Journal of Preventive Medicine and Public Health

Original Articles

Hepatitis B, C, and D Virus Infections and AFP Tumor Marker Prevalence Among the Elderly Population in Mongolia: A Nationwide Survey: Davaalkham Dambadarjaa, Yerkyebulan Mukhtar, Enkh-Oyun Tsogzolbaatar, Ser-Od Khuyag, Angarmurun Dayan, Nandin-Erdene Oyunbileg, Oyu-Erdene Shagdarsuren, Gunchmaa Nyam, Yosikazu Nakamura, Masaharu Takahashi, Hiroaki Okamoto; J Prev Med Public Health. 2022;55(3):263-272. Published online May 20, 2022; DOI: https://doi.org/10.3961/jpmph.21.573

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Objectives
Infections with hepatitis B, C, and D virus (HBV, HCV, and HDV) are a major public health problem and lead to serious complications such as cirrhosis and hepatocellular carcinoma. We aimed to determine the seroprevalence of hepatitis B surface antigen (HBsAg), anti-HCV, anti-HDV immunoglobulin G, alpha-fetoprotein (AFP), and dual and triple hepatitis virus infections in Mongolia.
Methods
A total of 2313 participants from urban and rural regions were randomly recruited for this cross-sectional study. A questionnaire was used to identify the risk factors for hepatitis virus infections, and the seromarkers were measured using immunoassay kits.
Results
Among all participants, the prevalence of HBV, HCV, and HDV was 15.6%, 36.6%, and 14.3%, respectively. The infection rates were significantly higher in females and participants with a lower education level, rural residence, older age, and a history of blood transfusion. HBV and HCV co-infection was found in 120 (5.2%) participants and HBV, HCV, and HDV triple infection was detected in 67 (2.9%) participants. The prevalence of elevated AFP was 2.7%, 5.5%, and 2.6% higher in participants who were seropositive for HBsAg (p=0.01), anti-HCV (p<0.001), and anti-HDV (p=0.022), respectively. Elevated AFP was more prevalent in participants co-infected with HBV and HCV (5.8%, p=0.023), HBV and HDV (6.0%, p<0.001), and triple-infected with HBV, HCV, and HDV (7.5%) than in uninfected individuals.
Conclusions
Nearly half (49.8%) of the study population aged ≥40 years were infected with HBV, HCV, or HDV, and 22.4% had dual or triple infections.

Summary

Citations

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The values of systemic immune-inflammation index and neutrophil-lymphocyte ratio in predicting testicular germ cell tumors: A retrospective clinical study
Shuo Wang, Xiao Yang, Ziyi Yu, Peng Du, Yudong Cao, Yongpeng Ji, Jinchao Ma, Yong Yang
Frontiers in Oncology.2022;[Epub] CrossRef
Genetic Diversity and Possible Origins of the Hepatitis B Virus in Siberian Natives
Victor Manuylov, Vladimir Chulanov, Ludmila Bezuglova, Elena Chub, Anastasia Karlsen, Karen Kyuregyan, Yulia Ostankova, Alexander Semenov, Ludmila Osipova, Tatjana Tallo, Irina Netesova, Artem Tkachuk, Vladimir Gushchin, Sergey Netesov, Lars O. Magnius, H
Viruses.2022; 14(11): 2465. CrossRef

Sex Differences Associated With Hepatitis B Virus Surface Antigen Seropositivity Unwareness in Hepatitis B Virus Surface Antigen-positive Adults: 2007‐2012 Korea National Health and Nutrition Examination Survey: Suk-Yong Jang, Sung-In Jang, Hong-Chul Bae, Jaeyong Shin, Eun-Cheol Park; J Prev Med Public Health. 2015;48(2):74-83. Published online March 16, 2015; DOI: https://doi.org/10.3961/jpmph.14.034

