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1
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Lin C, Clark R, Tu P, Tu R, Hsu YJ, Nien HC. The disconnect in hepatitis screening: participation rates, awareness of infection status, and treatment-seeking behavior. J Glob Health 2019; 9:010426. [PMID: 31073398 PMCID: PMC6486119 DOI: 10.7189/jogh.09.010426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Over 325 million people in the world are infected with hepatitis B or C virus. Chronic hepatitis is responsible for 78% of cases of hepatocellular carcinoma and an estimated 1.3 million preventable deaths a year. As “silent killers”, liver diseases are often asymptomatic and go undiagnosed until their terminal stage. Knowledge of infection status via screening is thus a vital part of preventing spread and seeking early treatment. Recently there has been a worldwide push to eliminate hepatitis. The objective of this study is to assess hepatitis B and C self-reported awareness of infection status vs correct awareness (compared to blood test results) and follow-up rates in Taiwan to inform global health promotion efforts that utilize screening interventions to prevent chronic liver diseases. Methods De-identified data from a Liver Foundation’s nationwide community-outreach free blood screening programs was utilized, including 50 909 participants’ data from 74 sites with a questionnaire (demographics, screening history, hepatitis awareness, monitoring behavior) and blood test results. Chi square tests were applied using R programing to examine the impacts of demographic variables on infection prevalence, awareness, and behavior relating to hepatitis. Results Among all participants, 41.1% indicated having had a hepatitis screening, of which only 60.8% knew their results. Around 69.7% and 66.5% self-reported awareness of their hepatitis B and C status respectively; 12.8% and 26.4% of individuals who tested positive for HBsAg and Anti-HCV respectively incorrectly thought they were not infected. Of those who self-reported awareness of their positive infection, 43.4% and 26.6% did not follow up with a health care professional for monitoring or treatment; the top reasons were “no symptoms”, “too busy”, and “don’t know where to follow up”. Rural populations showed higher infection prevalence but lower screening rates and self-reported awareness. Conclusions Intervention programs must address the substantial number of people that do not recall if they were screened or do not know the results of a screening. Discrepancies between self-reported awareness, correct awareness, and follow-up and disparities across demographic groups deserve further scrutiny. Global hepatitis eradication initiatives should reconsider how screening, test results, and education are presented in order to improve awareness and prevent chronic infection that could develop into life-threatening liver diseases.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, North Caroloina, USA.,Joint first authors
| | - Rachel Clark
- Policy and Organizational Management Program, Duke University, Durham, North Caroloina, USA.,Joint first authors
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, North Caroloina, USA
| | - Rungting Tu
- College of Management, Shen-Zhen University, Shenzhen, China
| | - Ya-Jung Hsu
- Liver Disease Prevention and Treatment Research Foundation, Taipei, Taiwan
| | - Hsiao-Ching Nien
- Liver Disease Prevention and Treatment Research Foundation, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Yeo YH, Le MH, Chang ET, Henry L, Nguyen MH. Prevalence of Undetectable Vaccine-Induced Immunity Against Hepatitis B Virus in US Adults at High Risk for Infection. Hepatology 2019; 69:1385-1397. [PMID: 30246260 DOI: 10.1002/hep.30285] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/14/2018] [Indexed: 12/24/2022]
Abstract
In 2015, the Centers for Disease Control and Prevention reported a substantial increase in the number of acute hepatitis B virus (HBV) infections in the United States. Although national guidelines recommend vaccination of adults at high risk for HBV infection, the prevalence of undetectable immunity (i.e., susceptibility) in this population remains unknown. In this study, we analyzed a nationally representative sample using the National Health and Nutrition Examination Survey to evaluate the prevalence, trend, and predictors of undetectable vaccine-induced antibodies against HBV surface antigen (<10 mIU/mL) among high-risk adults from 2003-2014. Among adults at high risk for HBV infection, the prevalence of undetectable immunity decreased from 83.2% in 2003-2004 (95% confidence interval [CI]: 81.3-85.0) to 69.4% (about 64 million) in 2013-2014 (95% CI: 66.0-72.6). The prevalence decreased significantly in individuals with multiple sex partners or sexually transmitted disease and in pregnant women. However, there were no significant changes in men who have sex with men (MSMs), intravenous drug users (IDUs), hepatitis C virus (HCV)-infected and patients with diabetes, and those with elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT). Mexican Americans had the highest prevalence of undetectable immunity (77.6%, 95% CI: 72.6-81.9), followed by non-Hispanic whites (70.1%, 95% CI: 66.9-73.1). Older age, lower socioeconomic status, and having at least 1 high-risk factor were associated with a higher risk of undetectable immunity, whereas an increased risk among the foreign-born disappeared after multivariable adjustment. Conclusion: Approximately 64 million high-risk adults in the United States remain susceptible to HBV infection, especially MSMs, IDUs, diabetics, HCV patients, and populations with elevated AST/ALT. To eliminate HBV, efforts should be made to increase screening and vaccination in high-risk adults.
