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Cho Y, Park S, Park S, Choi W, Kim B, Han H. Real-World Epidemiology, Treatment Patterns, and Disease Burden of Chronic Hepatitis B and HDV Co-Infection in South Korea. Infect Dis Ther 2023; 12:2387-2403. [PMID: 37768482 PMCID: PMC10600088 DOI: 10.1007/s40121-023-00860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Long-term complications of chronic hepatitis B (CHB) viral infection, such as cirrhosis, hepatocellular carcinoma (HCC), and liver failure, cause a large disease burden. This study aimed to describe the epidemiology, clinical outcomes, and treatment patterns of CHB infection and co-infection with hepatitis D virus (HDV) in South Korea. METHODS The retrospective, observational study used existing data from the Health Insurance Review and Assessment Service (HIRA) database. Confirmed cases of (CHB) and HBV/HDV co-infection were identified between 2013 and 2019. Hepatitis C virus co-infections and acute HBV infections were excluded. Incident cases diagnosed between 2015 and 2018 with no prior disease history up to 2 years were included. Patient characteristics, clinical outcomes, economic burden, and healthcare-resource utilization were described. RESULTS The estimated 7-year prevalence of CHB and HBV/HDV co-infection were 0.9% and 0.0024%, respectively. The prevalence was higher among 45-54 years old (CHB: 1.6%, HBV/HDV: 0.0049%) and males (1.1%, 0.0035%). The 5-year cumulative incidences of compensated cirrhosis, decompensated cirrhosis, HCC, and liver transplantation were 13.3%, 7.1%, 8.4%, and 0.7%, respectively. Hyperlipidemia (40.6%), hypertension (23.5%), and peptic ulcer (23.7%) were the more prevalent comorbidities. Among CHB patients, 48.1% received ≥ 1 prescribed anti-HBV drug including interferon or nucleos(t)ide analogues and 64.4% had ≥ 1 hospitalization compared to 80.4% and 79.4% HBV/HDV patients. Estimated total healthcare costs for CHB and HBV/HDV were US$786 million and $62 million, respectively. CONCLUSIONS These findings provide insights to the epidemiology, clinical burden, treatment patterns, and healthcare costs of CHB and HBV/HDV co-infection in South Korea.
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Affiliation(s)
- Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
| | | | | | - WonJung Choi
- Janssen Pharmaceuticals, Seoul, Republic of Korea
| | - Book Kim
- Cerner Enviza, Seoul, Republic of Korea
| | - Helin Han
- Cerner Enviza, Seoul, Republic of Korea
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Win A, King S, Wu G, Kwon S. Hepatitis B virus screening in Asian immigrants: Community-based campaign to increase screening and linkage to care: A cross-sectional study. Health Sci Rep 2023; 6:e773. [PMID: 36875931 PMCID: PMC9983072 DOI: 10.1002/hsr2.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 03/06/2023] Open
Abstract
Background and Aims Despite established screening guidelines, many Asian immigrants remain unscreened. Furthermore, those with chronic hepatitis B (CHB) are not linked to care citing multiple barriers. The objective of this study was to determine the role of our community-based hepatitis B virus (HBV) campaign on HBV screening and the success of linkage to care (LTC) efforts. Methods Asian immigrants from the New Jersey and New York metropolitan areas were screened for HBV from 2009 to 2019. We started to collect LTC data starting in 2015, and those found to be positive were followed up. In 2017, because of low LTC rates, nurse navigators were hired to aid in the LTC process. Those excluded from the LTC process included those who were already linked to care, declined, and/or had moved or passed away. Results Total of 13,566 participants were screened from 2009 to 2019, of which, the results for 13,466 were available. Of these, 372 (2.7%) were found to have positive HBV status. Approximately 49.3% were female and 50.1% were male, and the rest were of unknown gender. A total of 1191 (10.0%) participants were found to be HBV negative but required vaccination. When we started to track LTC, we found 195 participants that were eligible for LTC between 2015 and 2017 after the exclusion criteria were applied. It was found that only 33.8% were successfully linked to care in that time period. After hiring nurse navigators, we saw LTC rates increase to 85.7% in 2018 and to 89.7% in 2019. Conclusion HBV community screening initiatives are imperative to increase screening rates in the Asian immigrant population. We were also able to demonstrate that nurse navigators can successfully help increase LTC rates. Our HBV community screening model can address issues with barriers to care including lack of access in comparable populations.
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Affiliation(s)
- Aziza Win
- Ross University School of Medicine Miramar Florida USA
| | - Scott King
- Department of Computer Science University of British Columbia Vancouver British Columbia Canada
| | - Gregory Wu
- Department of Surgery Holy Name Medical Center Teaneck New Jersey USA
| | - Steve Kwon
- Department of Surgery Holy Name Medical Center Teaneck New Jersey USA.,Department of Surgery Columbia University Medical Center New York City New York USA
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Sasaki Y, Kajino H, Imazeki F. Possible Paternal Hepatitis B Virus Infection with Different Clinical Courses between Siblings: A Report of Two Cases. Case Reports Hepatol 2022; 2022:1-3. [PMID: 35295682 PMCID: PMC8920687 DOI: 10.1155/2022/5812135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
The incidence of hepatitis B virus (HBV) infection is expected to decrease in the future owing to the preventive measures adopted against mother-to-child transmission of HBV and implementation of universal HBV vaccination for children. However, no countermeasure has been established against horizontal infection in nonvaccinated children. We report the case of two siblings who had different clinical courses of possible paternal HBV infection. The younger sibling developed acute hepatitis, whereas the older sibling was an asymptomatic HBV carrier. To eradicate HBV, HBV vaccination of all children and HBV infection screening of fathers and other family members should be encouraged.