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Abstract PDF

Objectives
To examine the sex-specific factors associated with being unaware of one’s hepatitis B virus surface antigen (HBsAg) seropositivity status in a large, HBsAg-positive population of Koreans.
Methods
In total, 1197 subjects aged 19 years or older who were HBsAg-positive according to data from the 2007-2012 Korea National Health and Nutrition Examination Survey were included. Subjects were considered unaware of their HBsAg seropositivity status if they answered that they had no knowledge of being previously infected by the hepatitis B virus (HBV) or diagnosed with HBV hepatitis. Multivariate Poisson regression models with robust variance estimate were used to assess the significance of the variables using weighted frequencies.
Results
The majority (77.8%) of HbsAg-positive Korean adults (females, 81.9%; males, 74.6%) were unaware of their HBsAg seropositivity status. We found that sex (female: prevalence ratio [PR] 1.19), household income (low: PR, 1.15), marital status (never married: PR, 1.18), self-rated health (moderate: PR, 1.14; good: PR, 1.12), and alcohol use (at least 2-3 times/wk: PR, 1.21) were associated with being unaware. In females, age (50 to 59 years: PR, 1.29; ≥70 years: PR, 1.30), household income (low: PR, 1.37; middle–low: PR, 1.24), and marital status (never married: PR, 1.33) were associated with being unaware. In males, self-rated health (moderate: PR, 1.14; good: PR, 1.21) and alcohol use (at least 2–3 times/wk: PR, 1.21) were associated with being unaware.
Conclusions
Factors related to the socioeconomic status of females and the health-related behaviors of males were found to be associated with being unaware of one’s HBsAg seropositivity status.

Summary

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Association of perceived life satisfaction with attitudes toward life-sustaining treatment among the elderly in South Korea: a cross-sectional study
Il Yun, Hyunkyu Kim, Eun-Cheol Park, Suk-Yong Jang
BMC Palliative Care.2022;[Epub] CrossRef
Spatial epidemiologic analysis of the liver cancer and gallbladder cancer incidence and its determinants in South Korea
Jieun Jang, Dae-Sung Yoo, Byung Chul Chun
BMC Public Health.2021;[Epub] CrossRef
Socioeconomic differences in self- and family awareness of viral hepatitis status among carriers of hepatitis B or C in rural Korea
Hye-Ran Ahn, Sung-Bum Cho, Ik Joo Chung, Sun-Seog Kweon
American Journal of Infection Control.2018; 46(3): 328. CrossRef

A Study on the Seropositivity of HBsAg among Biennial Health Examinees: A Nation-wide Multicenter Survey.: Dae Sung Kim, Young Sik Kim, Jae Yong Kim, Yoon Ok Ahn; Korean J Prev Med. 2002;35(2):129-135.

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Abstract PDF: OBJECTIVE
The primary objective of this study was to estimate the prevalence of HBsAg-positives in the late 1990's among Korean adults. In addition, we evaluated the association of age, a residential area, a vaccination rate, a family history of chronic liver diseases and a past history of acute liver disease with the seropositivity of HBsAg, and estimated the prevalence of chronic HBV infection by follow-up for 6 month or more. METHODS: A total of 10 areas, six metropolitan and four small cities, were selected. In each cities, one health screening center was selected for recruitment of study subjects. The study subjects were enrolled from a general health examination program that is provided by medical insurance companies. Questionnaires on various risk factors were administered to the study subjects. Sera was drawn and tested for HBsAg by radioimmunoassay. HBeAg and ALT were also tested for those of HBsAg positive. The HBsAg positives was retest for HBsAg 6 months later. RESULTS: Among the study subjects (n= 1816), the seroprevalence of HBsAg was 5.5% (95% CI= 4.5%-6.6%), 7.4% in men (95% CI= 5.8-9.4) and 3.6% in women (95% CI= 2.5-5.0). A past history of acute liver disease and a family history of chronic liver diseases was shown to be risk factors for HBsAg positivity. Among the 31 HBsAg-positives, negative seroconversion rate was estimated to be 3.2 %, Thus, prevalence of chronic HBV infection was estimated to be 5.3% (95% CI= 3.7-6.6). CONCLUSION: In this study, the HBsAg seroprevalence rate was lower than that of the other studies in 1980's, particularly in young adult and women. Considering the public health importance of liver cancer and chronic liver diseases, the further effort is needed to prevent and reduce the HBV infection.; Summary

Serum HBsAg and Anti-HBs Positive Rate among a City Health Center Visitors.: Mal Sook Shin, Tae Yoon Hwang, Chang Yoon Kim; Korean J Prev Med. 1997;30(3):508-517.