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Affiliation(s)
- Yee Hui Yeo
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - Michael H Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - Ellen T Chang
- Center for Health Sciences, Exponent Inc, Menlo Park, CA
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
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3
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Vijayan T, Zheng P, Nguyen C, Brown AM, Chen YW, Peters MG. Survey of Asian patients with hepatitis B infection: limited knowledge of transmission and screening of family members. J Immigr Minor Health 2016; 17:112-7. [PMID: 23913129 DOI: 10.1007/s10903-013-9883-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Asian American families are disproportionately affected by Hepatitis B (HBV) infection. We aimed to assess the extent of screening family members of Asian patients with known HBV infection as well as patients' knowledge of HBV disease. A cross-sectional survey of established Asian patients with HBV-infection was performed at a university liver clinic. Outcome measures included the percentage of family members whose HBV serostatus was unknown and the percentage of patients who were able to correctly identify modes of transmission. A total of 803 US-based family members were identified by 58 patients. Patients did not know the HBV serostatus of 50% of their family members and 28% of their immediate family members. Fifty percent of participants did not know how they had acquired HBV or stated unlikely transmission modes. Though nationwide vaccination campaigns target this underrepresented population, screening family members of Asian patients with HBV remains a challenge.
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Affiliation(s)
- Tara Vijayan
- Division of Infectious Diseases, University of California, San Francisco, 513 Parnassus Ave, Room S-380, San Francisco, CA, 94143-0654, USA,
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Komatsu H, Inui A. Chronic hepatitis B in children in the United States and Canada: international origins place the disease burden on children even in the era of universal vaccination. Transl Pediatr 2016; 5:1-4. [PMID: 26835398 PMCID: PMC4729037 DOI: 10.3978/j.issn.2224-4336.2015.12.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 12/30/2015] [Indexed: 01/05/2023] Open
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Wang LJ, Xu YF, Liu XX, Chen Y. Single-nucleotide substitution of Hepatitis B virus in intrauterine infection. J Viral Hepat 2015; 22:433-40. [PMID: 25351410 DOI: 10.1111/jvh.12315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The relationship between hepatitis B virus (HBV) gene polymorphism and intrauterine infection has not been completely illuminated. Six pairs of mother and infant from intrauterine infection group and six mothers from nonintrauterine infection group in the previous study were randomly selected and separately divided into group M (Mother group), group N (Neonate group) and group NM (Negative-mother group) in this study. We found that age, gestational weeks, HBsAg titre, HBeAg titre and HBV DNA level of mothers from group M and group NM were not significantly different. Pre-S1/S2 and S regions in HBV genome were amplified, inserted into pUC19 plasmid and sequenced. It was found that all clone sequences clustered into genotype C (AY123041) through the Genotyping tool in NCBI and phylogenetic trees. Compared with AY123041, there were 20 (11 plus 9) mutations significantly different in the three groups. Most of the mutations were synonymous in pre-S1/S2/S region, while mutations of C2990T, T3205A, A167G, C407A, A667T and A680C resulted in amino acid substitution of A90V, S162T, T47A, P127T, L213F and I218L, respectively. In addition, most of the 20 mutations caused amino acid substitution in polymerase region for the tight structure of HBV genome. The occurrence and location of mutations indicated that mutation of C2990T only existing in group NM may serve as an index for nonintrauterine infection. In contrast, the incidence of intrauterine HBV infection from mothers with mutation of T3205A was lower. Then, mutations of G403A, T670G, A673G, A167G, C407A, A667T and A680C may be closely related to intrauterine HBV infection.