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Hu H, Shen Y, Hu M, Zheng Y, Xu K, Li L. Incidence and Influencing Factors of New Hepatitis B Infections and Spontaneous Clearance: A Large-Scale, Community-Based Study in China. Front Med (Lausanne) 2021; 8:717667. [PMID: 34869415 PMCID: PMC8637118 DOI: 10.3389/fmed.2021.717667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/23/2021] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
- Haiyang Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yangfan Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Ming Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yang Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Kaijin Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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Tan M, Bhadoria AS, Cui F, Tan A, Van Holten J, Easterbrook P, Ford N, Han Q, Lu Y, Bulterys M, Hutin Y. Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 6:106-119. [PMID: 33197397 PMCID: PMC7801814 DOI: 10.1016/s2468-1253(20)30307-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Mingjuan Tan
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland; Department of Medicine, National University Health System, Singapore
| | - Ajeet S Bhadoria
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Fuqiang Cui
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | | | - Judith Van Holten
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | | | - Nathan Ford
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Qin Han
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Ying Lu
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Marc Bulterys
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Yvan Hutin
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland.
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Abstract
Hepatitis B (HB) affects 240 million people around the world, and children and young adults make up a large proportion of the infected population. Approximately 1 million people die from HB each year. Despite the seriousness of HB and its complications, many are poorly linked to clinical care. A lack of health literacy may be a critical barrier hindering access to HB care for adults as well as children in these populations. We, therefore, performed a survey to assess the level of knowledge of HB among Korean American parents. The survey was conducted on 521 Korean American adults who attended community-based HB awareness campaigns held at various locations throughout the metropolitan New York area between January 2015 and November 2016. Of these, 296 parents, who had children between ages 1 and 30, were identified. All participants were asked a series of questions regarding various aspects of HB and were evaluated on the basis of their awareness on each subject. A separate questionnaire was also employed to obtain demographic characteristics of the participants. The study revealed a significant deficit of knowledge of HB in most aspects the survey evaluated. Although the majority of the participants knew that HB is a liver disease, and many of them had been screened for HB, they had a poor understanding of vaccination, screening, their own HB status, modes of HBV transmission, and the consequences and treatment of HB. The participants also had a low level of awareness of their own children’s HB status. This study demonstrates a low level of knowledge of HB among Korean American parents electing to attend a hepatitis education program. In addition, many parents are not aware of their children’s screening and immune (or non-immune) status. The lack of health literacy may contribute to poor health access in HB care, not only in adults but also in children. This suggests an urgent need for education on HB in Korean American parents as well as in young children.
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Affiliation(s)
| | - Seulgi Lee
- Holy Name Medical Center, Teaneck, NJ USA
| | | | - Joseph McMenamin
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
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Ma GX, Lee MM, Tan Y, Hanlon AL, Feng Z, Shireman TI, Rhee J, Wei Z, Wong F, Koh HS, Kim C, York W. Efficacy of a community-based participatory and multilevel intervention to enhance hepatitis B virus screening and vaccination in underserved Korean Americans. Cancer 2017; 124:973-982. [PMID: 29131316 DOI: 10.1002/cncr.31134] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/08/2017] [Accepted: 10/17/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND The primary objective of the current study was to evaluate the efficacy of a community-based participatory intervention program in improving hepatitis B virus (HBV) screening and vaccination among Korean Americans who were not previously screened. METHODS A cluster randomized trial involving 32 Korean church-based community organizations (1834 participants) was conducted. Sixteen churches were randomly assigned to an HBV screening and vaccination multicomponent intervention condition (972 participants) and 16 were assigned to a general cancer education control condition (862 participants). The main components of the intervention program included interactive group education; patient navigation; and the engagement of health care providers, church leadership, and church members in the medical field. The application of community-based participatory research principles was monitored and evaluated. HBV screening and vaccination rates (self-reported and medical record verification) were assessed at 6-month and 12-month follow-ups, respectively. RESULTS The results of the current study demonstrated significant efficacy in the HBV screening rate (92.5% in the intervention group vs 5.5% in the control group), 3-series HBV vaccination completion rate (84% in the intervention group vs 17.6% in the control group), and overall screening and vaccination compliance rate (87% in the intervention group vs 3.8% in the control group). Participants in the intervention group were significantly more likely to receive HBV screening (92.5%) compared with those in the control group (5.5%). In multivariate mixed-effect logistic regression analysis, the odds ratio for an intervention effect on HBV screening was 512.3 after adjusting for cluster effect and other demographic variables. With regard to vaccination rates, of the 332 participants who were screened with no immunity in the intervention group, 308 (92.8%) received at least 1 HBV vaccination, 300 (90.4%) received at least 2 shots, and 279 participants (84%) received all 3 shots. CONCLUSIONS A combination of community-based participatory research and a multilevel approach may produce the most optimal results and be essential in producing a considerable effect for enhancing HBV screening and vaccination, particularly for Korean American populations with limited language proficiency and insurance coverage. Cancer 2018;124:973-82. © 2017 American Cancer Society.
