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      Prevalence of Hepatitis B in Insular Regions of Southeast China: A Community-Based Study

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          Abstract

          Objective

          Hepatitis B virus (HBV) infection remains a significant public health problem. The purpose of this study was to investigate the seroepidemiology of HBV in people living in the insular regions, and to provide the most recent baseline data for planning and monitoring of health.

          Methods

          A cross-sectional, community-based survey was conducted without age restriction, on two isolated islands, Zhoushan and Yuhuan, China. The study sample was selected by random multistage cluster sampling. Serological samples and demographic information were collected from 15878 participants.

          Results

          The prevalences of anti-HBV core antibody (anti-HBc), hepatitis B virus surface antigen (HBsAg), and anti-HBV surface antibody (anti-HBs) were 33.1, 10.4, and 56.1%, respectively. We found statistically significant differences of HBV markers in men versus women ( P<0.01). The prevalence of HBV infection increased with age. There were significant differences in the rates of HBsAg and anti-HBc positivity between the two islands ( P<0.01). Alanine aminotransferase (ALT) levels were elevated (>38 IU/L) in 15.6% and 7.2% of the HBsAg-positive and negative groups, respectively. Elevated ALT levels were significantly higher in males (12.0%) compared with females (5.8%) ( P<0.01). The α-fetoprotein (AFP) positivity rate was 0.6% in HBsAg-positive participants over the age of 30.

          Conclusion

          Due to the geographic location, we found that the HBV prevalence and potential for the development of hepatocellular carcinoma remained high in insular regions of southeast China, and are far above the national figures. Although a vaccination program has been in effect over the last 20 years, several additional measures should be adopted by the government to limit the spread of hepatitis B. These include the management of high risk persons and the floating population living on the islands, expansion of the immune population, and increased health education for fisherman.

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          Most cited references15

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          Epidemiological serosurvey of hepatitis B in China--declining HBV prevalence due to hepatitis B vaccination.

          Xiaofeng Liang, Shengli Bi, Weizhong Yang … (2009)
          To determine the prevalence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core anti-body (anti-HBc) in a representative population in China 14 years after introduction of hepatitis B vaccination of infants. National serosurvey, with participants selected by multi-stage random sampling. Demographics and hepatitis B vaccination history collected by questionnaire and review of vaccination records, and serum tested for HBsAg, antibody to anti-HBc and anti-HBs by ELISA. The weighted prevalences of HBsAg, anti-HBs and anti-HBc for Chinese population aged 1-59 years were 7.2%, 50.1%, 34.1%, respectively. HBsAg prevalence was greatly diminished among those age <15 years compared to that found in the 1992 national serosurvey, and among children age <5 years was only 1.0% (90% reduction). Reduced HBsAg prevalence was strongly associated with vaccination among all age groups. HBsAg risk in adults was associated with male sex, Western region, and certain ethnic groups and occupations while risk in children included birth at home or smaller hospitals, older age, and certain ethnic groups (Zhuang and other). China has already reached the national goal of reducing HBsAg prevalence to less than 1% among children under 5 years and has prevented an estimated 16-20 million HBV carriers through hepatitis B vaccination of infants. Immunization program should be further strengthened to reach those remaining at highest risk.
          Article 0 comments Cited 300 times – based on 0 reviews     Review now
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            Hepatitis B-related hepatocellular carcinoma: epidemiological characteristics and disease burden.

            V Nguyen, M Law, G J Dore (2009)
            Worldwide, 350 million people are chronically infected with hepatitis B virus (HBV) who are at greater risk of hepatocellular carcinoma (HCC) compared with uninfected people. The relative risks of HCC among people infected with HBV ranges from 5 to 49 in case-control studies and from 7 to 98 in cohort studies. More than 50% of HCC cases worldwide and 70-80% of HCC cases in highly HBV endemic regions are attributable to HBV. Incidence of HCC (per 100,000 person/year) among people with chronic HBV infection ranges from 400 to 800 in male and from 120 to 180 in female. Factors associated with increased risk of HCC include demographic characteristics (male sex and older age), lifestyles (heavy alcohol consumption and smoking), viral factors (genotype C, D F, high level of HBV DNA, core/precore mutation) and clinical factors (cirrhosis, elevated alpha-fetoprotein (AFP) and alanine aminotransferase (ALT)). HBV-related HCC has extremely poor prognosis with median survival less than 16 months. Survival rates of HBV-related HCC ranged from 36% to 67% after 1 year and from 15% to 26% after 5 year of diagnosis. Older age, liver function impairment, vascular invasion, tumour aggressiveness and elevated AFP are associated with HCC survival. Global burden of HBV-related liver disease is still a major challenge for public health in the 21st century. While decreases in incidence of HBV infection have been observed in birth cohorts following the introduction of universal infant HBV vaccination programme, HBV-related HCC incidence in is projected to increase for at least two decades because of the high prevalence of chronic HBV infection and prolonged latency to HCC development. To reduce HBV-related HCC continued expansion of universal infant HBV vaccination is required along with antiviral therapy targeted to those individuals at highest risk of HCC. Broad public health strategies should include routine testing to identify chronic HBV infection, improved health infrastructures including human resource to provide diagnosis and treatment assessment.
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              Hepatitis B in China.

              Jie Liu, Daiming Fan (2007)
              Article 0 comments Cited 85 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Haitao Guo: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2013
                Publication date (Electronic): 20 February 2013
                Volume: 8
                Issue: 2
                Electronic Location Identifier: e56444
                Affiliations
                [1 ]The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, The Key Laboratory of Infectious Diseases, Zhejiang Province, Hangzhou, China
                [2 ]School of Medicine, Zhejiang University, Hangzhou, China
                Drexel University College of Medicine, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: LL PC CY WW BR. Performed the experiments: PC WW SY JR. Analyzed the data: PC WX ZL. Contributed reagents/materials/analysis tools: LL PC BR. Wrote the paper: PC WX CY BR SY.

                Article
                Publisher ID: PONE-D-12-30604
                DOI: 10.1371/journal.pone.0056444
                PMC ID: 3577891
                PubMed ID: 23437134
                SO-VID: bdfad569-78ce-44d5-9bd9-7c9a8dd9bc01
                Copyright statement: Copyright @ 2013
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 7 October 2012
                Date accepted : 9 January 2013
                Page count
                Pages: 7
                Funding
                This study was funded by the National Scientific and Technological Major Project of China (Grant No.2009ZX10004-901,2011ZX10004-901). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology
                Subject: Population Biology
                Subject: Epidemiology
                Subject: Infectious Disease Epidemiology
                Subject: Medicine
                Subject: Epidemiology
                Subject: Infectious Disease Epidemiology
                Subject: Gastroenterology and Hepatology
                Subject: Liver Diseases
                Subject: Infectious Hepatitis
                Subject: Hepatitis B
                Subject: Infectious Diseases
                Subject: Viral Diseases
                Subject: Hepatitis
                Subject: Hepatitis B
                Subject: Infectious Disease Control
                Subject: Public Health
                Subject: Immunizations

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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