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Affiliation(s)
- L-J Wang
- Institute of Liver Disease Research, Huai'an Fourth People's Hospital, Huai'an, Jiangsu Province, China
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6
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Komatsu H. Hepatitis B virus: where do we stand and what is the next step for eradication? World J Gastroenterol 2014; 20:8998-9016. [PMID: 25083074 PMCID: PMC4112872 DOI: 10.3748/wjg.v20.i27.8998] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/09/2013] [Accepted: 04/15/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B (HB) virus (HBV) infection, which causes liver cirrhosis and hepatocellular carcinoma, is endemic worldwide. Hepatitis B vaccines became commercially available in the 1980s. The World Health Organization recommended the integration of the HB vaccine into the national immunisation programs in all countries. HBV prevention strategies are classified into three groups: (1) universal vaccination alone; (2) universal vaccination with screening of pregnant women plus HB immune globulin (HBIG) at birth; and (3) selective vaccination with screening of pregnant women plus HBIG at birth. Most low-income countries have adopted universal vaccine programs without screening of pregnant women. However, HB vaccines are not widely used in low-income countries. The Global Alliance for Vaccine and Immunization was launched in 2000, and by 2012, the global coverage of a three-dose HB vaccine had increased to 79%. The next challenges are to further increase the coverage rate, close the gap between recommendations and routine practices, approach high-risk individuals, screen and treat chronically infected individuals, and prevent breakthrough infections. To eradicate HBV infections, strenuous efforts are required to overcome socioeconomic barriers to the HB vaccine; this task is expected to take several decades to complete.
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Han H, Perumalswami PV, Kleinman LC, Jandorf LH. Voices of multi-ethnic providers in NYC: health care for viral hepatitis to prevent hepatocellular carcinoma. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:214-223. [PMID: 24189830 DOI: 10.1007/s13187-013-0569-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Worldwide, hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths and the ninth in the US. Hepatitis B and C make up almost 80% of HCC cases. Based on our Hepatitis Outreach Network screening program data, approximately 40% of at-risk foreign-born community members who tested positive for viral hepatitis B and/or C did not follow up for additional care. Our aim was to use theory-driven qualitative research to identify barriers and facilitators to follow-up after viral hepatitis diagnosis among these community members from the viewpoint of primary care providers (PCPs). As viral hepatitis is a precursor of liver cancer, timely treatment of the virus has the potential to reduce the incidence and burden of liver cancer. We performed semi-structured key informant interviews with 20 primary care physicians who predominantly serve Korean, Chinese, Egyptian, and Russian communities. Barriers detected included cultural factors commonly seen amongst immigrant populations such as busy work schedules and non-English language. Common facilitators include increased primary care physician involvement and linkages to care within communities in which patients reside. Providers perceived that they are gatekeepers to specialty care for their patients and therefore key persons to engage in viral hepatitis evaluation and management by specialists. This initial study suggests that re-focusing energy into primary care physicians might offer promise for improved care for individuals from immigrant communities who have viral hepatitis to help them engage in care and thereby reduce the burden of liver cancer.