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Affiliation(s)
- Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Minsun M Lee
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alexandra L Hanlon
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ziding Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Theresa I Shireman
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Joanne Rhee
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Zhengyu Wei
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Frank Wong
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawai'i at Manoa, Manoa, Hawaii
| | - Han Seung Koh
- First Korean United Methodist Church of Cherry Hill, Cherry Hill, New Jersey
| | - Charles Kim
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Whitney York
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Although the Korean church has been frequently used to recruit Korean immigrants in research, little is known about the specific strategies and process. The purpose of this integrative review was to describe recruitment strategies in studies of Korean immigrants and to identify the process of Korean church-based recruitment. Thirty-three studies met inclusion criteria. Four stages of church-based recruitment were identified: initiation, endorsement, advertisement, and implementation. This review identified aspects of the church-based recruitment process in Korean immigrants, which are different from the Black and Hispanic literature, due to their hierarchical culture and language barriers. Getting permission from pastors and announcing the study by pastors at Sunday services were identified as the key components of the process. Using the church newsletter to advertise the study was the most effective strategy for the advertisement stage. Despite several limitations, church-based recruitment is a very feasible and effective way to recruit Korean immigrants.
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Li S, Sim SC, Lee L, Pollack HJ, Wyatt LC, Trinh-Shevrin C, Pong P, Kwon SC. Hepatitis B Screening & Vaccination Behaviors in a Community-based Sample of Chinese & Korean Americans in New York City. Am J Health Behav 2017; 41:204-214. [PMID: 28452698 PMCID: PMC5472990 DOI: 10.5993/ajhb.41.2.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES As Asian Americans are dis- proportionately affected by the hepatitis B virus (HBV), we explored predictors of HBV screening and vaccination among Chinese and Korean Americans. METHODS We used cross-sectional data from a com- munity-based sample of Chinese Americans (N = 502) and Korean Americans (N = 487) residing in the metropolitan New York City area during 2008-2009. Logistic regression models were stratified by Asian-American subgroup and sex to predict HBV screening (for the entire sam- ple) and HBV vaccination (among those not HBV positive). RESULTS Overall, screening rates were high (71.3% among Chinese and 70.1% among Koreans). The majority of respondents were aware of HBV; however, knowledge about HBV transmission was low. In logistic regression, a physician recommendation was consistently associated with HBV screening and vaccination outcomes across all groups; having heard of HBV was significantly associated with screening and vaccination among Chinese males and screening among Korean males and females. Screening and vaccination barriers were reported among all groups, and included lack of knowledge and feeling well/having no health issues. CONCLUSIONS Targeted efforts in these at-risk communities are necessary to improve HBV knowledge, address misinformation about HBV, and eliminate provider-, patient-, and resource-related barriers to HBV screening and vaccination.
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Affiliation(s)
- Shijian Li
- SUNY Old Westbury, Department of Public Health, Old Westbury, NY, USA
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Vijayan T, Zheng P, Nguyen C, Brown AM, Chen YW, Peters MG. Survey of Asian patients with hepatitis B infection: limited knowledge of transmission and screening of family members. J Immigr Minor Health 2016; 17:112-7. [PMID: 23913129 DOI: 10.1007/s10903-013-9883-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Asian American families are disproportionately affected by Hepatitis B (HBV) infection. We aimed to assess the extent of screening family members of Asian patients with known HBV infection as well as patients' knowledge of HBV disease. A cross-sectional survey of established Asian patients with HBV-infection was performed at a university liver clinic. Outcome measures included the percentage of family members whose HBV serostatus was unknown and the percentage of patients who were able to correctly identify modes of transmission. A total of 803 US-based family members were identified by 58 patients. Patients did not know the HBV serostatus of 50% of their family members and 28% of their immediate family members. Fifty percent of participants did not know how they had acquired HBV or stated unlikely transmission modes. Though nationwide vaccination campaigns target this underrepresented population, screening family members of Asian patients with HBV remains a challenge.