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Abstract PDF: Hepatitis B virus(HBV) infection is one of the major health problems in Korea and HBsAg positive rate was known to be about 5~15% in general population. This study was conducted to identify the positive rates of serum HBsAg and anti-HBs among community population regared as having high HBV vaccination rate than in previous decade, using EIA(Enzyme immunoassay) method, in Seo-Gu, Taegu, Korea. The study subjects were 1,160 who visited Seo-Gu Health Center for check-up serologic markers of hepatitis B. The data were obtained from the serologic test for hepatitis markers and questionnaire survey was conducted to obtain the general characteristics, vaccination history, past history of hepatitis and other liver disease , and exposure history to risk factors of hepatitis of the study subjects. The positive rates of HBsAg and anti-HBs were 5.2% and 62.4% respectively. The positive rates of HBsAg for male and female were 6.6% and 4.3% respectively. The age was divided into two groups as group I(less than 15 years old), group II(more than 16years old) according to the hypothesis that these two groups might be different in HBV vaccination rate. HBV vaccination rates for group I and II were 83.1% and 52.3%. The positive rates of HBsAg for group I and II were 2.6% and 6.5%. The positive rates of HBsAg for the vaccinated people of the group I and II were 2.2% and 3.5%, the positive rates of anti-HBs for the vaccinated people of the group I and II were 70.1% and 71.1% respectively. The most significant factor in positive rate of HBsAg was 'hepatitis carrier in family'. Multiple logistic regression analysis revealed that 'hepatitis history' and 'hepatitis carrier in family' were significant variables for positivity of HBsAg, and 'hepatitis B vaccination' was only a significant variable for positivity of anti-HBs.; Summary

The Incidence of Hepatitis B in Military Service ad the Effect of Asymptomatic HBsAg Carriers on the Incidence.: Rock Kwon Kim, Il Suh, Hung Mo Nam, Kwang Hyub Han; Korean J Prev Med. 1997;30(2):267-278.

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Abstract PDF: The purpose of this study was to investigate the incidence rate of hepatitis B in the military service and to examine the effect of the asymptomatic HBsAg carriers on the incidence of hepatitis B. The subject were 223,270 men who were conscripted to the Korean Army from 1991 to 1994 year. According to the conscripted year, four conscription cohort were constructed. At the screening examination for military service no test for hepatitis B were performed in 1991 and 1992. In 1993, a screening test for hepatitis B were performed and those who were confirmed as HBsAg positive or > or = SGPT 100IU were excluded from conscription. In 1994, the criteria for conscription was changed and those who were HBsAg positive were not excluded from conscription. Only those who were > or =SGPT 100IU were excluded. The main results were as follows ; 1. The positive rate of HBsAg is 5.5% in the conscripted men. 2. The incidence rates of the hepatitis B in 1991 and 1992 conscription cohort were 9.96 and 8.10 per ten thousand per son - year, respectively. The incidence rate of the hepatitis B was 1.34 per ten thousand per son - year in 1993 conscription cohort which was confirmed as HBsAg negative at the screening test, and 7.41 per ten thousand per son - year in 1994 conscription cohort which included the HBsAg positive. 3. The incidence rate of hepatitis B was 99.98 per ten thousand per son- year in HBsAg positive group and 2.25 per ten thousand per son - year in HBsAg negative group. The incidence rate of the group with high SGPT and HBsAg positive was 255 times higher than that of normal population. 4. The incidence of hepatitis B in HBsAg negative group did not increase even though the probability of personal contact with HBsAg positive had been increased. From the above result s, the men who have high SGPT with HBsAg positive should be excluded from military service, and it can not be said that asymptomatic HBsAg carrier s influence on the hepatitis B incidence among the HBsAg negative through personal contact.; Summary

Seroepidemiologic Study of Hepatitis B Virus(HBV) and Hepatitis C Virus(HCV) Infection among Koreans in Rural Area, Korea.: Hai Rim Shin, Joon Youn Kim, Jue Bok Song, Byung Seong Suh, Jung Man Kim, Bu Ok Lee, Su Ryang Kim, Mu Guan Yang, Chae Un Lee, Jin Ho Chun, Keun Young Yoo, Yoon Ok Ahn; Korean J Prev Med. 1997;30(1):17-30.

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Abstract PDF: To estimate the prevalence of hepatitis B virus(HBV) and hepatitis C virus(HCV) infection and to determine associated risk factors, a population-based seroepidemiologic study was carried out. In 1993, a health examination survey of the population was carried out in rural area known to have a high incidence of liver cancer. The study population were those who volunteered to participate in a health survey over 10 years of age. Examinees were interviewed by specially trained staffs. Sera from 1,033 study subjects were tested for hepatitis B surface antigen (HBsAg) by reverse passive hemagglutinin (RPHA) estimation and for hepatitis C virus antibody (anti-HCV) by 2nd generation passive hemagglutinin (PHA) estimation, The age and sex standardized prevalence of HBsAg was 6.3% which was similar to national average, but that of anti-HCV was 5.1% which was 4 to 5 times higher than that of blood or other health examinees in Korea. In a multivariate analysis, transfusion history, surgical operative history, and acupuncture history were not associated with HBsAg positivity. In contrast, acupuncture history (adjusted odds ratio[OR]=2.2 : 95% Confidence interval[CI] 1.0-4.7) and surgical operative history(adjusted OR=2.0 : 95% CI 1.0-4.1) were associated with anti-HCV positivity. The present study suggest that there is an highly endemic area of HCV infection in Korea and probably this endemicity is associated with a parenteral source of HCV infection other than blood transfusion.; Summary

