Journal of Preventive Medicine and Public Health

Original Article

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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Special Article

Trends of the Global Hepatitis C Disease Burden: Strategies to Achieve Elimination: Nathalie Brunner, Philip Bruggmann; J Prev Med Public Health. 2021;54(4):251-258. Published online June 24, 2021; DOI: https://doi.org/10.3961/jpmph.21.151

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Abstract PDF

Hepatitis C infection is responsible for high morbidity and mortality rates globally as well as for significant indirect costs. The disease burden caused by the hepatitis C virus (HCV) is comparable to the one caused by human immunodeficiency virus or tuberculosis. Today, simple detection methods, highly effective and easy to administer therapies and efficient preventative measures are available to combat hepatitis C. Nevertheless, in most countries around the world, the World Health Organization target of eliminating this infectious disease and its consequences by 2030 are not being met. Significant gaps in care for hepatitis C sufferers still exist, the shortcomings ranging from education and treatment to aftercare. Hepatitis C infection was and still is not on the radar of most politicians and health authorities. National programmes and strategies to combat the disease exist or are being developed in many countries. However, for these to be implemented efficiently and successfully, clear political commitment, strong civil society actors, well-functioning public health structures and the relevant support from global donors are needed.

Summary

Citations

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Original Articles

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

Assessment of Validity of RT-PCR and EIA for The Detection of Hepatitis C Virus Infection.: Byung Chul Son, Jin Ho Chun, Yeong Hong Park, Hai Rim Shin, Kyu Il Cho, Jong Han Kim, Kui Oak Jung, Jong Tae Lee, Chae Un Lee, Nak Whan Paik; Korean J Prev Med. 1995;28(2):526-541.

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Abstract PDF: This study was conducted to estimate the validity of reverse transcriptase-polymerase chain reaction(RT-PCR) compared to enzyme immunoassay(EIA) for the detection of hepatitis C virus (HCV) infection. ElA for antibody to HCV(anti-HCV) and RT-PCR for HCV was executed on the subjects from Pusan and kyungnam area with questionnaire survey to collect some relating factors of HCV infection As the result from 617 cases, the prevalence of flcv infection was 1.5% by ElA and 3.7% by RT-PCR(p<0.05), and the age standardized rate was 1.7% and 3.4% by ElA and RT-PCR, respectively. The prevalence of hepatitis B surface antigen(HBsAg) was 6.8% by enzyme linked immunosorbent assay(ELlSA) and the age standardized rate was 7.7%. It was the higher in male group comparing to female group(p<0.01). Both of the prevalence of HCV and HBsAg were higher in elevated asparate aminotransferase(AST) and alanine aminotransferase (ALT) group than in normal AST and ALT group(p<0.01). There was no specific risk factor of HCV infection. Though the degree of agreement of EIA and RT-PCR by gamma statistics was 97.2%, it showed a significant difference between the two methods(p<0.01). For the detection of HCV infection, positive predictive value of ElA was 66.7 % and negative predictive value of EIA was 97.2%. This study suggests that negative result to anti-HCV by ElA didn't mean the free state of HCV infection, therefore it would be helpful that further monitoring for HCV infection by RT-PCR in the case of elevated AST and ALT and/or clinically suspected.; Summary

A Baseline Study on the Choice of Optimal Screening Test Items among Workers with Abnormal Liver Function Tests on Workers' Periodic Health Examination.: Hae Kwan Cheong, Hyun Sul Lim, Gyu Hoi Kim; Korean J Prev Med. 1994;27(4):747-762.

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Abstract PDF: Workers', periodic health examination is the main tools used to manage the health problems of most workers in Korea. The most common health problem found in workers' periodic health examination is liver disorder. Liver disorder is also one of the most common health problems in general population and one of the leading causes of mortality in adult population. Regulation proposed by government(NO. 207, Ministry of Labor, 1992) defines the criteria for selection of workers with the liver dysfunction for further evaluative examination and the examination items used for diagnosis of the workers with liver dysfunction. This study was designed to evaluate the proficiency of each examination items presently defined in Regulation and propose the optimal examination items for detection of the liver disorders found by workers' periodic health examination. Study subjects are 186 workers with abnormal liver function tests in screening examination of workers' periodic health ex amination. Questionnaire survey including past history of liver disorder, drinking history, height and weight was done. Physical examination by physician, routine test items defined by Regulation (SGOT, SGPT, gamma- GTP, protein, albumin, total and direct bilirubin, alkaline phoshatase, alpha-feto protein, HBsAg and anti-HBs), anti-HCV antibody test and liver ultrasonography were done. Results are as follows; 1. Result of evaluative examination utilizing only the items defined in Regulation was; There were 75 workers with suspected liver disorder(40.3%), 63 with no liver dysfunction(33.90%), 13 with suspected hepatitis B(7.0%), 10 workers with hepatitis B(5.4%) 10 workers with hepatitis B carrier state(5.4%), 10 with alcoholic liver disorders(5.4%), 5 with fatty liver(2.7%). When alternative diagnostic criteria applying additional examination items (drinking history, body mass index, anti-HCV antibody and ultrasonography) diagnosability of liver disorder was increased. When all four items were included, final results were; 23 workers (l7.8%) with hepatitis B(10 carriers, 13 suspects and 10 hepatitis B), 10(5.4%) with hepatitis C(4 carriers, 5 suspects and 1 hepatitis C), 13(7.0%) with alcoholic liver disorder, 45 (24.2%) with fatty liver (40 suspects, 5 fatty liver), 41 0%) with suspected liver disorders and 44(23.7%) with normal liver. 2. Of examination items defined by Regulation, only SGOT, SGPT, gamma-GTP and HBsAg were significantly different in abnormal rate and mean value, and all other laboratory findings did not showed significant difference between two groups. Drinking history, body mass index and anti-HCV antibody test which are the items that authors included in this study, also showed significant difference between two groups. Utilization of body mass index(BMI) for abnormal liver function group in diagnosis of fatty liver had high specificity(97.6%) but sensitivity (22.3%) was low. Therefore we suggest that SGOT, SGPT, gamma-GTP, HBsAg, alcohol drinking history, BMI and anti-Hcv Ab were useful for diagnosis of liver disorders among worker's periodic health examination.; 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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