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Affiliation(s)
- Tara Vijayan
- Division of Infectious Diseases, University of California, San Francisco, 513 Parnassus Ave, Room S-380, San Francisco, CA, 94143-0654, USA,
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Hyun CS, Kim S, Kang SY, Jung S, Lee S. Chronic hepatitis B in Korean Americans: decreased prevalence and poor linkage to care. BMC Infect Dis 2016; 16:415. [PMID: 27526685 PMCID: PMC4986342 DOI: 10.1186/s12879-016-1732-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/22/2016] [Indexed: 01/05/2023] Open
Abstract
Background Chronic hepatitis B virus(HBV) infection is a major cause of liver related morbidity and mortality. HBV infection remains largely underdiagnosed in Asian American population, and it is also poorly linked to clinical care. We, therefore, assessed the HBV prevalence and evaluated linkage to care among Korean Americans in order to develop strategic plans to reduce the impact of HBV in a high risk community. Methods Serologic screening and survey were provided to 7157 Korean American adults (age 21–100) in New Jersey between December 2009 and June 2015. All participants were tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core IgG antibody (anti-HBc). Additional survey was conducted on the subjects chronically infected with HBV on their history of infection. Self-administered questionnaires were employed to evaluate demographic and epidemiologic characteristics. Results Of those 7157screened, 171 (2.4 %) were HBV infected, 2736(38.2 %) were susceptible to HBV, and 4250(59.4 %) were immune. The prevalence of chronic HBV varied between the age groups: 1.18 % (age21-30); 2.53 % (age 31–40); 2.76 % (age 41–50); 2.90 % (age 51–60); 2.06 % (age 61–70); and 1.37 % (age 71–100). The rate of HBsAg was significantly higher in males (3.04 %) as compared to females (1.93 %). At least 75 % of these HBV infected subjects had been previously diagnosed, but were not engaged in care. Conclusion This screening study suggests that the HBV prevalence in Korean Americans is significantly lower than currently understood. On the other hand, many of the individuals chronically infected with HBV cannot access care, suggesting a poor linkage-to-care (LTC). Further, a large percentage of the population is still susceptible to HBV. Study findings will be used to develop strategies to tailor community-based HBV screenings and LTC to the high risk populations.
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Affiliation(s)
- Chul S Hyun
- Holy Name Medical Center, Teaneck, NJ, USA. .,Center for Viral Hepatitis, 35 Van Nostrand Avenue, Englewood, NJ, 07631, USA.
| | - Sue Kim
- Holy Name Medical Center, Teaneck, NJ, USA
| | - Seung Y Kang
- Center for Viral Hepatitis, 35 Van Nostrand Avenue, Englewood, NJ, 07631, USA
| | - Seo Jung
- Center for Viral Hepatitis, 35 Van Nostrand Avenue, Englewood, NJ, 07631, USA
| | - Seulgi Lee
- Center for Viral Hepatitis, 35 Van Nostrand Avenue, Englewood, NJ, 07631, USA
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Regev A, Seeff LB, Merz M, Ormarsdottir S, Aithal GP, Gallivan J, Watkins PB. Causality assessment for suspected DILI during clinical phases of drug development. Drug Saf 2015; 37 Suppl 1:S47-56. [PMID: 25352327 PMCID: PMC4212150 DOI: 10.1007/s40264-014-0185-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Causality assessment is a critical step in establishing the diagnosis of drug induced liver injury (DILI) during drug development. DILI may resemble almost any type of liver disease, and often presents a serious challenge to clinical investigators and drug makers. The diagnosis of DILI is largely based upon a combination of a compatible clinical course, exclusion of all other reasonable causes, resemblance of clinical and pathological features to known features of liver injury due to the drug (i.e., “drug’s signature”), and incidence of liver injury among patients treated with the drug compared to placebo or comparator. Causality assessment for suspected DILI is currently performed using either evaluation by physicians with expertise in liver disorders (i.e., expert opinion) or standardized scoring instruments such as the Roussel Uclaf Causality Assessment Method (RUCAM). Both approaches are widely used in the post marketing setting. Causality assessment based on expert opinion is considered superior to standardized instruments such as RUCAM, in the setting of drug development, and is currently the preferred approach during clinical trials. There is a need for a systematic revision of RUCAM that will render it more suitable for the setting of clinical trials and drug development. Careful monitoring and meticulous data collection during clinical trials are essential in all cases with established liver injury to allow for a proper causality assessment. A workshop was convened to discuss best practices for the assessment of drug-induced liver injury (DILI) in clinical trials. This publication is based on the conclusions of this workshop.
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Affiliation(s)
- Arie Regev
- Global Patient Safety, Eli Lilly and Company, Lilly Corporate Center, Drop Code 2121, Indianapolis, IN, 46285, USA,
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Li Z, Hou X, Cao G. Is mother-to-infant transmission the most important factor for persistent HBV infection? Emerg Microbes Infect 2015; 4:e30. [PMID: 26060603 PMCID: PMC4451268 DOI: 10.1038/emi.2015.30] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/24/2015] [Accepted: 04/06/2015] [Indexed: 02/06/2023]
Abstract
Of the infants born to hepatitis B surface antigen (HBsAg)-positive mothers globally, 42.1% who did not receive hepatitis B virus (HBV) passive-active immunoprophylaxis and 2.9% of infants who received the immunoprophylaxis acquired HBV infection perinatally. Moreover, perinatal infection occurred in 84.2% (18.8%-100%) and 8.7% (0.0-21.0%) of infants born to hepatitis B e-antigen (HBeAg)-positive mothers who did not and did receive immunoprophylaxis, respectively; by contrast, the infection rates were 6.7% (0.0-15.4%) and 0.4% (0.0-2.5%) for infants born to HBeAg-negative-carrier mothers, respectively. The chronicity rates of HBV infection acquired perinatally were 28.2% (17.4%-33.9%) in infants born to HBeAg-negative mothers and 64.5% (53.5%-100%) in infants born to HBeAg-positive mothers. HBV mother-to-child transmission was more frequent in East Asia relative to other areas. In addition to differences in the endemic HBV genotype, the interchange of allelic dominance in genetic polymorphisms in HLA class II and NF-κB between the Chinese and European populations may explain why chronic HBV infection frequently affects the Chinese. The risk of progressing into chronic infection was inversely related to the age of children at the time of horizontal transmission. To further diminish HBV chronic infection, it is necessary to enforce antiviral treatment after the 28th week of gestation for HBeAg-positive mothers and to improve the health habits of carrier mothers and household sanitary conditions.