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Affiliation(s)
- Hyosun Han
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Room 11-70, Box 1123, New York, NY, 10029, USA
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Ma L, Norton MG, Mahmood I, Zhao Z, Zhong L, Zhang P, Struble EB. Transplacental Transfer of Hepatitis B Neutralizing Antibody during Pregnancy in an Animal Model: Implications for Newborn and Maternal Health. HEPATITIS RESEARCH AND TREATMENT 2014; 2014:159206. [PMID: 24800066 PMCID: PMC3985303 DOI: 10.1155/2014/159206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/11/2014] [Accepted: 02/26/2014] [Indexed: 12/24/2022]
Abstract
Despite the success of postexposure prophylaxis (PEP) of the newborn in preventing mother-to-child transmission of hepatitis B virus), in non-US clinical trials, administering hepatitis B immune globulin (HBIG) to mothers at the end of pregnancy (in addition to passive-active PEP of the newborn) only partially improved outcomes. That is, a significant percentage of newborns became infected during their first year of life. We used a relevant animal model for human IgG transplacental transfer to study dose, time and subclass dependence of HBV neutralizing antibody (nAb) maternal, and fetal levels at the end of pregnancy. Pregnant guinea pigs received 50 or 100 IU/kg HBIGIV 2-5 days before delivery. Human total IgG, IgG subclasses, and nAb in mothers and their litters were measured. In vitro analyses of guinea pig Fc neonatal receptor binding to HBIGIV, as well as to all human IgG subclasses, were also performed. Our study showed that nAb transferred transplacentally from the pregnant guinea pigs to their litters; no transfer occurred during parturition. The amount of the transferred nAb was dose and time dependent. Thus, selection of an efficacious dose in the clinic is important: microdosing may be underdosing, particularly in cases of high viraemia.
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Affiliation(s)
- Li Ma
- Laboratory of Plasma Derivatives, Division of Hematology, Office of Blood Research and Review, Center for Biologics Evaluation and Research, FDA 1401 Rockville Pike, Rockville, MD 20852, USA
| | - Malgorzata G. Norton
- Laboratory of Plasma Derivatives, Division of Hematology, Office of Blood Research and Review, Center for Biologics Evaluation and Research, FDA 1401 Rockville Pike, Rockville, MD 20852, USA
| | - Iftekhar Mahmood
- Division of Hematology, Office of Blood Research and Review, Center for Biologics Evaluation and Research, FDA 1401 Rockville Pike, Rockville, MD 20852, USA
| | - Zhong Zhao
- Laboratory of Plasma Derivatives, Division of Hematology, Office of Blood Research and Review, Center for Biologics Evaluation and Research, FDA 1401 Rockville Pike, Rockville, MD 20852, USA
| | - Lilin Zhong
- Laboratory of Plasma Derivatives, Division of Hematology, Office of Blood Research and Review, Center for Biologics Evaluation and Research, FDA 1401 Rockville Pike, Rockville, MD 20852, USA
| | - Pei Zhang
- Laboratory of Plasma Derivatives, Division of Hematology, Office of Blood Research and Review, Center for Biologics Evaluation and Research, FDA 1401 Rockville Pike, Rockville, MD 20852, USA
| | - Evi B. Struble
- Laboratory of Plasma Derivatives, Division of Hematology, Office of Blood Research and Review, Center for Biologics Evaluation and Research, FDA 1401 Rockville Pike, Rockville, MD 20852, USA
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Chao SD, Cheung CM, Yang EJ, So SK, Chang ET. Low Levels of Knowledge and Preventive Practices Regarding Vertical Hepatitis B Transmission among Perinatal Nurses. J Obstet Gynecol Neonatal Nurs 2012; 41:494-505. [DOI: 10.1111/j.1552-6909.2012.01379.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Beltran VM, Harrison KM, Hall HI, Dean HD. Collection of social determinant of health measures in U.S. national surveillance systems for HIV, viral hepatitis, STDs, and TB. Public Health Rep 2011; 126 Suppl 3:41-53. [PMID: 21836737 DOI: 10.1177/00333549111260s309] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Challenges exist in the study of social determinants of health (SDH) because of limited comparability of population-based U.S. data on SDH. This limitation is due to differences in disparity or equity measurements, as well as general data quality and availability. We reviewed the current SDH variables collected for HIV, viral hepatitis, sexually transmitted diseases, and tuberculosis at the Centers for Disease Control and Prevention through its population-based surveillance systems and assessed specific system attributes. Results were used to provide recommendations for a core set of SDH variables to collect that are both feasible and useful. We also conducted an environmental literature scan to determine the status of knowledge of SDH as underlying causes of disease and to inform the recommended core set of SDH variables.
