Hepatitis B markers in heterosexual patients attending two genitourinary medicine clinics in the West Midlands

Hepatitis B virus infection among Chinese residents in the United Kingdom

OBJECTIVE

To determine prevalence of hepatitis B virus (HBV) serological markers in Chinese residents in the United Kingdom.

METHOD

Retrospective case-controlled study between January 1997 and June 2000 in two genitourinary medicine (GUM) clinics.

RESULTS

117 Chinese and 234 non-Chinese controls were studied. Baseline characteristics except marital status showed no difference. Overall prevalence of HBV serological markers was 35.8% in Chinese, controls 5.5% (p<0.001). Hepatitis B surface antigen (HBsAg) positive carrier rate was 12.8% in Chinese, controls 0.4% (p<0.001); 1.7% of Chinese patients were also hepatitis B e antigen (HBeAg) positive, none in controls. Natural immunity was acquired in 23.0% of Chinese, controls 5.1% (p<0.001). Prevalence of HBV serological markers in UK born Chinese was 6.7%, non-UK born Chinese 40.1% (p<0.011). Only 7.6% of Chinese had a history of previous HBV vaccination.

CONCLUSIONS

Prevalence of HBV serological markers among Chinese patients attending two GUM clinics in London was high and only a minority of Chinese had immunisation against HBV. Although the prevalence of HBV markers in UK born Chinese was lower than non-UK born Chinese, they may be at continuous risk of HBV infection. Non-UK born Chinese patients attending GUM services in the United Kingdom should be targeted for screening and vaccination to reduce HBV transmission.

Hepatitis B virus infection in patients attending a genitourinary medicine clinic: risk factors and vaccine coverage

BACKGROUND

The hepatitis B virus (HBV) immunisation policy in the United Kingdom includes offering vaccines selectively to those at risk by sexual contact. Among genitourinary medicine (GUM) clinic attenders, homosexual men are offered vaccine, but estimates of the vaccine uptake are required to monitor policy and estimate the possible impact on transmission; heterosexuals are not routinely offered vaccine, but this policy might change if the prevalence was found to be high.

OBJECTIVE

To determine the prevalence of HBV infection and vaccine uptake among patients attending a GUM clinic.

METHODS

HBV seroprevalence determined by unlinked anonymous testing of consecutive blood samples sent for syphilis serology. Demographic and risk factor data and history of HBV immunization extracted from clinic notes before unlinking. Prevalence data were compared with a population of first time blood donors from the same area.

SETTING

Open access GUM clinic in central London.

RESULTS

Samples were obtained and tested from 441 homosexual and 527 heterosexual men and from 821 women over a 4 month period in 1990. After exclusion of injecting drug users and their sexual partners (n = 30) and HBV carriers attending for follow up (n = 12), the prevalence of antibody to HBV core (anti-HBc) was 38.7% in homosexual men, 5.9% in heterosexual men, and 3.5% in women (50.0%, 6.0%, 3.7% respectively if previous vaccinees were also excluded). The prevalence of HBV surface antigen positivity was 4.2%, 0.60%, and 0.39% respectively after exclusion of vaccinees (chi(2) p < 0.001 for homosexual men versus others). The prevalence of the anti-HBc in first time blood donors was 1.1% (8/749). Among male GUM clinic attenders, the prevalence of anti-HBc was higher in those of non-UK origin or place of birth and/or non-white ethnicity (odds ratios 2.87, 95% CI 1.57-5.24 and 8.06, CI 3.39-19.1, in homosexuals and heterosexuals respectively). In homosexual men anti-HBc prevalence increased with age (OR 1.05, CI 1.02-1.07 for each year) and lifetime number of STDs (OR 6.36, CI 3.77-10.8 for > or = 2 versus < 2) and in clinic reattenders compared with new patients (OR 5.42, 95% CI 3.32-9.16). Among heterosexuals, age was associated with anti-HBc prevalence in women (OR 1.09, CI 1.04-1.12) but not men (OR 0.99, 95% CI 0.95-1.02). There were no other associations in heterosexuals. A history of HBV immunisation in homosexual men was recorded in 13/131 (9.9%) of new patients and 103/305 (33.8%; OR 4.63, CI 2.49-8.60) clinic reattenders.

CONCLUSIONS

Although higher than a sample of blood donors, the prevalence of serological markers of HBV infection among heterosexuals was low, providing little support for extending HBV immunisation to all heterosexuals attending GUM clinics as a targeted strategy for control of HBV infection. Homosexual men remain at high risk of infection, but many are now being immunised. Efforts to improve compliance with existing vaccine policies in GUM clinics should be encouraged.

Prevalence and risk factors for hepatitis B virus infections among visitors to an STD clinic

OBJECTIVE

To determine the prevalence and risk factors for hepatitis B virus (HBV) infections among individuals attending an STD clinic in a low endemic region.

STUDY DESIGN

A total of 1228 women and 1648 men attending the STD clinic at the University Hospital Rotterdam, Netherlands, were examined for HBV infection by determination of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B core antigen (anti-HBc). Demographic characteristics, information on sexual behaviour, and intravenous drug use were recorded.

RESULTS

The seroprevalence of HBsAg was 1.4% in women and 2.1% in men (0% in homosexual men). The seroprevalence of anti-HBc was 13% in women and 20% in men (36% in homosexual men). Native country, intravenous drug use, a history of STD, and the number of partners in the past half year (inversely) were independent risk factors for HBsAg positivity in women and heterosexual men. For anti-HBc independent associations were observed for native country, age, intravenous drug use, commercial sex, number of lifetime partners, homosexual contacts, orogenital contact (inverse), and a history of STD.

CONCLUSION

The HBV prevalence in the STD clinic attendants was high, exceeding the national estimate, and indicates that the STD clinic population may be considered a high risk group. Our data confirmed an increased risk for HBV infections among established risk groups. Therefore, these risk groups should be routinely screened to identify HBV cases for counselling and contact tracing.