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Affiliation(s)
- Zixiong Li
- Department of Epidemiology, Second Military Medical University , Shanghai 200433, China
| | - Xiaomei Hou
- Department of Epidemiology, Second Military Medical University , Shanghai 200433, China
| | - Guangwen Cao
- Department of Epidemiology, Second Military Medical University , Shanghai 200433, China
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Kim MJ, Lee H, Kiang P, Watanabe P, Torres MI, Halon P, Shi L, Church DR. Debunking the myth: low knowledge levels of HBV infection among Asian American college students. Asia Pac J Oncol Nurs 2015; 2:8-16. [PMID: 27981087 PMCID: PMC5123458 DOI: 10.4103/2347-5625.152399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: To examine the hepatitis B virus (HBV)-related knowledge among Asian American college students and to determine whether there are significant differences in the level of HBV knowledge among Asian American subgroups. Methods: A cross-sectional survey was self-administered to assess a sample of 258 Asian American students’ knowledge about HBV at the campus of the research site. Results: Knowledge regarding transmission and consequences of HBV infection was poor. Of a possible knowledge score of 14, the median number of correct answers was eight. There were no significant differences between the subgroups of Asian American college students in total knowledge of HBV infection. Conclusion: The findings of this study point to the fact that the lack of knowledge and awareness is not limited to community settings only but also includes higher education environment. This finding brings to the forefront the importance of HBV education for Asian American college students.
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Affiliation(s)
- Min-Jin Kim
- College of Nursing and Health Sciences, MA, USA
| | - Haeok Lee
- College of Nursing and Health Sciences, MA, USA
| | - Peter Kiang
- College of Education, the Asian American Studies Program, MA, USA
| | - Paul Watanabe
- Department of Political Science, the Institute for Asian American Studies, MA, USA
| | - Maria I Torres
- Gaston Institute for Latino Community Development and Public Policy, University of Massachusetts Boston, MA, USA
| | | | - Ling Shi
- College of Nursing and Health Sciences, MA, USA
| | - Daniel R Church
- Bureau of Infectious Disease, Massachusetts Department of Public Health, Jamaica Plain, MA, USA
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15
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Li Z, Xie Z, Ni H, Zhang Q, Lu W, Yin J, Liu W, Ding Y, Zhao Y, Zhu Y, Pu R, Zhang H, Dong H, Fu Y, Sun Q, Xu G, Cao G. Mother-to-child transmission of hepatitis B virus: Evolution of hepatocellular carcinoma-related viral mutations in the post-immunization era. J Clin Virol 2014; 61:47-54. [DOI: 10.1016/j.jcv.2014.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/29/2014] [Accepted: 06/10/2014] [Indexed: 12/13/2022]
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16
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Said A, Jou JH. Hepatitis B vaccination and screening awareness in primary care practitioners. Hepat Res Treat 2014; 2014:373212. [PMID: 24729872 DOI: 10.1155/2014/373212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 01/10/2014] [Indexed: 11/17/2022]
Abstract
Introduction. The goals of Healthy People US 2020 have called for increased screening and vaccination of high-risk groups for Hepatitis B (HBV). Methods. We performed a survey of 400 randomly chosen primary care practitioners (PCPs) in Wisconsin to assess their knowledge, attitudes, and practices regarding screening and vaccination for HBV. Results. Screening rates of patients at risk of sexual transmission were low, with 61% of respondents stating that they screen patients who had more than 1 sex partner in 6 months and 86% screening patients with a history of sex with prostitutes. Screening rate for persons with a history of intravenous drug use was 94%. Children of immigrants were screened by 65%, persons on hemodialysis by 73%, and prison inmates by 69%. Screening increased with provider experience with HBV. Deficiencies in vaccination rates mirrored screening practices. Major barriers to screening were cost, someone else's responsibility, time constraints, or lack of knowledge. Conclusions. Without improved education and practices of PCPs about HBV screening and vaccination, the goals of healthy people 2020 regarding HBV will not be met. Barriers to screening and vaccination need to be addressed. Cost-effectiveness of alternative strategies such as universal vaccination under the age of 50 should be explored.
