I M Ifeorah

Bio: I M Ifeorah is an academic researcher from University of Nigeria, Nsukka. The author has contributed to research in topics: Hepatitis B virus & Population. The author has an hindex of 5, co-authored 13 publications receiving 60 citations. Previous affiliations of I M Ifeorah include University of Ibadan.

Detection of hepatitis B virus isolates with mutations associated with immune escape mutants among pregnant women in Ibadan, southwestern Nigeria.

Abstract: Perinatal transmission of hepatitis B virus (HBV) and its associated immune escape mutants (IEMs), is the major vehicle through which a population of chronically infected people who serve as infectious HBV reservoirs is maintained in communities. Therefore, to assess the risk of perinatal transmission, 272 pregnant women attending ante-natal clinics in Ibadan metropolis, southwestern, Nigeria, were screened for HBsAg using ELISA technique. Samples positive for HBsAg were subjected to HBV DNA detection by PCR amplification of the S-gene and amplicon sequencing. Isolates were genotyped and subtyped using a combination of molecular techniques. Fifteen (5.5%) of the pregnant women were positive for HBsAg of which HBV DNA was detected in seven. Five of the isolates were typed as genotype E subtype ayw4 using amino acid residues at positions 122, 127, 134 and 160. Another could only be typed as genotype E subtype ayw4 by further phylogenetic analysis. The remaining one isolate did not belong to any of genotypes A – H. Three of the HBV isolates including the untypable, had mutations in the ‘a’ determinant associated with IEMs. This study confirms the endemicity of HBV, the risk of perinatal transmission and the circulation of genotype E subtype ayw4 in Nigeria. It further demonstrates the presence of IEMs in Nigeria.

Patterns of serologic markers of hepatitis B virus infection and the risk of transmission among pregnant women in southwestern Nigeria.

Abstract: Hepatitis B virus (HBV) infection is a major health concern in developing countries that has a high morbidity and mortality rate. Vertical transmission of HBV from mother to child has been identified as a major factor leading to chronicity with attendant liver conditions, especially in poor socioeconomic settings. This study aims to evaluate the prevalence of serological HBV markers among pregnant women in Ibadan southwestern Nigeria and to determine the implications for perinatal HBV transmission. This study revealed the presence of varied HBV serological patterns of infection or immunity among pregnant women in Ibadan, Nigeria, and thus the risk of mother to child transmission.

Acute Hepatitis E Virus Infection in Two Geographical Regions of Nigeria.

Abstract: Hepatitis E virus (HEV) remains a major public health concern in resource limited regions of the world. Yet data reporting is suboptimal and surveillance system is inadequate. In Nigeria, there is dearth of information on prevalence of acute HEV infection. This study was therefore designed to describe acute HEV infection among antenatal clinic attendees and community dwellers from two geographical regions in Nigeria. Seven hundred and fifty plasma samples were tested for HEV IgM by Enzyme Linked Immunosorbent Assay (ELISA) technique. The tested samples were randomly selected from a pool of 1,115 blood specimens previously collected for viral hepatitis studies among selected populations (pregnant women, 272; Oyo community dwellers, 438; Anambra community dwellers, 405) between September 2012 and August 2013. One (0.4%) pregnant woman in her 3rd trimester had detectable HEV IgM, while community dwellers from the two study locations had zero prevalence rates of HEV IgM. Detection of HEV IgM in a pregnant woman, especially in her 3rd trimester, is of clinical and epidemiological significance. The need therefore exists for establishment of a robust HEV surveillance system in Nigeria and especially amidst the pregnant population in a bid to improve maternal and child health.

Seroprevalence of hepatitis B and delta viruses among HIV-infected population attending anti-retroviral clinic in selected health facilities in Abuja, Nigeria.

