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

et al. (2013) Prevalence of Hepatitis B in Insular Regions of Southeast China: A Community-Based Study. PLoS ONE 8(2): e56444. doi:10.1371/journal.pone.0056444 Prevalence of Hepatitis B in Insular Regions of Southeast China: A Community-Based Study Ping Chen 0 Chengbo Yu 0 Bing Ruan 0 Shigui Yang 0 Jingjing Ren 0 Weijian Xu 0 Zhuanbo Luo 0 Lanjuan Li 0 Haitao Guo, Drexel University College of Medicine, United States of America 0 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 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 a-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. - 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. Competing Interests: The authors have declared that no competing interests exist. HBV infection remains a severe public health problem worldwide [1,2]. Each year around the world, HBV infection is responsible for about one million deaths due to liver failure, cirrhosis and more than 75% of the hepatocellular carcinomas world-wide develop from HBV infection [3,4]. Prior to 2006, China had been classified as an area with high prevalence of HBV [5]. According to a national study published in the early 1979, the overall prevalence of chronic HBV carriage was approximately 8.75% [6], which rose to 9.75% in 1992 [7]. Following recommendations from the WHO, the Expanded Program on Immunization (EPI) for infants was established in China in 1992, and caused a significant decline in HBV prevalence to 7.18% according to a national survey in 2006 [8]. Moreover, significant variations in the seroepidemiology of HBV across regions in China were found, with the highest rate observed in the mid-south, and lowest rate in northern China. The prevalence of HBsAg in Zhejiang Province, which is located in the south of China, was found to be over 11% in 1992, higher than the national rate, but had declined to 5.8% by 2001 [9]. In the insular regions of Zhejiang Province, due in part to a more developed economy, and a high floating population, the prevalence of HBsAg in the residents was found to be 19.33% in 1997, notably higher than that in Zhejiang Province as a whole [10]. Although the EPI, which started from 1992 in these islands, was considered a success in this region, an epidemiological study of 3657 randomly selected fishermen in the coastal islands of Zhejiang Province found that the prevalence of anti-HBc, a marker of HBV exposure was 61.4%, and the prevalence of HBsAg, a marker of active infection, was 15.5% in 2007 [11]. This prevalence rate, although slightly lower than in the past, is still much higher than that for the entire Zhejiang Province (6.75%) [12]. However, to date, there have been very fe (...truncated)