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High carrier rate after hepatitis B virus infection in the elderly
Y Kondo1, K Tsukada, T Takeuchi
1First Department of Internal Medicine, Nagoya City University Medical School, Aichi-Ken, Japan.
Insights
Elderly patients in a nursing facility experienced a hepatitis B virus (HBV) outbreak. Over half of those followed became chronic HBV carriers, highlighting a high risk in this population.
Area of Science:
- Infectious Diseases
- Geriatric Medicine
- Virology
Background:
- Hepatitis B virus (HBV) infection can lead to chronic carrier states.
- Elderly individuals, particularly those in long-term care facilities, may be vulnerable to outbreaks.
- Cerebrovascular accident (CVA) sequelae can impact patient health and immune status.
Purpose of the Study:
- To investigate an outbreak of hepatitis B virus infection in a nursing facility.
- To determine the incidence of chronic HBV carrier status in elderly patients post-outbreak.
- To analyze the genetic relatedness of HBV strains involved in the outbreak.
Main Methods:
- Polymerase chain reaction (PCR) amplification of the HBV S gene from patient DNA.
- Nucleotide sequencing to compare viral strains from patients and a suspected source.
- Clinical and laboratory parameter assessment (age, sex, nutrition, immunocompetence).
Main Results:
- An outbreak involved 31 elderly patients with CVA sequelae.
- 59% (13 of 22) of followed patients became hepatitis B surface antigen (HBsAg) carriers.
- Sequencing confirmed the outbreak originated from an HBsAg-positive nursing assistant, with high genetic similarity among viral strains.
Conclusions:
- Elderly individuals, especially those with CVA sequelae in nursing facilities, have a high incidence of becoming HBV carriers.
- Age, sex, nutritional status, or immunocompetence did not differentiate transient from persistent HBV infections in this cohort.
- Effective infection control measures are crucial in long-term care settings to prevent HBV transmission.
Abstract:
An outbreak of hepatitis B virus infection occurred in a nursing facility; it involved 31 patients with sequelae of cerebral vascular accidents (15 men and 16 women; mean age, 77.4 +/- 9.3 yr). HBsAg disappeared within 6 mo in 9 patients and persisted during an observation period of more than 6 mo in 13; the remaining 9 patients were lost to follow-up while they carried HBsAg. Thus 13 of 22 patients followed (59%) became HBsAg carriers. We amplified a part of the S gene (436 nucleotides) with polymerase chain reaction on hepatitis B virus DNA from 12 randomly selected patients. The sequences of nine patients were the same as that of a nursing assistant who was an HBsAg carrier and suspected as the source of infection; it differed by only 1 or 2 (< 0.5%) nucleotides from those of the remaining three patients. Between the group of nine patients with transient HBV infection and the 13 patients with persistent HBV infection, we found no differences in age or sex or in parameters of nutrition or immunocompetence. These results indicate a high incidence of HBV carrier state in the elderly.