Prevalence of hepatitis B in insular regions of southeast China: a community-based study

Exploring the Humanistic Care Competencies of Nurses in Infectious Disease Hospitals in China: A Modified Delphi Study

AIM

This study aims to develop an indicator system for assessing the humanistic care competencies of nurses in infectious disease hospitals and provide a scientific measurement tool to understand the current humanistic care competencies level of infectious disease nurses.

DESIGN

A mixed-methods design integrating qualitative interviews and a modified Delphi study.

METHODS

Initially, we derived a list of potential indicators of humanistic care for nurses in infectious disease hospitals from literature reviews and interviews with a nominal group technique (n=41). Following this, 26 experts from across China participated in two Delphi rounds from May to July 2023. Then the indicators were screened, revised and supplemented using the boundary value method and expert opinions. Next, the hierarchical analysis method was utilised to determine the weights of the indicators.

RESULTS

The average effective response rate across the two Delphi rounds was 94%. The authority coefficients for the first and second rounds were 0.85 and 0.90, respectively, suggesting the experts were highly authoritative. There was a consistent rating among experts with a coordination coefficient for each indicator (p < 0.001). Ultimately, this study identified 4 primary indicators, 8 secondary indicators, and 35 tertiary indicators. The four primary indicators and their weights are basic care competency (0.158), therapeutic care competency (0.544), spiritual care competency (0.158) and safety care competency (0.140).

CONCLUSION

This research provides a scientifically rigorous and comprehensive framework to evaluate the humanistic care competencies of nurses in infectious disease hospitals in China. This system will serve as an effective tool for evaluating the humanistic care competencies of nurses in specialized infectious disease hospitals in China and other overseas regions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study provides a new tool to assess the humanistic care competencies of nurses in infectious disease hospitals. Form an effective humanistic care competencies index system that can be used to build and develop the need for nurses to possess different aspects of humanistic care competencies tailored to infectious disease patients in hospitals.

PATIENT OR PUBLIC CONTRIBUTION

No patients or public contribution.

Analysis of reported incidence of chronic hepatitis B in Chaoyang District, Beijing during 2005-2022 with age-period-cohort model

Objective

The study aimed to describe the trend of chronic hepatitis B among the population in Chaoyang District from 2005 to 2022 and explore the effects of age, period, and cohort factors on the incidence risk.

Methods

Incidence rates of chronic hepatitis B were collected from the national infectious disease reporting and information management system. Descriptive epidemiological methods were employed to characterize the incidence of chronic hepatitis B from 2005 to 2022. Trends in chronic hepatitis B were analyzed using an age-period-cohort model. The effects of age, period, and cohort on chronic hepatitis B incidence were estimated using the Intrinsic Estimator operator. Model goodness of fit was assessed by introducing variance, AIC, and BIC, comparing the established model with conventional two-factor models.

Results

From 2005 to 2022, the reported incidence of chronic hepatitis B in Chaoyang District showed a gradual decrease followed by stabilization, declining from 49.58/100,000 to 8.58/100,000 overall, from 63.36/100,000 to 11.69/100,000 in males, and from 35.15/100,000 to 5.55/100,000 in females. The age effect coefficient for males with chronic hepatitis B increased initially and then decreased with age, whereas for females, it decreased initially and then increased with age. The period effect on chronic hepatitis B incidence risk in both genders initially decreased and then increased over time. The cohort effect coefficient for males exhibited a pattern of decrease, increase, and then decrease, whereas for females, it generally increased and then decreased. The APC model constructed with the intrinsic estimator demonstrated the best goodness of fit, as indicated by lower variance, AIC, and BIC compared to conventional two-factor models.

Conclusion

The reported incidence of chronic hepatitis B in Chaoyang District from 2005 to 2022 declined and stabilizing after 2013. We found distinct age, period, and cohort effects on the incidence, with higher risks observed in males aged 25-29 and 75-79, and females born in 1966-1970. These findings highlight the importance of targeted surveillance, expanded screening, and improved diagnosis and treatment rates to reduce the long-term chronic hepatitis B burden.

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

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.

Cost-Effectiveness of Hepatitis B Mass Screening and Management in High-Prevalent Rural China: A Model Study From 2020 to 2049

BACKGROUND

Chronic hepatitis B (CHB) is highly prevalent among adults in rural China and better management of those populations is of vital importance for viral hepatitis elimination. Adult immunization has been the subject of much controversy in previous studies. This study estimates the cost-effectiveness of population-based hepatitis B screening, treatment, and immunization strategy (comprehensive strategy) in rural areas with high prevalence under the national policy of sharp-drop drug prices.

METHODS

We constructed a Markov model comparing 4 strategies in a 30-year horizon from the healthcare payer perspective: (1) the conventional pattern; (2) screening and treating infected (treatment); (3) screening and immunizing susceptible individuals (immunization); and (4) the comprehensive strategy. Screening intensity ranged from 50% to 100%. Outcomes were measured by costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and clinical outcomes.

RESULTS

The costs for the conventional pattern, treatment strategy, immunization strategy, and comprehensive strategy were US$ 341, 351, 318, and 323, respectively. In addition, effects were 17.45, 17.57, 17.46, and 17.58 QALYs, respectively. The ICER of the comprehensive strategy was US$ 35/QALY gained at 50% screening intensity and 420 US$/QALY gained at 100%. The net monetary benefit increased with increasing screening intensity and declined after 90%, with the highest value of US$40 693. All new infections and 52.5% mortality could be avoided from 2020 to 2049 if all patients were properly treated and all susceptible individuals were immunized. The results were stable within a wide range of parameters.

CONCLUSION

It was cost-effective to implement the mass hepatitis B screening, treatment, and immunization strategy in areas of rural China with high prevalence, and the strategy gained the most net monetary benefit at a screening intensity of 90%. Although it was impractical to fulfill 100% coverage, efforts should be made to obtain more people screened.

Incidence and Influencing Factors of New Hepatitis B Infections and Spontaneous Clearance: A Large-Scale, Community-Based Study in China

Background: Hepatitis B surface antigen (HBsAg) is widely used in hepatitis B screening, and HBsAg seroclearance indicates hepatitis B eradication. Few studies have explored the incidence of and determinants for spontaneous seroclearance using a long-term follow-up cohort study. Our research aimed to examine the incidence of and influencing factors for hepatitis B virus infection and spontaneous clearance of HBsAg from a large-scale cohort in China.

