hepatitis B and C care system in Iran were reviewed. Fifteen semi-structured expert interviews were conducted, and 31 documents were reviewed. The activities, plans and programs associated with the viral hepatitis surveillance system were extracted based on the interview results and the documents.
Results: The activities of the hepatitis surveillance system in Iran were categorized into six categories, including the viral hepatitis surveillance system goals, target groups, current structure of hepatitis B and C surveillance system, upstream policies and documents, current programs, and infrastructures. The most prominent interventions were the following: hepatitis B vaccination in target groups, screening, hepatitis surveys, needle and syringe distribution, safe injection, safe blood transfusion, and hepatitis treatments.
Conclusion: This study showed that the main weakness of the hepatitis surveillance system is detecting active disease cases, which can be improved by integrating the hepatitis program into the network system and active participation of private and public sectors as well as non-governmental organizations. Vaccination campaigns and treatment of hepatitis B and C can also help in eliminating hepatitis C and controlling hepatitis B by 2030.