A Case-Control Study on Association Between Hepatocellular Carcinoma and Infection of Hepatitis B and Hepatitis C Virus.: Hyeong Sik Ahn, Min Ho Kim, Young Sick Kim, Joung Soom Kim; Korean J Prev Med. 1997;30(1):1-16.

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Abstract PDF: To investigate the association between hepatocellular carcinoma(HCC) and infection of hepatitis B virus(HBV) and hepatitis C virus(HCV) in an HBV endemic area , a case-control study of 254 patients with HCC and of 1,270 age and sex matched health control subjects was done. Among the 254 HCC patients 166(65.4%) were positive for hepatitis B surface antigen(HBsAg), 49(19.3%) were positive for HCV antibody(anti-HCV Ab). The crude odd ratio of patients with HBsAg was 36.1(95% CI :22.4-58.2) and with anti-HCV Ab was 9.0(95% CI :5.5-14.6). In an analysis, which HBsAg(-), HBcAb(-), anti-HCV Ab(-) group was chosen as referent group, odd ratio of HBsAg(+) group was 14.4(95% CI: 7.2-28.9) and of anti- HCV Ab(+) was 10.7(95% CI: 2.9-40.0). Odd ratio of anti-HCV Ab(+), HBsAg(+) group and anti-HCV Ab(+), HBsAg(-), HBcAb(+) group for HCC were elevated to 27.3(95% CI : 9.0-82.9) , 15.9(95% CI:7.1-35.8) respectly. The odd ratio of anti-HCV Ab(-), HBsAg(-), HBcAb(+) group was 2.4(95% CI : 1.1-5.0). These result suggested that HBV and HCV were associated with HCC. In HBV endemic area patients with HBcAb alone should be considered risk group for HCC.; Summary

Seroepidemiology of Hepatitis B virus Infection in Healthy Korean Adults in Seoul.: Keun Young Yoo, Byung Joo Park, Yoon Ok Ahn; Korean J Prev Med. 1988;21(1):89-98.

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Abstract PDF: While there have been not a few reports on the seroepidemiological characteristics of hepatitis B virus (HBV) infection in Korea, most of them, however, have had several limitations; operational definition of HBV infection, validity of detection methods of HBV serologic markers, size of the study population, and confirmation of the vaccination history against HBV, etc. In order to avoid such limitations, authors randomly selected 1,495 healthy adults among the 217,511 insured (target population) of Korean Medical Insurance Corporation, living in seoul, and tested HBV(HBsAg, anti-HBs and anti-HBc) of all the subjects were tested, 392(26.2%) of interview failure cases 742 nonvaccinee were excluded from the actual population. Finally, the serologic markers tested of 742 nonvaccinee (study population) only were analyzed for the seroepidemiologic observation of the natural infection of HBV. The seroepidemiological characteristics of HBV infection in Korea were as follows ; 1 Point prevalence of HBs antigenemia was 11.7(9.1-14.3)% in male, which was slightly higher than that of female, 9.5(3.7-15.3)%. This level was one of the highest among those of Asian-Pacific countries. Decreasing tendency of HBsAg prevalence after the age of 50 was observed, which seems to be due to selective attrition of HBV chronic carriers among the healthy adults and/or to the limited-lasting duration of the HBs antigenemia, in part. 2. Point prevalence of anti-HBc(78.8% in male, 50.9% in female) was higher than that of anti-HBs(65.2% in male, 46.6% in female), respectively. And both of them were higher in male than in female. Increasing tendency of the prevalence of both antibodies was observed by age, which seems to be largely due to recurrent infection in adults and to some cumulative effect, in part, of their relatively longer-lasting duration. 3. The level of HBV infection defined by positive for at least one of the 3 serologic markers of HBV by RIA method was 84.7(81.8-87.6)% in male and 61.2(51.9-70.5)% in female, which was also one of the highest among those of Asian-Pacific countries. The proportion of susceptible population to HBV infection among healthy adults was 15.3% in male and 38.8% in female. 4. The relative frequency of current or past infection and chronic carrier among HBV infected person was estimated. The currently or past infected was estimated 75.7% in male and 71.8% in female, and chronic carrier state, 13.8% in male and 14.1% in female. The analysis of the geometric mean of the antibody titer in anti-HBs positive sera indicated also to be compatible with the above findings, suggesting that active, even though inapparent, infection of HBV occur so frequently among healthy adults in Korea.; Summary

Knowledge and Practice of College Entrants Toward Hepatitis B.: Sung Ai Chi, Kyou Chull Chung, Jong Yoon Park; Korean J Prev Med. 1988;21(1):31-46.