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Affiliation(s)
- Victoria M Beltran
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Office of the Director, Office of Health Equity, Atlanta, GA 30333, USA.
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Willis BC, Wortley P, Wang SA, Jacques-Carroll L, Zhang F. Gaps in hospital policies and practices to prevent perinatal transmission of hepatitis B virus. Pediatrics 2010; 125:704-11. [PMID: 20211952 DOI: 10.1542/peds.2009-1831] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to examine hospital policies and practices to prevent perinatal transmission of hepatitis B virus (HBV) in the United States and to and identify gaps. METHODS In March 2006, a nationally representative sample of 242 delivery hospitals in the 50 states, District of Columbia, and Puerto Rico (with at least 100 annual births) were surveyed about hospital perinatal hepatitis B prevention policies and asked to review paired maternal-infant medical records for 25 consecutive live births. Main outcome measures were hospital policies related to the prevention of perinatal transmission of hepatitis B and the proportion of infants who received recommended care. RESULTS A total of 190 of 242 hospitals responded to the survey and completed medical record reviews for 4762 mothers and 4786 infants. The proportion of hospitals that reported each of the 6 policies examined ranged from 63.0% to 80.6%. Among infants who were born to the 18 hepatitis B surface antigen (HBsAg)-positive women with documented prenatal test results, 62.1% received both hepatitis B vaccine and hepatitis B immunoglobulin within 12 hours, but 13.7% were unvaccinated and 19.7% did not receive hepatitis B immunoglobulin before hospital discharge. Among infants who were born to the 320 women with unknown HBsAg status, only 52.4% were vaccinated within 12 hours of birth and 20.1% were unvaccinated before discharge. Among infants who were born to HBsAg-negative mothers, 69.1% received the hepatitis B vaccine before hospital discharge. The strongest predictor of vaccine administration was having a written hospital policy for newborn hepatitis B vaccination. CONCLUSIONS These findings indicate that significant gaps persist in hospital policies and practices to prevent perinatal HBV transmission in the United States. Efforts to avoid medical errors through appropriate implementation and monitoring of hospital practices are needed to eliminate perinatal HBV transmission.
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Affiliation(s)
- Bayo C Willis
- Immunization Services Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E52, Atlanta, GA 30333, USA.
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Mitchell AE, Colvin HM, Palmer Beasley R. Institute of Medicine recommendations for the prevention and control of hepatitis B and C. Hepatology 2010; 51:729-33. [PMID: 20186842 DOI: 10.1002/hep.23561] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
UNLABELLED Despite federal, state, and local public health efforts to prevent and control hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, these diseases remain serious health problems in the United States. About 1%-2% of the U.S. population has chronic HBV or HCV infections, and each year about 15,000 people die from liver cancer or liver disease related to these preventable infections. The Institute of Medicine formed an expert committee to determine ways to reduce new HBV and HCV infections and the morbidity and mortality related to chronic viral hepatitis and released its findings in a report. The major factor found to impede current efforts to prevent and control HBV and HCV is lack of knowledge and awareness about these diseases among healthcare and social-service providers, members of the public, and policy makers. Because the extent and seriousness of this public health problem is not appreciated, inadequate resources are being allocated to prevention, control, and surveillance programs. This situation has led to continued transmission of HBV and HCV and inadequate identification of and medical management for chronically infected people. CONCLUSION To address the situation, the Institute of Medicine report makes recommendations in four areas: improved surveillance for HBV and HCV; improved knowledge and awareness among healthcare and social-service providers and the public, especially at-risk people; improved HBV vaccine coverage; and improved viral hepatitis services and access to those services.
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Affiliation(s)
- Abigail E Mitchell
- Board on Population Health and Public Health Practice, Institute of Medicine of the National Academies, Washington, DC, USA.
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