Abstract: INTRODUCTION Triple infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis D virus (HDV) is rare. There is limited data on the seroprevalence of HIV/HBV/HDV tri-infection especially in Nigeria. The aim of this study was to determine the seroprevalences of HBsAg and HDV among HIV-infected individuals attending anti-retroviral (ARV) clinics in Abuja, Nigeria. METHODS In this cohort study, blood samples were collected from 1102 (male = 450; female = 652), with age range <20 to ≥51 years (mean age = 34.0; SD = 11.5), consenting HIV-infected population attending ARV clinics at selected health facilities in Abuja, Nigeria, between April and October 2016. A well-structured questionnaire was used to capture demographic information from the respondents. Enzyme-linked immunosorbent assay (ELISA) was used to determine the seroprevalence of hepatitis B surface antigen and anti-HDV. The result was interpreted according to manufacturer's instruction. Statistical data were analyzed using SPSS software version 21, and chi-square (χ2) test was used to determine association with P < 0.05 considered significant. RESULTS Overall seroprevalences of 10.3%, 7.1%, and 0.7% for HBV, HBV/HDV, and HIV/HBV/HDV, respectively, were found among the study population. The infection rate (13.3%) peaked at age range of 31-40 years for HBV (P = 0.002), 50% at <20 years for HBV/HDV (P = 0.049), and 1.5% at 31-40 years for HIV/HBV/HDV (P = 0.202). By gender, the rate was higher in males (10.9%, 10.2%, 1.1%) than females (9.8%, 4.9%, 0.5%) for HBV, HBV/HDV, and HIV/HBV/HDV infections, respectively. However, there was no significant association between infection rate and gender. CONCLUSION This study has established that HBV and HDV prevalence is still high in the population studied and that the rate of triple infection is low. We advocate for more robust control measures for HBV which should be extended to HDV in HIV population through screening and vaccination.

The status of hepatitis B control in the African region.

Abstract: The World Health Organization (WHO) African Region has approximately 100 million people with chronic hepatitis B virus (HBV) infection. This review describes the status of hepatitis B control in the Region. We present hepatitis B vaccine (HepB) coverage data and from available data in the published literature, the impact of HepB vaccination on hepatitis B surface antigen (HBsAg) prevalence, a marker of chronic infection, among children, HBsAg prevalence in pregnant women, and risk of perinatal transmission. Lastly, we describe challenges with HepB birth dose (HepB-BD) introduction reported in the Region, and propose strategies to increase coverage. In 2015, regional three dose HepB coverage was 76%, and 16(34%) of 47 countries reported ≥ 90% coverage. Overall, 11 countries introduced HepB-BD; only nine provide universal HepB-BD, and of these, five reported ≥ 80% coverage. From non-nationally representative serosurveys among children, HBsAg prevalence was lower among children born after HepB introduction compared to those born before HepB introduction. However, some studies still found HBsAg prevalence to be above 2%. From limited surveys among pregnant women, the median HBsAg prevalence varied by country, ranging from 1.9% (Madagascar) to 16.1% (Niger); hepatitis B e antigen (HBeAg) prevalence among HBsAg-positive women ranged from 3.3% (Zimbabwe) to 28.5% (Nigeria). Studies in three countries indicated that the risk of perinatal HBV transmission was associated with HBeAg expression or high HBV DNA viral load. Major challenges for timely HepB-BD administration were poor knowledge of or lack of national HepB-BD vaccination guidelines, high prevalence of home births, and unreliable vaccine supply. Overall, substantial progress has been made in the region. However, countries need to improve HepB3 coverage and some countries might need to consider introducing the HepB-BD to help achieve the regional hepatitis B control goal of < 2% HBsAg prevalence among children < 5 years old by 2020. To facilitate HepB-BD introduction and improve timely coverage, strategies are needed to reach both facility-based and home births. Strong political commitment, clear policy recommendations and staff training on HepB-BD administration are also required. Furthermore, high quality nationally representative serosurveys among children are needed to inform decision makers about progress towards the regional control goal.

A systematic review of hepatitis B virus (HBV) drug and vaccine escape mutations in Africa: A call for urgent action.

