Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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S66 Abstracts / Journal of Clinical Virology 82S (2016) S1–S142
Abstract no: 100
Presentation at ESCV 2016: Poster 90
Hepatitis A virus epidemiology in Turkey as
childhood vaccination begins: Seroprevalence
and endemicity by region
T. Demiray ∗, M. Koroglu , K.H. Jacobsen ,
A. Ozbek , H.A. Terzi , M. Altindis
1 Sakarya Training and Research Hospital Cl
Microbiology Lab„ Sakarya, Turkey
2 Sakarya University Faculty of Medicine Dept of
Clinical Microbiology, Sakarya, Turkey
3 George Mason University, Department of Global &
Community Health, Fairfax, VI, USA
Introduction and aim: Hepatitis A virus (HAV) is usually
acquired through contact with an infected person or through inges-
tion of contaminated water or food, and it is one of the major
causes of acute viral hepatitis globally The incidence of the
disease varies with access to clean drinking water and other indi-
cators of socioeconomic status urkey introduced hepatitis
A virus (HAV) into its routine childhood immunization program in
2012. Over time, this will change the age-seroprevalence profile
of the country. This study provides a baseline evaluation of hep-
atitis A endemicity rates by province prior to the initiation of the
vaccination program.
Methods: A systematic reviewof all hepatitis A serosurveys that
collected data between 2000 and 2015 and published their results
in English and Turkish was conducted. The systematic review was
conducted in accordance with the PRISMA guidelines
Results: In total, 51 studies from23 of the 81 provinces in Turkey
were identified, although for most provinces the quality of the data
was poor. Adult prevalence rates were high and similar across the
country. Child prevalence rates were lower in the western and
central regions than in the eastern region. The age at midpoint of
population immunity was in the teenage years for the west and
central regions (intermediate endemicity), while the midpoint was
in children less than 10 years old in the east (high endemicity).
However, there was significant heterogeneity by province.
Discussion and conclusions: Provinces with a more urban pop-
ulation tended to have intermediate endemicity and provinceswith
a more rural population tended to have high endemicity. This pre-
diction does not suit to the provinces where has migration areas
and undeveloped neighborhood of the provinces cause increase in
endemicity
Turkey’s current universal childhood vaccination recommenda-
tions are appropriate one based on the current endemicity status.
The incidence rate will likely further decrease as a function of both
the vaccination program and ongoing infrastructural development.
Keywords: Hepatitis A virus, Endemicity, Seroprevalence, Vac-
cination, Socioeconomic development.
Reference
[1] K.H. Jacobsen, S.T. Wiersma, Hepatitis A virus seroprevalence by age and world
region, 1990 and 2005, Vaccine 28 (2010) 6653–6657.
[2] K.H. Jacobsen, J.S. Koopman, Declining hepatitis A seroprevalence: a global
review and analysis, Epidemiol. Infect. 132 (2004) 1005–1022.
[3] K.H. Jacobsen, J.S. Koopman, The effects of socioeconomic development on
worldwide hepatitis A virus seroprevalence patterns, Int. J. Epidemiol. 34
(2005) 600–609.
[4] D. Moher, L. Shamseer, M. Clarke, D. Ghersi, A. Liberati, M. Petticrew, et al.,
Preferred reporting items for systematic review and meta-analysis protocols
(PRISMA-P) 2015 statement, Syst. Rev. 4 (2015) 1.
[5] Z. Kurugol, A. Aslan, E. Turkoglu, G. Koturoglu, Changing epidemiology of
hepatitis A infection in Izmir, Turkey, Vaccine 29 (2011) 6259–6261.
Abstract no: 137
Presentation at ESCV 2016: Poster 91
Evaluation of anti-HCV Line immunoassay
indeterminant results
Imre Altuglu ∗, Aysin Zeytinoglu,
Kamer Varici Balci, Ruchan Sertoz, Candan Cicek,
Selda Erensoy
Ege University Faculty of Medicine, Dept of Medical
Microbiology, Izmir, Turkey
Introduction: Chronic hepatitis caused by hepatitis C virus
infection is one of the leading causes of liver cirrhosis and hepa-
tocellular carcinoma globally. Testing for HCV infection begins
with the detection of antibodies to recombinant or synthetic HCV
proteins using enzyme immunoassays (EIA). Because of the false
positive results especially in low prevalence settings, positive anti-
HCV EIA results are usually confirmed by recombinant immunoblot
tests and Line immunoassays (LIA). The current clinical practice
after identifying a positive anti-HCV result is to measure HCV RNA
to assess whether viremia is present. The main problem related
to LIA testing concerns the indeterminate results. The aim of this
study is to determine the frequency of LIA indeterminant results
in our routine practice and to evaluate the characteristics of these
samples.
Materials and methods: A total number of 245 anti-HCV Line
Immunoassay (Innogenetics Ghent, Belgium) results previously
tested in Ege University Hospital, Department of Medical Micro-
biology Virology Laboratory between January 2013-August 2015
were reviewed. All the samples were positive with Architect Anti-
HCV assay (Abbott Laboratories, IL, USA) run on the i2000SR
analyser.
Results: Between January 2013 and August 2015 a total number
of 81,948 samples were sent to Ege University Medical Microbiol-
ogy Virology Laboratory for anti-HCV EIA testing. Of these samples
2576 (%3.14) were reactive, and 79,372 (%96.86) were nonreac-
tive. During this period 245 samples mostly with low signal to
cutoff ratios were tested by LIA. Of the 245 samples, 49 were pos-
itive (20%), 155 were negative (63.3%) and 41 were indeterminant
(16.7%) by line immunoassay testing. Of the patients with inde-
terminant LIA results, 22 were female and 19 male, ages ranging
1-84 (mean 41.1 ± 16.1). The distribution of Architect reactivity
ratios expressed as s/co of these samples were between 1.01 and
8.49 (mean s/co 2.3) and 37 samples had s/co < 5.0. 39 samples had
HCV RNA results and HCV RNA positivity was recorded in only one
patient with s/co ratio 6.3 and NS3 band reactivity. Of the samples
with indeterminant results 29 samples presented reactivity to NS3
antigen, 7 samples to C1 antigen, 3 samples to C2 antigen, one to
E2 and one to NS4 antigen.
Conclusion: Overall there are 41 indeterminate samples out
of 245 samples tested. Most of the samples are below the s/co
index value <5.0. All the indeterminate samples were PCR nega-
tive except one patient. Some possible causes for indeterminant
results are seroconversion phase during which EIA is already pos-
itive and seroreversion in patients who spontaneously eliminate
HCV. In these individuals antibodies against some antigenic frac-
tions have already turned negative for LIA but they are sufficient to
cause an EIA positive result and other factors related to kit perfor-
mance or to patient immunoresponse variability may be involved.
The other possibility that must be considered is false positive EIA
result.