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Abstract PDF: In order to designate a status necessary for establishment of preventive measures and guidelines of health education against hepatitis B in the course of secondary school education, knowledge and practice toward hepatitis B virus infection was surveyed by a questionnaire method on total of 4,855 college entrants in the academic year of 1987 and analyzed the data collected using IBM PC(Trigem 88-II) with SAS package program. About two percent of college entrants had past history of HBV infections not showing any difference between both sexes and geographical regions. About one third(33.7%) of total students had tested hepatitis B surface antigen(HBsAg), only 4% had tested hepatitis B surface antibody(HBsAb) and vaccination rate amounted to 24.6%, one fourth of total subjects. Both serological tests and vaccination were most commonly performed during adolescence, showing higher rates in female students than in male students. The rates also seemed to be higher in those from urban cities than those from rural cities. Students who had acquired correct knowledge that hepatitis B was infected by virus were amounted to 78.5% of college entrants, and remaining 21.5% had misunderstood that rickettsia, bacteria, fungi or parasites were casual agents. Female students were better aware of the causal agents than male students but there was no difference between places of growth. As for mode of transmission of HBV, 51.5% of male students and 47.7% of female students had correct knowledge. A very few student had known that fact that HBV was transmitted by body fluids such as tear (6.9%), nasal discharge(10.1%) and semen or vaginal secretion(19.2%) and majority(75%) of students had misunderstood that hepatitis B virus would be transmitted per os through food ingestion. Approximately one half(48.9%) of college entrants had correctly whom to be vaccinated. Approximately one half of the students knew that hepatoma(57.8%) and liver cirrhosis(57.4%) might complicate with hepatitis B virus infection, whereas 12.0% of the students responded that bronchitis was one of the complications of hepatitis B infection. In summary of the above results, we highly recommend that health education program for eradication of hepatitis B virus infection should be introduced in curricula of secondary school education in this country.; Summary

A seroepidemiological Study of Hepatitis B and C Virus (HBV and HCV) Infections in the Young Population in parts of Busan, Korea.: Young Hee Ju, Hai Rim Shin, Jin Kyoung Oh, Dong IL Kim, Duk Hee Lee, Byeong Kweon Kim, Jung Il Kim, Kap Yeol Jung; J Prev Med Public Health. 2004;37(3):253-259.

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Abstract PDF: OBJECTIVES
To investigate the prevalence of hepatitis B and C virus infections and determine the associated risk factors among young adults in Busan, Korea, which is known to have a high incidence of liver cancer. METHODS: The study population consisted of volunteer participants in a health survey during 2002, which included 1, 350 students (515 males and 835 females) aged between 16 and 24 years, from three different schools in Busan. The participating students were asked to fill in a selfadministered questionnaire which included lifestyle habits and risk factors of hepatitis. Sera obtained from the participants were studied for HBsAg, anti-HBs, and Anti- HCV by enzyme immunoassay (EIA) method and for liver function tests. RESULTS: Among the study subjects (N=1, 350), the seropositivities of HBsAg 7.9% (95% CI=7.8-8.0), 7.6% (95% CI=7.6-7.7) in male and 8.1% (95% CI=8.0-8.2) in female. And the seropositivity of Anti-HBs was 69.7% (95% CI=69.0- 70.4), 70.5% (95% CI=69.8-71.2) in male and 69.2% (95% CI=68.5-69.9) in female. The seropositivity of Anti-HCV was 0.4%, 0.2% in male and 0.5% in female. The seropositivity for HBsAg in the subjects not having a hepatitis B vaccination history was twice (95% CI=1.0-4.4) that of those that did. Also, the seropositivity for HBsAg in subjects having experienced sexual intercourse was 1.7 times (95% CI=0.9-3.0) that of the subjects who had not. CONCLUSIONS: The present study confirmed the high prevalence of HBsAg seropositivity and sexual transmission of HBV among adolescents and young adults may occur. Further studies to evaluate the relationship between HBV vaccination and sexual transmission are required for the young population in Korea.; Summary

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