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17
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Marzio DHD, Hann HW. Then and now: The progress in hepatitis B treatment over the past 20 years. World J Gastroenterol 2014; 20:401-413. [PMID: 24574709 PMCID: PMC3923015 DOI: 10.3748/wjg.v20.i2.401] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/25/2013] [Accepted: 11/29/2013] [Indexed: 02/06/2023] Open
Abstract
The ultimate goals of treating chronic hepatitis B (CHB) is prevention of hepatocellular carcinoma (HCC) and hepatic decompensation. Since the advent of effective antiviral drugs that appeared during the past two decades, considerable advances have been made not only in controlling hepatitis B virus (HBV) infection, but also in preventing and reducing the incidence of liver cirrhosis and HCC. Furthermore, several recent studies have suggested the possibility of reducing the incidence of recurrent or new HCC in patients even after they have developed HCC. Currently, six medications are available for HBV treatment including, interferon and five nucleoside/nucleotide analogues. In this review, we will examine the antiviral drugs and the progresses that have been made with antiviral treatments in the field of CHB.
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MESH Headings
- Antiviral Agents/adverse effects
- Antiviral Agents/history
- Antiviral Agents/therapeutic use
- Carcinoma, Hepatocellular/epidemiology
- Carcinoma, Hepatocellular/prevention & control
- Carcinoma, Hepatocellular/virology
- Drug Resistance, Viral
- Hepatitis B, Chronic/diagnosis
- Hepatitis B, Chronic/drug therapy
- Hepatitis B, Chronic/epidemiology
- Hepatitis B, Chronic/history
- History, 20th Century
- History, 21st Century
- Humans
- Liver Cirrhosis/epidemiology
- Liver Cirrhosis/prevention & control
- Liver Cirrhosis/virology
- Liver Neoplasms/epidemiology
- Liver Neoplasms/prevention & control
- Liver Neoplasms/virology
- Time Factors
- Treatment Outcome
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18
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Affiliation(s)
- Faisal Abaalkhail
- Department of Liver and Small Bowel Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hussien Elsiesy
- Adult Transplant Hepatology, Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed AlOmair
- Department of Medicine, Gastroenterology Unit, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Y. Alghamdi
- Department of Gastroenterology, King Fahad Military Medical Complex, Dharan, Saudi Arabia
| | - Abduljaleel Alalwan
- Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Nasser AlMasri
- Department of Gastroenterology, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Waleed Al-Hamoudi
- Adult Transplant Hepatology, Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Gastroenterology Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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19
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Affiliation(s)
- Dieter Ebert
- Universität Basel, Zoologisches Institut, 4051 Basel, Switzerland; Wissenschaftskolleg zu Berlin, 14193 Berlin, Germany;
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20
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Seem DL, Lee I, Umscheid CA, Kuehnert MJ. PHS guideline for reducing human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission through organ transplantation. Public Health Rep 2013; 128:247-343. [PMID: 23814319 DOI: 10.1177/003335491312800403] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Debbie L Seem
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Office of Blood, Organ, and other Tissue Safety, Atlanta, GA 30329, USA.
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21
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Xu JJ, Tien C, Chang M, Rhee J, Tien A, Bae HS, Ho FCS, Chan LS, Fong TL. Demographic and serological characteristics of Asian Americans with hepatitis B infection diagnosed at community screenings. J Viral Hepat 2013; 20:575-81. [PMID: 23808996 DOI: 10.1111/jvh.12073] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/01/2012] [Indexed: 12/16/2022]
Abstract
There is limited information regarding follow-up and hepatitis B serological status of Asian Americans diagnosed with chronic hepatitis B (CHB) through community screening. The aims of this study were to evaluate the prevalence and characterize CHB among Asians living in Los Angeles, assess follow-up of individuals with CHB diagnosed at screening and compare with patients with CHB followed by community gastroenterologists. Between October 2007 and May 2010, 7387 Asians were tested for HBV. HBsAg positive individuals (CHB) underwent additional testing for ALT, HBeAg/anti-HBe and HBV DNA. Patients with CHB were contacted 6 months later to determine whether they received follow-up care. We compared serological patterns of these individuals with CHB to patients with CHB who were seen for the first time (treatment naïve) by community gastroenterologists during the study period. Prevalence of CHB was 5.2%. About 99% patients with CHB were foreign-born, and only 27% could read/write English. 297 (77%) patients with CHB could be reached 6 months after diagnosis; 43% did not receive follow-up care, mostly because of lack of medical insurance. Patients with CHB followed by gastroenterologists were more likely to have insurance (69% vs 26%, P < 0.0001). 90% patients with CHB at screening were HBeAg negative/anti-HBe positive with 62% having inactive disease compared to only 30% of patients seen by gastroenterologists (P < 0.0001). Among CHB participants, 13% met criteria for treatment compared to 51% of patients with CHB (P < 0.0001). Only a small number of CHB screening participants require antiviral therapy. Lack of medical insurance is the main reason for most patients with CHB not seeking follow-up care after screening.