Abstract: International sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the pressing need to optimize strategies for prevention, diagnosis and treatment. Selected or transmitted resistance associated mutations (RAMs) and vaccine escape mutations (VEMs) in hepatitis B virus (HBV) may reduce the success of existing treatment and prevention strategies. These issues are particularly pertinent for many settings in Africa where there is high HBV prevalence and co-endemic HIV infection, but lack of robust epidemiological data and limited education, diagnostics and clinical care. The prevalence, distribution and impact of RAMs and VEMs in these populations are neglected in the current literature. We therefore set out to assimilate data for sub-Saharan Africa through a systematic literature review and analysis of published sequence data, and present these in an on-line database (https://livedataoxford.shinyapps.io/1510659619-3Xkoe2NKkKJ7Drg/). The majority of the data were from HIV/HBV coinfected cohorts. The commonest RAM was rtM204I/V, either alone or in combination with associated mutations, and identified in both reportedly treatment-naive and treatment-experienced adults. We also identified the suite of mutations rtM204V/I + rtL180M + rtV173L, that has been associated with vaccine escape, in over 1/3 of cohorts. Although tenofovir has a high genetic barrier to resistance, it is of concern that emerging data suggest polymorphisms that may be associated with resistance, although the precise clinical impact of these is unknown. Overall, there is an urgent need for improved diagnostic screening, enhanced laboratory assessment of HBV before and during therapy, and sustained roll out of tenofovir in preference to lamivudine alone. Further data are needed in order to inform population and individual approaches to HBV diagnosis, monitoring and therapy in these highly vulnerable settings.

Seroprevalence of anti-SARS-CoV-2 antibodies in Africa: A systematic review and meta-analysis.

Abstract: We estimated the seroprevalence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in residents of African countries and explored its associated factors. We searched PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases for peer reviewed articles and pre-prints that reported anti-SARS-CoV-2 antibody seroprevalence of general or specific human populations resident in Africa. The eligible studies were evaluated using Joana Briggs Institute prevalence critical appraisal tool. Twenty-three studies involving 27,735 individuals were included in our paper. The pooled seroprevalence of anti-SARS-CoV-2 antibodies in Africa was 22% (95%CI: 14-31) with very high heterogeneity (I2 = 100%, p < 0.001). Seroprevalence was highest in studies conducted in Central Africa compared to Southern Africa, West Africa, North Africa and East Africa respectively. The number of days between the first reported coronavirus disease 2019 case in each country and when a seroprevalence study was conducted was a significant moderator of seroprevalence. Seropositivity was numerically influenced by gender and age of the participants with males and those aged below 50 years being most affected with SARS-CoV-2 infection. The highest pooled seroprevalence in Africa reported in this review should be interpreted cautiously due to high heterogeneity between studies. Continued seroprevalence surveillance is warranted to establish Africa's transition towards herd immunity.