Methods: A total of 151,926 resident individuals in Tongxiang underwent HBsAg screening at least thrice in a 7-year period. Serum samples collected at baseline and follow-up examinations were tested for HBsAg. Cox proportional hazard models were used to analyze determinants of HBsAg seroclearance and persistent HBsAg presence.

Results: Among the 151,926 participants, new hepatitis B infections occurred in 4,497 participants, yielding an incidence rate of 571.38 per 100,000 person-years. The incidence rate for males was higher than that for females. In the multivariate Cox regression analysis, female gender, alcohol drinking history, hepatitis family history and middle-age group were predictors for persistent positive HBsAg status.

Conclusions: The incidence rate of new hepatitis B infections was 571.38 per 100,000 person-years. Male and aged people in this community cohort have a higher infection rate. Alcohol drinking and hepatitis family history were risk factor leading to chronic infection. Female and middle-aged people were prone to persistent positive HBsAg status.

Analysis of epidemiological serosurvey of hepatitis B virus among people under 29 years of age in Jiangsu Province, China

Background: The purpose of this paper was to analyze the prevalence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core anti-body (anti-HBc)in1-29 years old living in the most populous eastern province of China,22 years after introduction of hepatitis B vaccine (HepB) vaccination of infants and provide provincial baseline data for developping a better prevention and control plan for hepatitis B virus (HBV)in Jiangsu Province, ChinaMethods: The incidence rates of HBV in Jiangsu province from 2004 to 2014 were obtained from the National Notifiable Disease Reporting System (NNDRS). A stratified cluster random sampling method was used to select 3,002 participants aged 1-29 years across 13 HBV monitoring points throughout the province, which had been classified as either urban or rural. HBV serological markers were measured by Abbott microparticle enzyme immunoassay (MEIA) kits (Abbott Laboratories, Chicago, Illinois).Results: The incidence of hepatitis B decreased by approximately 71.44% in Jiangsu province between 2004 and 2014. Serological assessments showed that the prevalence of the HBsAg, anti-HBc, and anti-HBsin the 1-29 age group were 1.20%, 5.33%,and 66.89%, respectively. There was a significantly lower prevalence of HepB who were vaccinated than in unvaccinated subjects (0.46% vs 14.93%, p < .0001). Among these the ages of 1-29, the coverage rate drops from 97.7% to 56.6% with age,andthe timely rate among people aged 1-14 years was 90.93%.Conclusions: Since the HepB was integrated into the immunization programme in Jiangsu province,the rate of hepatitis B reported and the prevalence of HBsAg decreased significantly, and the coverage of HepB and the vaccination rate within 24 hours after birth have played an important role in reducing HBV infection.

Prevalence and co-infection of schistosomiasis/hepatitis B among rural populations in endemic areas in Hubei, China

Background

Both hepatitis B virus (HBV) infection and schistosomiasis are important public health problems in China. Concurrent infection between HBV and schistosomiasis is often observed in areas where schistosomiasis is endemic. The aim of this study was to determine the prevalence of schistosomiasis and HBV in schistosomiasis-affected areas, to explore whether schistosomiasis patients are more susceptible to HBV and to determine if the prevalence of HBV in high-endemic areas of schistosomiasis is higher than in low-endemic areas.

Methods

A total of 6526 participants from 13 villages in Hubei province were included in a cross-sectional study and blood samples were collected and examined. Qualitative variables were compared between groups using Pearson’s chi-squared test or Fisher’s exact test as appropriate.

Results

Of the 6526 participants, the overall prevalence was 8.27% for schistosomiasis and 2.67% for HBV. The prevalence of hepatitis B among participants who were Schistosoma antibody positive (25.37%) was higher than the prevalence in participants who were Schistosoma antibody negative (0.62%; χ²=1169.358, p<0.001, odds ratio 54.659). We also observed that there was no difference in the prevalence of hepatitis B between males and females in areas where schistosomiasis was endemic (χ²=1.827, p=0.177), but the prevalence of hepatitis B in middle-aged people was higher than in other age groups (χ²=47.877, p<0.001).

Conclusions

There was an association between schistosomiasis and HBV infection. However, more work is needed to find the causal relationship between schistosomiasis and HBV infection.

The effect of hepatitis B vaccination after five years on an entire population in an insular region of Southeast China

Prevalence of hepatitis B (HB) remains high among adults in insular regions of southeast China. To address this issue, large-scale HB vaccination was implemented in Putuo County of Zhoushan City in 2013. To examine the effects of this large-scale HB vaccination, a cross-sectional serological survey was conducted on two isolated islands, Putuo (intervention group) and Dinghai (control group) Counties of Zhoushan City in southeastern China five years later. The data showed lower prevalence of HBsAg and negative results for all HBV markers in the intervention group compared to the control group (4.2% and 6.0%, 20.8% and 33.0%), while the positive rate for anti-HBs and only anti-HBs were higher (68.4% and 53.4%, 47.9% and 34.3%). Therefore, large-scale adult HB vaccination could lower the HB epidemic level. However, the proportion of susceptible people who were negative for all HBV markers remained high. Hence, several additional measures to limit the spread of HBV should be taken by the government.

Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis

BACKGROUND

In 2016, of the estimated 257 million people living with chronic hepatitis B virus (HBV) infection worldwide, only a small proportion was diagnosed and treated. The insufficiency of information on the proportion of people infected with HBV who are eligible for treatment limits the interpretation of global treatment coverage. We aimed to estimate the proportion of people with chronic HBV infection who were eligible for antiviral treatment worldwide, based on the WHO 2015 guidelines.

METHODS

In this systematic review and meta-analysis, we searched Medline, EMBASE, and the Cochrane databases from Jan 1, 2007, to Jan 31, 2018, for studies describing HBsAg-positive people in the population or health-care facilities. We extracted information from published studies using a standardised form to estimate the frequency of cirrhosis, abnormal alanine aminotransferase (ALT), HBV DNA exceeding 2000 IU/mL or 20 000 IU/mL, presence of HBeAg, and eligibility for treatment as per WHO and other guidelines as reported in the studies. We pooled proportions through meta-analysis with random effects. The study was registered with PROSPERO, CRD42020132345.

