Changing incidence of hepatitis B and persistent infection risk in adults: a population-based follow-up study from 2011 in China

Abstract

Background This study aimed to estimate hepatitis B incidence and chronicity risk in rural adults in China under the background of eliminating viral hepatitis. Methods Hepatitis B surface antigen (HBsAg) screening was conducted every 2 years in demonstration areas since 2011. Individuals with baseline HBsAg-negative were included. Incidence was calculated as the number of HBsAg-positive cases divided by the total person-times. HBsAg-positive individuals were followed up to study the persistent infection (> 6 months), chronic infection (> 12 months), and recovery with hepatitis B surface antibody (anti-HBs). The chi-square test and cox proportional regression analysis were performed. Results There were 8,942 incident cases over 2,138,532 person-years, yielding an average incidence of 0.42 per 100 person-years. HBV incidence decreased rapidly in both genders and all age groups and then kept stable. Male gender, low population density, low gross domestic product per capita, and islanders were associated with higher incidence. Of the positive cases, 4,989 (55.8%) patients were followed up. The persistent infection, chronic infection, and recovery with anti-HBs rates were 32.3%, 31.0%, and 31.4%, respectively. Persistent or chronic infection was more common in younger adults and males, while seroconversion had no concern with gender or age. Conclusions HBV incidence in adult rural residents was decreasing and stayed low. The chronicity rate was relatively high and protective antibodies were induced in only one third. The importance of population-based screening and vaccination for susceptible individuals should be addressed.

Trends and age-period-cohort effect on incidence of hepatitis B from 2008 to 2022 in Guangzhou, China

“…Consistent with previous research, our findings revealed significant period effects 9 – 11 , 21 . The incidence of acute hepatitis B decreased significantly over time, while that of chronic hepatitis B remained stable in recent years.…”

“…We attribute this to hepatitis B vaccination coverage and prevention of mother-to-child transmission of hepatitis B virus 22 . For instance, according to laboratory surveillance data in England, the HB incidence decreased from 7.4/100,000 in 1995–2000 to 1.1/100,000 in 2008, representing an 85% reduction 11 . In China, the plasma-derived hepatitis B vaccine (HepB) was licensed in 1985.…”

“…It may vary depending on age, period, and birth cohort 9 , 10 . For example, due to sexual transmission, adults aged 35–54 are more susceptible to HBV infection 11 . With the universal vaccination of newborns, the global HBV infection rate has been decreasing in recent decades.…”

The prevalence of hepatitis B in Chinese general population from 2018 to 2022: a systematic review and meta-analysis

“…Since 2012, universal screening for HBsAg in pregnant women has been implemented per national policy in China, leading to improved detection and treatment rates for women [45]. Previously, it was shown that males had a higher risk of contracting HBV [46]. Other investigations on sex and risk of HBV attributed to males relatively greater exposure to sexually transmitted risk factors, such as men who have sex with men and persons with multiple sexual partners to increased prevalence of HBV compared to females [47,48].…”

Opportunistic screening using point-of-care testing leads to successful linkage to care of HBV-infected migrant populations in a low endemic country

“…Approximating the Asian population as 20,000 individuals with an HBsAg prevalence of 8.5% and precision of 5.0%, the required number to screen is 119. 8 , 9 , 10 …”