Hepatitis B: The Hunt for a Killer Virus

Abstract: The way we finance health care is extremely important—but also very hard to get right. This is the topic of discussion in Pricing the Priceless: A Health Care Conundrum. Joseph Newhouse, a leading health economist, carefully examines various methods for paying for health care, noting the incentives that each system creates for patients, providers and payers, and highlighting the problems inherent in each approach. The health care market is similar to other markets in many ways: there is a commodity (health care products and services) that consumers (patients or their representatives) buy from sellers (such as physicians, hospitals and pharmaceutical companies). The existence of a number of ‘imperfections’ in the health care market, however, means that efficient and equitable distribution of health care is difficult to achieve. In a perfect market, buyers and sellers would have all the information they need to make their purchasing decisions; in health care, buyers know far less about the products they are purchasing than the sellers do. In addition, even providers are often uncertain about the best course of action. A related problem is that the products in health care are often not well defined. It is not the specific medical treatment that we are trying to purchase, but the improvement in health that it can provide. Because various treatments can be used to achieve the same goal, purchasing decisions can become even more complex. In a perfect market, prices would reflect the value of the commodity to the buyer; in health care, insurance greatly lowers the price that buyers face, potentially resulting in the over-purchase of health care (economists call this ‘moral hazard’). Over the years, the United States, among other countries, has tried a number of different methods for financing health care. We have explored ways of changing consumers’ payments for insurance or health care by increasing premium cost-sharing and altering co-payment schemes. We have altered payments to sellers by moving from a predominantly retrospective, fee-for-service system to one that emphasizes fixed, predetermined payments for specific services (such as Medicare’s hospital prospective payment system or capitation). Most of these changes involved increasing the risk borne by patients and providers in order to combat distortions created by insurance, imperfect information and uncertainty. Pricing the Priceless thoughtfully examines the strengths and weaknesses associated with different methods of financing health care. Newhouse begins with a discussion of traditional feefor-service financing, a system that dominated the American health care marketplace for decades. He then explores the motivation for and the impact of important changes to that model: administered pricing, such as Medicare’s current physician payment system based on a detailed fee schedule; prospective episode pricing, such as Medicare’s hospital payment system based on diagnosis-related groups; and capitation, where plans or providers are paid a fixed amount per member per month in exchange for providing services covered under the insurance contract. Chapter 3 focuses on the management of consumer moral hazard and seller stinting, the tendency to under-provide when paid prospectively. In chapters 4 and 5, Newhouse highlights the significant problems associated with demand-side and supply-side selection. On the demand side, healthy consumers want to purchase minimal insurance because they don’t expect high health care expenses. This increases premiums for sicker consumers because their higher expected expenses demand higher premiums and they are no longer able to pool that risk with healthier consumers. On the supply side, health care plans and capitated providers may have a strong financial incentive to seek out healthy patients in order to increase their profits. One answer to this type of selection has been risk adjustment of payment based on patient demographics or clinical conditions. In chapter 6, the author discusses the current state of the art in risk adjustment, emphasizing the difficulties associated with this approach and directions for new research. In concluding statements, the author notes that because “...all arrangements that can be implemented have important drawbacks,” we will continue to search for new answers and experiment with payment reform. In Pricing the Priceless, Newhouse carefully synthesizes years of empirical and theoretical research on the impact of various financing arrangements. He draws on a wide range of scholarly publications, but also includes work that does not appear in the general literature. The book is well crafted and comprehensive. It will serve as an excellent overview of health care financing for years to come and will be invaluable to economists, students in the field of health economics, and policymakers with an economics background. Because this book is quite technical, however, its readership will be a relatively narrow and select group, predominantly economists. Thus, Pricing the Priceless will not—and does not purport to—educate the rest of the world about the strengths and weaknesses of various financing arrangements. Such a book can and should be written.

Monitoring of anti-Hepatitis E virus antibody seroconversion in asymptomatically infected blood donors

Abstract: Diagnosis of hepatitis E virus (HEV) is usually determined serologically by detection of the presence of immunoglobulin (Ig)M antibodies or rising anti-HEV IgG titers. However, serological assays have demonstrated a significant variation in their sensitivities and specificities. In this study, we present the systematic comparison of different immunological anti-HEV assays using complete seroconversion panels of 10 virologically confirmed HEV genotype 3 infected individuals. Assay sensitivities were further evaluated by testing serially diluted World Health Organization (WHO) reference reagent for hepatitis E virus antibody and one patient sample infected with HEV genotype 3. Anti-HEV IgM and IgG antibody presence was determined using the immunological assays Wantai HEV IgM/IgG enzyme-linked immunosorbent assay (ELISA) (Sanbio, Uden, The Netherlands), recomWell HEV IgM/IgG (Mikrogen, Neuried, Germany), HEV IgM ELISA 3.0, HEV ELISA, HEV ELISA 4.0, Assure HEV IgM Rapid Test (all MP Biomedicals Europe, Illkirch Cedex, France) and Anti-HEV ELISA (IgM/IgG, Euroimmun, Lubeck, Germany). The assays showed differences regarding their analytical and diagnostic sensitivities, with anti-HEV IgM assays (\(\it n\) = 5) being more divergent compared to anti-HEV IgG (\(\it n\) = 4) assays in this study. Considerable variations were observed particularly for the detection period of IgM antibodies. This is the first study systematically characterizing serologic assays on the basis of seroconversion panels, providing sample conformity for a conclusive comparison. Future studies should include the assay comparison covering the four different genotypes.