FINDINGS

Of the 13 497 studies, 162 were eligible and included in our analysis. These studies included 145 789 participants. The pooled estimate of the proportion of cirrhosis was 9% (95% CI 8-10), ranging from 6% (4-8) in community settings to 10% (9-11) in clinic settings. Examining the proportion of participants who had characteristics used to determine eligibility in the WHO guidelines, 1750 (10·1%) of 17 394 had HBV DNA exceeding 20 000 IU/mL, and 20 425 (30·8%) of 66 235 had ALT above the upper limit of normal. 32 studies reported eligibility for treatment according to WHO or any other guidelines, with a pooled estimate of eligibility at 19% (95% CI 18-20), ranging from 12% (6-18) for studies in community settings to 25% (19-30) in clinic settings.

INTERPRETATION

Many studies described people with HBV infection, but few reported information in a way that allowed assessment of eligibility for treatment. Although about one in ten of the 257 million people with HBV infection (26 million) might be in urgent need of treatment because of cirrhosis, a larger proportion (12-25%) is eligible for treatment in accordance with different guidelines. Future studies describing people with HBV infection should report on treatment eligibility, according to broadly agreed definitions.

FUNDING

WHO and US Centers for Disease Control and Prevention.

Prevalence of Hepatitis C Virus Infection in a Surgical Population of Southeast China: A Large-Scale Multicenter Study

BACKGROUND

Chronic HCV infection affects 80 million people globally and may progress to advanced liver disease. The present study aims to investigate the present epidemiology of HCV infection in a southeastern Chinese surgical patient cohort.

METHODS

Blood samples obtained from 78,484 surgical patients from 18 different city and county hospitals were enrolled. The incidence of serum HCV antibody positivity, HCV RNA load, and HCV genotyping, as well as demographics and relevant clinical history, were investigated. Data were stratified using the multistage cluster random sampling method and further analyzed using the SPSS-20 package.

RESULTS

HCV antibody positivity was detected in 0.15% of the population (95% confidence interval (CI): 0.12%-0.18%). Genotype 1b (55.74%) was the dominant type. The HCV infection peaked in the age groups of 16-20, 41-50, and 61-65 years, and it was higher in males than in females (0.19% vs. 0.13%, P < 0.05). The geographical distribution of infection rates differed: 0.19% (95% CI: 0.14%-0.24%), 0.18% (95% CI: 0.13%-0.23%), and 0.06% (95% CI: 0.03-0.09%) in plain areas, islands, and valley regions, respectively. Patients with transfusion history and urban residence were associated with high HCV RNA levels (adjusted odds ratio = 11.24 and 6.20, P < 0.05).

CONCLUSION

The prevalence of HCV infection in this cohort from southeast China was 0.17%, which is lower than the reported 0.43% infection rate in China in 2006. This result can be (partially) explained by the improvement of blood donor screening and the successful campaign for the use of disposable syringes and needles.

Prevalence of hepatitis B surface antigen in coastal area of Tianjin, China

Aim: The hepatitis B surface antigen (HBsAg) prevalence in coastal area of Tianjin, China was investigated. Methods: This was a cross-sectional study. A total of 12,074 participants aged from 1 month to 98 years old were enrolled (the number of participants were 136, 431, 1648, 1718, 1957, 2184, 2069, 1370 and 561 in age groups 0–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, 71–80 and greater than 80, respectively). Hepatitis B serological markers were detected. Results: The results showed that HBsAg prevalence was 5.52% (666/12,074). For children and teenagers the HBsAg positivity was 0–1.39%. Whereas for the middle-aged population, the HBsAg positivity was relatively high (6.74–8.58%). In the elderly (greater than 60 years old), HBsAg prevalence was 1.43–3.24%. The anti-hepatitis B core antibody-positive proportion was 43.09% (5230/12,074). Hepatitis B surface antibody seroprevalence was 49.83% (5685/11,408) in HBsAg-negative participants. Conclusion: HBsAg prevalence was at intermediate endemicity in this region. Management of HBsAg-positive patients and strategies for the expansion of an immune population were suggested.

A retrospective serological survey of hepatitis B virus infection in Northeast China

BACKGROUND

Hepatitis B virus (HBV) infection is a major public health burden in China although it has steadily declined over the last two decades. A valid updated prevalence of HBV infection in China relies on a large sample size. Hence this study aimed to estimate HBV seroprevalence using a large inpatient population in Northeast China.

METHODS

We consecutively enrolled 218,627 inpatients aged 1-70 years admitted to the First Hospital of Jilin University from January 2010 through December 2014. HBV serological markers were detected by chemiluminescence immunoassay (CLIA).

RESULTS

Among the 218,627 collected samples, 16,254 (7.43%) were positive for HBsAg and 41.64% of patients were negative for all the HBV markers. The highest HBsAg prevalence was 10.05% in the 41-50 year age group and the lowest were 0.47% in the 1-10 and 2.35% in the 11-20 year age groups, respectively. HBsAg positivity was higher in males compared to females (8.94% vs. 5.80%). An HBsAg positivity of nearly 14% was found in middle-aged males, and positivity was 6.2% in females of childbearing age. One-third of this population only had a single HBsAb marker, which was also detected in 60% of patients aged under 20 years.

CONCLUSION

Though universal hepatitis B vaccination of infants has significantly reduced HBsAg prevalence in children, the number of most adults who have been infected with HBV remains steady. Extra care and resources should be provided to HBV-infected middle-aged males to stop the progression of chronic hepatitis B, and HBsAg positive females of childbearing age to block vertical HBV transmission.