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Affiliation(s)
- J J Xu
- Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA
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22
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Gómez Rodríguez R, Guardiola Arévalo A, Gómez Moreno AZ, García Vela A, Gómez Hernando C, Rodríguez Merlo R, Sánchez Ruano JJ, de la Cruz Pérez G. [Characteristics of patients with chronic hepatitis B virus infection. analysis of a series of 474 patients]. Gastroenterol Hepatol 2013; 36:243-53. [PMID: 23414836 DOI: 10.1016/j.gastrohep.2012.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/21/2012] [Accepted: 10/29/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine the clinical, laboratory, serological and histologic characteristics of chronic hepatitis B virus carriers in our environment. MATERIAL AND METHODS A retrospective cohort study was performed that included chronic AgHBs carriers aged more than 13 years attending our service since January 2000. RESULTS A total of 474 patients were included. At diagnosis, 55.49% were men, with a mean age of 41.05±13.93 years. Alanine aminotransferase (ALT) levels were within the normal range in 57.17% of the patients, and 87.76% were AgHBe(-). Hepatitis C and D virus coinfection was found in 3.62% and 1.86%, respectively. Liver biopsy was performed in 31.22%; varying grades of inflammation-fibrosis were found in 63.51% and cirrhosis was found in 12.84%. Compared with AgHBe(-) patients, those who were AgHBe(+) were younger and had greater disease activity. This difference was statistically significant. Patients in the immunotolerant phase were the least numerous (5.26%), while AgHBe(-) patients with chronic HBV infection were the most numerous (48.32%). Patients in the immunoreactive phase showed greater histological involvement (16.67% cirrhosis). A familial history of chronic HBV was found in 21.52%. The percentage of non-Spanish patients increased in the last few years and accounted for 18.78%. CONCLUSION Chronic HBV infection in our environment occurs mainly in middle-aged persons. GPT values are normal in more than 50%, most are AgHBe(-), and approximately half are inactive carriers. The incidence of chronic infection has increased in the non-Spanish population in recent years.
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23
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Lee H, Kiang P, Watanabe P, Halon P, Shi L, Church DR. Hepatitis B virus infection and immunizations among Asian American college students: infection, exposure, and immunity rates. J Am Coll Health 2013; 61:67-74. [PMID: 23409856 DOI: 10.1080/07448481.2012.753891] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the prevalence of hepatitis B virus (HBV) infection, exposure, and immunity among Asian American college students as a basis for evaluating HBV screening and vaccination policy. PARTICIPANTS AND METHODS Self-identified Asian American college students aged 18 years or older were examined. Serological tests of HBV surface antigens, antibodies to HBV core antigens (anti-HBc), and antibodies to HBV surface antigens (anti-HBs) were used to determine HBV infection and immunization prevalence. RESULTS Among US-born students (n = 66), none was infected with HBV, 68% (n = 45) had immunity from vaccination, and 1 student had evidence of past exposure to HBV. Among foreign-born students (n = 142), 4% (n = 5) had evidence of chronic HBV infection, 62% (n = 88) had immunity from vaccination, and 19% (n = 27) had results indicating past exposure to HBV. Asian American college students showed very little knowledge of HBV vaccination; 43% reported that they had received vaccination, whereas 50% did not know whether they had received it or not. CONCLUSIONS The prevalence of current and past HBV infection among foreign-born Asian American college students is significantly higher (p < .01), than US-born students. The lack of awareness of their HBV-infected status points out the importance of routine HBV screening of high-risk populations such as Asian students.
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Affiliation(s)
- Haeok Lee
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts 02125-3393, USA.
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24
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Cai QX, Zhu YY. Is hepatitis B virus transmitted via the male germ line? A seroepidemiological study in fetuses. Int J Infect Dis 2012; 17:e54-8. [PMID: 23154176 DOI: 10.1016/j.ijid.2012.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/18/2012] [Accepted: 09/03/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To detect father-to-fetus transmission of hepatitis B virus (HBV) in utero. METHODS We conducted a study at the prenatal diagnosis center of Taizhou City. Fetuses with one or both parents carrying the hepatitis B surface antigen (HBsAg) were identified before genetic testing during the period 2008-2010. Intrauterine samples were obtained by amniocentesis or cordocentesis and tested for serological markers and by quantitative DNA assays. All neonates received combined hepatitis B immunoprophylaxis after delivery, and serological follow-up tests were performed at 1 year of age. RESULTS Of the 407 couples enrolled in the study, HBV was carried by fathers only in 164, and none of their fetuses were found to be HBV DNA-positive in utero. All fetal serological markers were found to be of maternal but not paternal origin. The response rate to postnatal vaccination was 98.6%, and none of the children who failed immunoprophylaxis were the offspring of the HBV carrier fathers. CONCLUSIONS The infection of fetuses with HBV from the spermatozoa of carrier fathers seems unlikely, especially in an area where pre-conception hepatitis B vaccination is routinely provided.
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Affiliation(s)
- Qun-Xi Cai
- Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai City, China
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25
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Congly SE, Burak KW, Coffin CS. Hepatitis B immunoglobulin for prevention of hepatitis B virus infection and recurrence after liver transplantation. Expert Rev Clin Immunol 2011; 7:429-36. [PMID: 21790285 DOI: 10.1586/eci.11.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Intravenous hepatitis B immunoglobulin (HBIG) is a human plasma-derived purified gammaglobulin (IgG) that has proven efficacy and dose-dependent response in the prevention of hepatitis B virus (HBV) recurrence after liver transplantation. It is also indicated for postexposure prophylaxis after contact with blood or body fluids of serum hepatitis B surface antigen (HBsAg)-positive carriers and in prevention of mother-to-child (vertical) transmission. The exact mechanism of passive immunization is unknown; HBIG may block HBV entry and binding to hepatocytes, neutralize circulating HBV and target HBV-infected cells through an antibody-mediated immune response. The drug is well tolerated and common side effects include fever, chills and arthralgias that are usually mild and transient. This article summarizes the main indications and the recommendations for use of intravenous HBIG, as well as the usage of intramuscular HBIG in the liver transplant setting.
