PTH-113 The success of kaffes stent insertions for post liver transplant anastomotic strictures

Deepak Joshi, Ben Warner, Phillip Harrison, John Devlin, David Reffitt, Yasser El-Sherif, Shirin Khorsandi, Andreas Prachalias, Miriam Cortes Cerisuelo, Krishna Menon, Wayel Jassem, Parthi Srinivasan (+3 others)
2018 Liver   unpublished
linked by a common source of transmission or a shared behaviour and that this link could be demonstrated by phylogenetic analysis. Methods A case definition of men, aged 35-75, presenting with acute HBV, with no recorded risk factors, was adopted. The PHE Database 'HP zone' was used to compile a line list of new acute HBV matching the case definition within the undisclosed county, from January 2012 to January 2015. Inclusion criteria for all cases required HBV core IgM positive status with
more » ... cal symptoms or biochemical markers consistent with acute hepatitis. Data on risk factors was compiled, as part of routine investigation, from the PHE acute HBV questionnaire using open and focussed questioning. Serum specimens on the line list were sent to the PHE laboratory, Colindale for phylogenetic analysis. Results 33 cases of acute HBV were identified with 19 men fitting the case definition. The line list was expanded to include the remaining 7 men aged 35-75 in the same region and timeframe who did report risk factors for HBV exposure (total=26). 6 cases did not have stored serum for genotyping. 17 cases of HBV Genotype A2 were identified, 14 met the exact case definition with no risk factors with the remaining 3 reporting high-risk sexual activity with men. 3 Cases of Genotype D were identified, all of which reported risk factors.14 of the 19 cases that fitted the definition described themselves as heterosexual and married at the time of diagnosis. All spouses tested negative for HBV. Of the 17 A2 genotypes 16 were 99%-100% identical and 12 were 99.7%-100% identical at the nucleotide level with one case differing by a single base pair at the HBsAg region. All cases were of a single, stable strain known as the 'Prisoner Variant', which has increased in prevalence from 1990, primarily in the prison population of north England. Conclusions The genotypic link of at least 16 cases with a non-prevalent strain of HBV indicates a common source of infection. The lack of confirmed risk factors in so many cases may indicate a shift in the 'epi-picture' with new behaviours making at-risk groups harder to identify for targeted healtheducation or vaccination. The cluster remains active with further cases being investigated. Abstract PTH-112 Figure 1 Epidemic curve displaying cases of acute Hep B per quarter 2012 to 2015; cases other than A/A2 excluded
doi:10.1136/gutjnl-2018-bsgabstracts.269 fatcat:o6js5rwiifgufo3gq65u6lii7m