Distribution of ABO/Rh blood groups and their association with hepatitis B virus infection in 3.8 million Chinese adults: A population-based cross-sectional study

ABO and Rh blood groups play a vital role in blood transfusion safety and clinical practice and are thought to be linked with disease susceptibility. The results from previous studies that focused on the association between blood groups and HBV infection remain controversial. China has the world's largest burden of HBV infection. We assessed the distribution of ABO/Rh blood groups in Chinese adults and examined the association between these groups and HBV infection. We did a nationwide cross-sectional study using data from a physical check-up programme from 31 provinces examined between 2010 and 2012. ELISA was used to test for HBsAg in serologic samples. Multivariable logistic regression was used to estimate aOR of the association between ABO and Rh blood groups and HBV infection. Among 3 827 125 participants, the proportion of participants with blood group A was highest (30.54%), followed by O (30.37%), B (29.42%) and AB (9.66%). A total of 38 907 (1.02%) were Rh-D negative. The prevalence of HBsAg in blood groups O, A, B and AB were 6.34%, 5.55%, 5.18% and 5.06%, respectively. HBsAg prevalence was 5.65% in Rh-D-positive and 3.96% in Rh-D-negative participants. After controlling for other potential risk factors, multivariate models showed that participants with blood group O (adjusted OR = 1.22, 95% CI: 1.20-1.25) were at higher risk of HBV infection compared with group AB. Rh-D-positive participants (adjusted OR = 1.44, 95% CI: 1.37-1.52) were at higher risk of HBV infection than Rh-D-negative participants. The associations between ABO/Rh blood groups and HBV infection were similar in subgroup analysis. The proportions of O, A, B and AB blood groups were approximately 3:3:3:1, and nearly 1 in 100 people was Rh-D negative among Chinese adults. Blood group O and Rh-D positivity were both associated with increased HBV infection. The risk of HBV infection and blood safety should be taken into consideration in clinical practice, especially when transfusing those with blood group O. Awareness and prevention of HBV infection is of particular importance for individuals with blood group O.

Hepatitis B virus infection in hilly/mountainous regions of southeastern China: a locality-dependent epidemiology

Background

The overall prevalence of hepatitis B virus (HBV) infection in China is declining. The purpose of this study was to use a community-based epidemiological study to update the infection status of hepatitis B virus (HBV) in mountainous regions of China, and to evaluate the impact of the Expanded Program of Immunization (EPI) on HBV transmission.

Methods

In total, 10,383 participants were selected by multi-stage stratified random cluster sampling in two mountainous regions, Xianju and Anji, in Zhejiang province, China.

Results

The positive rates of hepatitis B virus surface antigen (HBsAg), anti-HBV core antigen (anti-HBc), and anti-HBV surface antigen (anti-HBs) were 9.5%, 33.9%, and 51.0%, respectively. Positive HBV markers were more frequently detected in males than in females (P < 0.01). The alanine aminotransferase (ALT) levels were elevated (>38 IU/L) in 15.3% of the HBsAg-positive and 6.3% of the HBsAg-negative subjects. The α-fetoprotein (AFP) level was elevated in 0.8% of the HBsAg-positive participants who were older than 30 years old.

Conclusions

The epidemiology of HBV infection is location dependent. The prevalence of HBV infection in the mountainous regions is higher than the national levels. Moreover, HBV infection in women of childbearing age is up to 10%, which represents a main factor for continuous HBV transmission.

Socioeconomic inequality in Hepatitis B vaccination of rural adults in China

Hepatitis B (HB) vaccination is the most effective way to prevent HB virus infection. While measures taken to control the prevalence of HB have achieved significant results, HB prevalence in rural China among adults remains problematic. This study sheds new light on the determinants of HB vaccine uptake and its inequality according to socioeconomic status in rural areas of China. We interviewed 22,283 adults, aged 18-59 years, from 8444 households, in 48 villages from 8 provinces. Vaccination status was modeled by using two logistic models: whether take at least one HB vaccine and whether to complete the entire vaccination regime. The Erreygers' concentration index ([Formula: see text]) was used to quantify the degree of inequality and the decomposition approach was used to uncover the determinants of inequality in vaccine uptake. We found that the coverage rate of HB vaccination is 20.2%, and the completion rate is 16.0%. The [Formula: see text] of at least one dose (0.081) and three doses (0.076) revealed a substantial pro-rich inequality. Income contributed the largest percentage to HB vaccination inequalities (52.17% for at least one dose and 52.03% for complete vaccinations). HB awareness was another important cause of inequality in HB vaccination (around 30%). These results imply that rich had a greater tendency to vaccinate and inequality favouring the rich was almost equal for the complete three doses. While the factors associated with HB vaccination uptake and inequalities were multifaceted, income status and HB awareness were the main barriers for the poor to take HB vaccine by adults in rural China.

Prevalence of HBsAg/HBeAg amongst 1 936 801 couples preparing for pregnancy in rural China: An observational study

There are few extant studies on the prevalence of HBV infection in couples preparing for pregnancy. We assessed the prevalence of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) in couples preparing for pregnancy in rural China, and the association between HBV prevalence and the statuses of HBsAg/HBeAg and ALT in the spouses. We performed a nationwide cross-sectional study, using data from a health check-up program for 1 936 801 rural couples from 31 provinces preparing for pregnancy between 2010 and 2012. ELISA was used to test serologic samples, and we defined couples who were either discordant or both positive for HBsAg as "POSITIVE COUPLES" (PC). Amongst the 1 936 801 couples, 202 816 (10.47%; 95% CI, 10.43%-10.51%) were PC. HBeAg (high infectiousness) was detected in 56 474 (27.84%; 95% CI, 27.65%-28.04%) of 202 816 HBsAg-positive couples. Multivariate models showed that the prevalence of HBV infection in wives increased along with the positive statuses for HBsAg/HBeAg and alanine aminotransferase (ALT) of their husbands (adjusted odds ratio increased from 2.31 to 4.98), after adjustment for potential confounders. Similarly, the prevalence of HBV infection in husbands was associated with the positive statuses of HBsAg/HBeAg and ALT of their wives (adjusted odds ratio increased from 2.04 to 4.93). The prevalence of POSITIVE COUPLES in couples preparing for pregnancy in rural China was high, and the prevalence of HBV infection was independently associated with the positive statuses of HBsAg/HBeAg and ALT of the spouses. Instead of solely focussing on mothers prior to becoming pregnant, POSITIVE COUPLES should be taken as an important unit of care.

Comparison between two population-based hepatitis B serosurveys with an 8-year interval in Shandong Province, China

BACKGROUND

Tremendous progress has been made in hepatitis B virus (HBV) prevention and control in the last 30 years in China, but it continues to be a major public health problem. The most recently reported population-based seroepidemiological survey on HBV in Shandong Province in China was published in 2006, and an updated baseline for HBV prevalence was badly needed in the province to identify the change in HBV epidemiology in the last decade.

