Targeted case finding for hepatitis B using dry blood spot testing in the British–Chinese and South Asian populations of the North‐East of England

Abstract

Chronic infection with the hepatitis B virus (HBV) is a frequent cause of cirrhosis and liver cancer. Targeted HBV screening is recommended by the Centre for Disease Control (CDC) and Prevention for subjects born in countries with >2% HBV prevalence. However, there are no UK guidelines. Here, we applied the (CDC) recommendations to the British-Chinese and British-South Asian community of North-East (NE) England. British-Chinese and South Asian subjects were invited to attend for HBV education and screening sessions held in community centres. Hepatitis B surface antigen (HBsAg) and hepatitis B core total antibody (HBcAb) were tested with dry blood spot tests. South Asians were also tested for hepatitis C antibody (HCVAb). A total of 1126 subjects (606 Chinese and 520 South Asian) were screened. Sixty-two (5.5%) were HBsAg positive. Ten of these reported a previous diagnosis of HBV. The prevalence of HBsAg positivity was 4.6% when previously diagnosed individuals were excluded. The HBsAg prevalence was significantly higher in the Chinese subjects compared with South Asians (8.7% VS. 1.7% P < 0.001). In Chinese subjects, HBsAg positivity was highest in subjects born in Vietnam (17.4%), followed by China (11%), Hong Kong (7.8%) and the UK (6.7%). Subjects from Pakistan had the highest HBsAg and HCV Ab prevalence in the South Asians (3.1% and 1.8%, respectively). Ten percentage of HBsAg positive patients who had follow-up assessment had active disease requiring antiviral treatment. Undiagnosed HBV infection was above the 2% threshold for screening suggested by the CDC in the British-Chinese and Pakistani community of NE England, which provides evidence for a UK HBV-targeted screening programme.

Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine

“…Dry blood spot samples were tested for HCV, HBV and HIV using Roche Elecsys® Anti‐HCV II, Elecsys® HIV combi PT and Elecsys® HBsAg II assays on a Cobas® 8100 platform as previously described …”

Low hepatitis B testing among migrants: a cross-sectional study in a UK city

“…10 A 2013 UK study demonstrated that 1.1% of tested individuals were positive for HBsAg; 11 in 2009, the prevalence of HBV among migrants in the UK was estimated to be 4%, 12 ranging from 0.1% to 17.4% depending on ethnic group and study method. [13][14][15][16][17][18] In 2012, the National Institute for Health and Care Excellence (NICE) recommended that all people born in a country with HBV prevalence of ≥2% should be offered a HBV test and that testing is offered in primary care. 19 In 2011, approximately 7.5 million (13%) individuals living in England and Wales were born outside of the UK.…”

Hepatitis B in pregnancy

“…A recent case finding study of more than 1000 individuals in the north east of England using dry blood spot testing found that 8.7% of the British-Chinese and 3.1% of the Pakistani community had undiagnosed HBV, including individuals with active disease requiring treatment 8. In order to address this issue, recent NICE guidelines (UK) have recommended case finding in primary care for individuals at increased risk of HBV,38 which it is hoped will lead to the early diagnosis and treatment of HBV.…”