METHODS

Two population-based cross-sectional serosurveys were performed among the population aged 1-59 years in the same sample areas in Shandong Province, China in 2006 and 2014, respectively. Data on demographic characteristics were collected. A blood sample was obtained from each person and was tested for hepatitis B surface antigen (HBsAg), antibody against HBsAg (anti-HBs), and antibody against hepatitis B core antigen (anti-HBc).

RESULTS

Overall, the prevalence rates of HBsAg, anti-HBs, and anti-HBc were 3.39% (95% confidence interval (CI) 2.51-4.26), 44.96% (95% CI 41.34-48.57), and 24.45% (95% CI 22.19-26.71), respectively, among the population aged 1-59 years in the 2006 serovsurvey; the corresponding prevalence rates were 2.49% (95% CI 1.81-3.17), 48.27% (95% CI 45.63-50.92), and 22.56% (95% CI 20.14-24.97), respectively, in 2014. The prevalence rates of HBsAg and anti-HBc were lower in 2014 than in 2006. Conversely, the prevalence of anti-HBs showed an increase. However, none of these differences were statistically significant (all p>0.05). The prevalence of HBsAg showed an increase among persons aged 20-24 years in 2014 (3.83%) compared with 2006 (2.98%) (t=0.45, p=0.67). Among all occupation groups, the prevalence of HBsAg was lower in 2014 than in 2006, while the prevalence of anti-HBc showed moderate increases in students and farmers (all p>0.05). The prevalence of HBsAg decreased more obviously in urban areas (65.49%) than rural areas (7.07%) from 2006 to 2014.

CONCLUSIONS

The epidemiology of HBV infection has changed in Shandong Province, China over the last decade. More attention should be paid to HBV infection among students and farmers.

Virological and serological features of acute hepatitis B in adults

Various viral kinetics among patients with acute hepatitis B (AHB) have been observed in clinical practice. This study investigated the virological, biochemical, and serological characteristics of AHB in adults.A total of 192 adult patients with AHB were recruited between December 2010 and January 2014. The quantification of biochemical and serologic markers for hepatitis B virus (HBV) infection was monitored from the onset.Of the 192 patients, 113 patients were followed up. One patient died due to acute liver failure, 2 developed chronic HBV infection. Clinical recovery was observed in 110 patients; 92.7% (102/110) achieved clinical recovery within 24 weeks, and 7.3% (8/110) between 24 and 44 weeks. There were 3 different viral kinetics patterns among the patients with AHB: the clearance of HBV DNA preceded hepatitis B e antigen (HBeAg) and hepatitis B surface antigen (HBsAg), the clearance of HBeAg preceded HBV DNA and HBsAg, the clearance of HBsAg preceded HBV DNA and HBeAg.In the absence of HBV DNA clearance within 13 weeks, the risk of development of chronic HBV infection increased. The serologic HBV markers clearance occurred between 24 and 44 weeks (6-11 months) from the onset in 8 of the AHB patients, which was longer than 6 months. Thus, AHB may be redefined as HBV DNA undetectable, HBsAg and HBeAg seroconversion within 44 weeks.

A survey of knowledge about hepatitis B among new military recruits in China

BACKGROUND

Hepatitis B is a disease that affects the liver and is caused by the hepatitis B virus (HBV). Hepatitis B is a serious public health problem in China. The objective of this study was to assess knowledge of and behaviours towards the transmission and prevention of hepatitis B of new military recruits in China.

METHODS

A cross-sectional study was conducted among 800 new military recruits. A self-administered, structured questionnaire was used to collect information, and 727 questionnaires were returned completed. Analysis was performed using SPSS 18.0, and P < 0.05 was considered statistically significant.

RESULTS

Of the respondents, 665 (91.5%) were male and 62 (8.5%) were female. The mean age was 18.9 ± 1.7 years. A total of 608 respondents (83.6%) demonstrated poor knowledge and 119 (16.4%) adequate knowledge about HBV. Older age, female and higher education level were statistically associated with a higher mean knowledge score. Multivariate logistic regression showed that age (OR = 3.040, 95%CI 1.724-5.359, P < 0.001) and gender (OR = 1.791, 95%CI 1.325-2.421, P < 0.001) were significantly associated with appropriate behavioural practices towards prevention of HBV.

CONCLUSION

Against a backdrop of high HBV prevalence in China, new military recruits had poor knowledge of HBV. New recruits need better education about HBV to assist in reducing and preventing HBV infection.

Longitudinal profiles of highly sensitive hepatitis B surface antigen levels: re-evaluation of HBsAg seroclearance

BACKGROUND & AIMS

Serologic profiles after hepatitis B surface antigen (HBsAg) seroclearance in chronic hepatitis B (CHB) have not been well-studied.

METHODS

We employed a highly sensitive HBsAg (hs-HBsAg) assay (lower detection limit 0.5 mIU/ml), 100 times more sensitive than conventional HBsAg measurements. CHB patients achieving HBsAg seroclearance defined by conventional assays were followed up for serum hs-HBsAg, HBV DNA and antibody to HBsAg (anti-HBs) levels at 0 months, 6-12 months and 3-5 years after HBsAg seroclearance. Factors associated with hs-HBsAg detectability were determined.

RESULTS

One hundred and nine patients were recruited; 94 (86.2%) were followed up to years 3-5; and 25 patients (22.9%) were on nucleoside analogue therapy for a median duration of 6.0 (range 1.5-12.7) years before HBsAg seroclearance. Detectable hs-HBsAg was noted in 88 (80.7%), 60 (55.0%) and 20 (21.3%) patients at 0 months, 6-12 months and 3-5 years respectively. At years 3-5, genotype B patients, when compared to genotype C patients, had a higher anti-HBs positive rate (63.2% and 41.1% respectively, P = 0.036). Serum anti-HBs positivity, when compared to persistent anti-HBs negativity, was associated with a lower rate of hs-HBsAg detection (7.4% and 40% respectively, P < 0.001). Multivariate analysis showed anti-HBs negativity at years 3-5 to be independently associated with persistently positive hs-HBsAg (P = 0.007, odds ratio 7.1, 95% confidence interval 1.7-29.3).

CONCLUSION

Serum hs-HBsAg could detect HBsAg presence in a substantial proportion of CHB after HBsAg seroclearance defined by conventional assays, especially among anti-HBs negative individuals. Serum hs-HBsAg could potentially assist differentiating HBsAg-negative CHB from individuals with only past HBV exposure without carrier state.

Hepatitis C virus infection in the general population: A large community-based study in Mianyang, West China

Hepatitis C virus (HCV) infection remains a major public health problem. The objective of the current study was to reveal the seroepidemiology of HCV in the general population in Mianyang City. This study collected 438,575 blood samples from participants who had enrolled in the National Science and Technology Development Project and their demographic information, and then evaluated HCV antibody and alanine aminotransferase (ALT) levels. The overall anti-HCV positive rate was 0.80% (3,491/438,575) in the Mianyang general population, and it was 1.19% in rural population and 0.20% in urban. Anti-HCV positive rate increased with age, peaked at 45-54 years (2.01%), and then decreased. Anti-HCV prevalence was higher in males (0.89%) than that in females (0.73%). The prevalence of anti-HCV in participants with a history of blood transfusion, surgery, or with a previous diagnosis of hypertension was higher. The abnormal ALT levels (> 40 IU/L) were observed in 50.11% and 7.74% of anti-HCV positive and negative groups, respectively. In anti-HCV positive groups, the rate of abnormal ALT levels was higher in 55-64 age groups, male, and rural population. Though Mianyang was a low endemic area for HCV infection, the alarming fact was the large number of abnormal ALT levels in patients related to hepatitis C. This revealed delayed diagnosis and treatment of HCV infections. It is a necessity to promote early diagnosis and timely treatment of HCV infections.

Sustained high prevalence of viral hepatitis and sexually transmissible infections among female sex workers in China: a systematic review and meta-analysis

Background

The 1980’s economic boom has been associated with a rapid expansion of China’s sex industry over the past three decades. Consequently, the spread of sexually transmitted infections (STIs) and hepatitis infections among female sex workers (FSW) has become an important public health issue in China. This study identifies prevalence and risks of hepatitis and STIs in Chinese FSWs.

Method

Four electronic databases were searched for Chinese and English language peer-reviewed studies conducted between 01/2000-12/2011 that reported prevalence of hepatitis and STIs (excluding HIV) among Chinese FSW. Following the PRISMA guidelines, meta-analysis was used to estimate pooled prevalence and 95 % confidence intervals for each infection.

Result

Three hundred and thirty nine articles (34 in English and 305 in Chinese) investigating 603,647 FSWs in 29 Chinese provinces were included in this review. Over the period 2000–2011, the seroprevalence of active hepatitis B and hepatitis C among FSW were 10.7 % (7.3–15.5 %) and 1.0 % (0.7–1.3 %), respectively. The most prevalent STI was human papillomavirus (HPV, 27.0 % [10.1–55.1 %]), followed by herpes simplex virus-2 (HSV-2, 15.8 % [11.7–20.9 %]), chlamydia (13.7 % [12.1–15.4 %]), gonorrhoea (6.1 % [5.3–7.0 %]), syphilis (5.2 % [4.8–5.7 %]), genital warts (3.3 % [2.5–4.2 %]) and Trichomonas vaginitis (2.1 % [1.5–24.2 %]). Disease burden of both hepatitis and STI among FSW were concentrated in South Central and Southwest China. In particular, chlamydia and syphilis demonstrated a significant declining trend during the studied period (P < 0.05). Compared with the general Chinese population, FSW had significantly higher prevalence of all STIs except Trichomonas vaginitis. Further, compared to the general FSW population, HIV-positive FSW had significantly higher prevalence of syphilis, chlamydia, HSV-2 and Trichomonas vaginitis.

Conclusion

Prevalence of hepatitis and STIs remained high and mostly stable among Chinese FSW over the period of 2000–2011. Targeted STI and hepatitis surveillance and interventions should be strengthened among Chinese FSWs, especially those who are HIV-positive.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-015-1322-0) contains supplementary material, which is available to authorized users.

Epidemiology of Hepatitis B and Hepatitis C Infections and Benefits of Programs for Hepatitis Prevention in Northeastern China: A Cross-Sectional Study

BACKGROUND

To investigate the epidemiology of hepatitis B and C infections and the benefits of programs aimed at hepatitis prevention and control in Northeastern China.

METHODS

Individuals receiving health examinations were recruited to complete a questionnaire and undergo laboratory tests for hepatitis infection. Data on demographic characteristics, results of hepatitis B virus (HBV) and hepatitis C virus (HCV) serological tests, for HBV and HCV infection were analyzed.

RESULTS

Among 227 808 study participants, the hepatitis B surface antigen (HBsAg) and anti-HCV-positive rates were 6.1% and 3.0%, respectively. Among HBsAg-positive participants, 63.8% tested positive for HBV DNA, 20.2% had an abnormal alanine aminotransferase (ALT) level, and 10.7% had cirrhosis. Among anti-HCV-positive participants, 57.2% tested positive for HCV RNA, 29.6% had an abnormal ALT level, and 8.4% had cirrhosis. Among HBsAg- or anti-HCV-positive participants, 47.1% and 32.0%, respectively, were aware of their infection. Among participants infected with HBV or HCV and suitable for antivirus treatment, 23.5% and 16.1%, respectively, had received antivirus treatment. The HBV plus HCV coinfection rate was 0.08%.

CONCLUSIONS

The HBsAg-positive rate decreased significantly after implementation of recently introduced HBV control programs in China. However, the anti-HCV-positive rate showed only a slight decrease, indicating that programs for the prevention and control of hepatitis viruses require continued strengthening.

CHINESE CLINICAL TRIALS REGISTRATION

ChiCTR-ECS-13004009.

A meta-analysis of HBsAg-positive rate among general Chinese populations aged 1--59 years

BACKGROUND

The third nationwide hepatitis B virus (HBV) sero-epidemiological survey conducted in China in 2006 showed a hepatitis B surface antigen (HBsAg)-positive rate of 7.18% and the number of carriers to be 93 million. To compensate for the lack of data on the national prevalence of hepatitis B from 2006 onwards, we performed a meta-analysis to investigate HBsAg-positive rates among the general Chinese population aged 1-59 years.

METHODS

We systemically reviewed published studies (January 2007 to September 2013) from full-text databases such as VIP, Chinese National Knowledge Infrastructure, and PubMed and assessed HBsAg-positive rates using a random effects regression model with comprehensive meta-analysis software.

RESULTS

After evaluation of the quality of the papers, 36 were finally included, with a total sample size of 314 103 individuals. The meta-analysis showed that the combined HBsAg-positive rate was 6.1% (95% confidence interval (CI), 5.4-6.8%) among general Chinese populations aged 1-59, with a higher HBsAg-positive rate in males (6.6%; 95% CI, 5.7-7.7%) than in females (5.1%; 95% CI, 4.4-5.9%). Our data also showed a higher HBsAg-positive rate of 6.9% in mid-western China (95% CI, 5.2-9.1%) against 5.6% in eastern China (95% CI, 4.9-6.4%).

CONCLUSION

This meta-analysis suggested that the positive rates of HBsAg in China are reducing compared with previous 2006 sero-survey results, and China has changed from a high endemic area for HBV to an intermediate endemic area. However, owing to the large population, there remain an estimated 80 million HBsAg carriers in China. Thus, the prevention and control of hepatitis B represent a serious challenge, particularly in mid-western China.

Prevalence of hepatitis B and knowledge about hepatitis B among migrant workers in shandong province, china: a cross-sectional study

Background:

China is a country with a high prevalence of hepatitis B. As a special population, migrant workers are more vulnerable to hepatitis B.

Objectives:

The present study was conducted to gain insight into the prevalence of hepatitis B and knowledge about hepatitis B among migrant workers in Shandong Province, China, as well as to explore a series of strategies for preventing and controlling the spread and prevalence of hepatitis B.

Patients and Methods:

A cross-sectional study was conducted without age restriction, in Shandong Province in China. The sample-size was determined scientifically. The study population was selected using the random multistage cluster sampling. Personal information, including sex, age, ethnicity, marital status, education level, years of duration of stay in Jinan and health insurance were obtained from 2065 migrant workers. Moreover, blood samples were collected for hepatitis B infection screening. Knowledge about hepatitis B was assessed using a self-administered questionnaire. Correct response rates were calculated.

Results:

Of 2065 migrant workers tested for Hepatitis B Surface Antigen (HBsAg), 167 (126 men and 41 women) tested positive for HBsAg; the overall prevalence was 8.1%. The prevalence rates in men and women were 9.6% and 5.4%, respectively. The prevalence rates in subjects 18 - 30 years old and 30 years older were 3.5% and 9.3%, respectively. There were statistically significant differences between those groups (P < 0.05). Correct response rates for the transmission of hepatitis B questions were low, especially for a question regarding whether hepatitis B can be transferred by sexual contact (36.8%) and whether it can be transferred from mothers to infants (33.9%). A total of 80.9% of migrant workers correctly responded that vaccination is effective for hepatitis B. However, 68% of migrants also had the misconception that it is necessary to receive a booster vaccination.

Conclusions:

The hepatitis B virus infection rate in migrant workers is higher than average infection rates in China, and these workers’ knowledge regarding hepatitis B is poor. It is urgent that an appropriate program be undertaken for the prevention and control of hepatitis B among migrant workers.

Trends of acute hepatitis B notification rates in eastern China from 2005 to 2013

Zhejiang Province was a high endemicity for hepatitis B disease in the 1990's. A number of measures implemented since then have begun to control and prevent hepatitis B. In 1992, hepatitis B vaccine came on the market. In 2002, hepatitis B vaccine was included in the national Expanded Programme on Immunization (EPI). Between 2007 and 2010, catch-up vaccination was implemented for children under 15. Since 2010, vaccination guidelines for high-risk groups have also been adopted. This study evaluated the impact of these control and prevention strategies on acute hepatitis B notification rates from 2005 through 2013. Data from the National Notifiable Disease Reporting System (NNDRS) revealed a steady downward trend in notification rates of acute hepatitis B. The most dramatic decline occurred among pre-adults, highlighting the benefits of EPI's policy of universal vaccination for children. However, the highest notification rates occurred among young adults of lower socio-economic status. These findings indicate the strong need to vaccinate young adults at risk for HBV infection as well as to collect risk-factor information in the NNDRS for monitoring and following up persons with acute hepatitis B.

The impact of vaccination and antiviral therapy on hepatitis B and hepatitis D epidemiology

The major cause of liver cancer around the globe is hepatitis B virus (HBV), which also contributes to a large number of deaths due to liver failure alone. Hepatitis delta virus (HDV) is as potentially alarming as HBV since life threatening cases are 10 times more likely with HBV-HDV dual infection compared to HBV monoinfection. So far, there is no established effective treatment against HDV and the only preventive action suggested by the World Health Organization is to introduce HBV vaccination for children immediately after birth (newborns) and thus reduce the available pool for HDV infection. Here the main objective is to understand the complex dynamics of HBV-HDV infection in a human population that can inform public health policy makers on the level of different preventive measures required to eliminate HBV and HDV infections. Model simulations suggest that HBV vertical transmission and HBV vaccination rates for newborns are instrumental in determining HBV and HDV prevalence. A decrease in HBV prevalence is observed as vaccination coverage increases and it is possible to eradicate both HBV and HDV using high vaccination coverage of ≥80% in the long term. We further found that HDV presence results in lower HBV prevalence. An application of our model to China revealed that vaccinating every newborn in China will further prevent 1.69 million new infections by 2028 as compared to the current 90% vaccination coverage. Although, higher vaccination coverage of newborns should eliminate both HBV and HDV over a long time period, any short term strategy to eradicate HDV must include additional preventive measures such as HBV adult vaccination. Implementation of HBV adult vaccination programs at a rate of 10% per year over 15 years will further prevent 39 thousand new HDV infections in China by 2028 as compared to HBV vaccination programs solely for newborns.

Hepatitis B virus in the Lao People's Democratic Republic: a cross sectional serosurvey in different cohorts

Background

Despite hepatitis B vaccination at birth and at 6, 10 and 14 weeks of age, hepatitis B virus (HBV) infection continues to be endemic in the Lao People’s Democratic Republic (PDR). We carried out a cross-sectional serological study in infants, pre-school children, school pupils and pregnant women to determine their burden of disease, risk of infection and vaccination status.

Methods

A total of 2471 participants between 9 months and 46 years old were recruited from urban (Vientiane Capital, Luang Prabang), semi-urban (Boulhikhamxai and Savannakhet) and remote rural areas (Huaphan). All sera were tested for anti-HBs and anti-HBc. Sera testing positive for anti-HBc alone were further tested for the presence of HBsAg.

Results

A low prevalence of HBsAg (0.5%) was detected among infants from Vientiane and Luang Prabang, indicating some success of the vaccination policy. However, only 65.6% had protective anti-HBs antibodies, suggesting that vaccination coverage or responses remain sub-optimal, even in these urban populations.

In pre-school children from remote areas in Huaphan, 21.2% were positive for anti-HBc antibodies, and 4.6% were for HBsAg positive, showing that a significant proportion of children in these rural regions have early exposure to HBV. In pre-school children with 3 documented HBV vaccinations, only 17.0% (15/55) were serologically protected.

Among school-children from semi-urban regions of Luang Prabang, Boulhikhamxai and Savannakhet provinces, those below the age of 9 who were born after HBV vaccine introduction had anti-HBc and HBsAg prevalence of 11.7% and 4.1%, respectively. The prevalence increased to 19.4% and 7.8% of 10–14 year olds and to 27% and 10.2% of 15–19 year olds.

Pregnant women from Luang Prabang and Vientiane had very high anti-HBc and HBsAg prevalence (49.5% and 8.2%), indicating high exposure and risk of onward vertical transmission to the unborn infant.

Conclusions

Overall, the results demonstrate a dramatic deficiency in vaccination coverage and vaccine responses and/or documentation within the regions of Lao PDR studied, which included urbanized areas with better health care access. Timely and effective hepatitis B vaccination coverage is needed in Lao PDR.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-457) contains supplementary material, which is available to authorized users.

Evaluation of the impact of hepatitis B vaccination in adults in Jiangsu province, China

Hepatitis B immunization programs for newborns, children, and adolescents in China have shown remarkable results. To establish whether there would be any benefit in extending the program to cover older individuals, we examined both the epidemiology of hepatitis B virus (HBV) infection and the coverage of hepatitis B vaccinations among adults born before routine vaccinations were implemented. We then evaluated the impact of hepatitis B vaccination in adults aged 20-59 years. A large-scale cross-sectional epidemiological survey of HBV infection was performed in the province of Jiangsu, south-east China, between September 2009 and March 2010. A total of 86,732 adults aged 20-59 years were included, of which 8,615 (9.9%, 95% CI = 9.7-10.1%) were HBsAg sero-positive. Self-reported vaccination status suggested that the coverage was approximately 23.7% (95% CI = 23.4-24.0%). It was shown that higher HBV vaccination coverage was associated with a lower rate of HBsAg seropositivity among adults. There was a negative correlation between hepatitis B vaccination coverage and HBsAg prevalence (correlation coefficient = -0.805, p = 0.016), which might demonstrate the combined effects of vaccination and pre-vaccination HBsAg screening. In the unvaccinated group, the HBsAg-positive rate had an obvious upward trend with age growing among 20-39 year-olds (Trend χ2 = 22.605, P<0.001), while the vaccinated group showed no such trend (Trend χ2 = 3.462, P = 0.063). Overall, hepatitis B vaccination in adults might reduce the rate of HBsAg positivity. Therefore, routine immunization of adults aged 20-39 years should be seriously considered.

Molecular epidemiology of hepatitis B virus in Asia

Although safe and effective vaccines against hepatitis B virus (HBV) have been available for three decades, HBV infection remains the leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC) worldwide, especially in Asian countries. HBV has been classified into at least 9 genotypes according to the molecular evolutionary analysis of the genomic DNA sequence and shown to have a distinct geographical distribution. Novel HBV genotypes/subgenotypes have been reported, especially from Southeast Asian countries. The clinical characteristics and therapeutic effectiveness of interferon (IFN) and nucleos(t)ide analogues vary among different HBV genotypes. Mutations at T1653C in subgenotype C2 from Japan and South Korea, C/A1753T and C1858T in subgenotype C1 from Vietnam, and C1638T and T1753V in subgenotype B3 from Indonesia were reported to be associated with advanced liver diseases including HCC. Genotype distribution in Japan has been changed by an increasing ratio of subgenotype A2 in chronic hepatitis B. While a large number of epidemiological and clinical studies have been reported from Asian countries, most of the studies were conducted in developed countries such as Taiwan, China, South Korea and Japan. In this review, the most recent publications on the geographical distribution of genetic variants of HBV and related issues such as disease progression and therapy in Asia are updated and summarized.

Disparities and risks of sexually transmissible infections among men who have sex with men in China: a meta-analysis and data synthesis

Background

Sexually transmitted infections (STIs), including Hepatitis B and C virus, are emerging public health risks in China, especially among men who have sex with men (MSM). This study aims to assess the magnitude and risks of STIs among Chinese MSM.

Methods

Chinese and English peer-reviewed articles were searched in five electronic databases from January 2000 to February 2013. Pooled prevalence estimates for each STI infection were calculated using meta-analysis. Infection risks of STIs in MSM, HIV-positive MSM and male sex workers (MSW) were obtained. This review followed the PRISMA guidelines and was registered in PROSPERO.

Results

Eighty-eight articles (11 in English and 77 in Chinese) investigating 35,203 MSM in 28 provinces were included in this review. The prevalence levels of STIs among MSM were 6.3% (95% CI: 3.5–11.0%) for chlamydia, 1.5% (0.7–2.9%) for genital wart, 1.9% (1.3–2.7%) for gonorrhoea, 8.9% (7.8–10.2%) for hepatitis B (HBV), 1.2% (1.0–1.6%) for hepatitis C (HCV), 66.3% (57.4–74.1%) for human papillomavirus (HPV), 10.6% (6.2–17.6%) for herpes simplex virus (HSV-2) and 4.3% (3.2–5.8%) for Ureaplasma urealyticum. HIV-positive MSM have consistently higher odds of all these infections than the broader MSM population. As a subgroup of MSM, MSW were 2.5 (1.4–4.7), 5.7 (2.7–12.3), and 2.2 (1.4–3.7) times more likely to be infected with chlamydia, gonorrhoea and HCV than the broader MSM population, respectively.

Conclusion

Prevalence levels of STIs among MSW were significantly higher than the broader MSM population. Co-infection of HIV and STIs were prevalent among Chinese MSM. Integration of HIV and STIs healthcare and surveillance systems is essential in providing effective HIV/STIs preventive measures and treatments.

Trial Registration

PROSPERO No: CRD42013003721