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Affiliation(s)
- Stephen E Congly
- Liver Unit, Division of Gastroenterology, Faculty of Medicine, University of Calgary, Alberta, Canada
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26
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Abstract
There have been major advances in the field of hepatitis B (HBV) over the last few decades. These advances have resulted in the understanding of the natural history of chronic HBV infection, effective vaccines against the virus, sensitive assays for screening and monitoring of treatment, and effective treatments for viral suppression, all leading to improved outcomes. Debates and controversies remain, however, over the ideal management strategies of patients with chronic hepatitis B. To eradicate HBV, the global community needs to improve current preventive, screening, and treatment strategies.
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Affiliation(s)
- Michelle Lai
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA 02215, USA.
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27
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Zheng X, Huang Y, Zheng C, Dong S, Liang W. Alginate-chitosan-PLGA composite microspheres enabling single-shot hepatitis B vaccination. AAPS J 2010; 12:519-24. [PMID: 20577912 DOI: 10.1208/s12248-010-9213-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 06/07/2010] [Indexed: 11/30/2022]
Abstract
Hepatitis B vaccination typically requires a multi-dose administration protocol over a course of 3-6 months. Aiming at developing a single-shot formulation for hepatitis B vaccine (hepatitis B surface antigen (HBsAg)), a novel vaccine delivery system, the composite microspheres of alginate-chitosan-poly(lactic-co-glycolic acid) (PLGA), was synthesized by a two-step preparation. The composite microspheres showed distinct advantages over the conventional PLGA microspheres in aspects of the high loading capacity and the elimination of lyophilizing process. The loading capacity of the composite microspheres was about seven times higher than those in the conventional PLGA microspheres, due to the protein-friendly microenvironment created by the hydrophilic alginate-chitosan cores of the composite microspheres. This vaccine delivery system was shown to be able to induce robust immune responses by single injection and display no significant difference in HBsAg-specific antibody levels compared to the double-injection method.
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Affiliation(s)
- Xiaoling Zheng
- Department of Pharmacy, Women's Hospital, Zhejiang University, Hangzhou, China
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28
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Mellen JS, Xia VW, Hashemzadeh M, Imagawa D, Jamal M, Hoefs J, Hu KQ. The clinical presentation of chronic hepatitis B virus infection in Asian Americans: a single center retrospective study. J Clin Gastroenterol 2010; 44:364-70. [PMID: 19770675 DOI: 10.1097/MCG.0b013e3181b5c7a8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The clinical course of chronic hepatitis B virus (HBV) infection varies with ethnicity. Little is known about the clinical presentation of chronic HBV infection in Asian Americans. OBJECTIVES To define the clinical presentation of chronic HBV infection in Asian Americans. METHODS This is a retrospective study that used systematic chart review and statistical analysis to investigate 213 Asian-American patients with chronic HBV infection who presented to a university medical center. RESULTS This cohort included 55.8% male patients, 97.9% were born outside the US, and 52.3% reported a family history of HBV infection. Of the 56 patients with liver biopsy, 34.0% had stage 3 to 4 fibrosis. In patients with available data, 21.5% were hepatitis B e antigen positive [HBeAg (+)] and 31.1% had HBV DNA levels >1 x 10(6) copies/mL. Patients with HBeAg (+) HBV infection were diagnosed at a younger age (P=0.002) and with higher alanine aminotransferase (P=0.001) and HBV DNA (P=0.001) levels. Although only 3.3% presented with obesity (ie, body mass index >or=30 kg/m2), 43.4% had evidence of hepatic steatosis. Presentation of hepatocellular carcinoma was associated with an older age at diagnosis (P<0.001), male sex (P<0.001), tobacco use (P<0.001), a greater degree of fibrosis on liver biopsy (P=0.01), and higher alanine aminotransferase, aspartate aminotransferase (P<0.001), and a fetoprotein (P<0.001) levels. CONCLUSIONS Chronic HBV infection in foreign-born Asian Americans was characterized by a low rate of HBeAg (+) and male predominance as well as high rates of family history of HBV infection, hepatic fibrosis, and hepatic steatosis.
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Tong MJ, Chavalitdhamrong D, Lu DS, Raman SS, Gomes A, Duffy JP, Hong JC, Busuttil RW. Survival in Asian Americans after treatments for hepatocellular carcinoma: a seven-year experience at UCLA. J Clin Gastroenterol 2010; 44:e63-70. [PMID: 19745756 DOI: 10.1097/MCG.0b013e3181b4b68b] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/RATIONALE Hepatocellular carcinoma (HCC) is a common malignancy in Asians and is related to the high incidence of chronic viral hepatitis in this ethnic population. The aims of this study were to examine the tumor characteristics and liver disease status in HCC patients of Asian ancestry and determine their survival after treatments for HCC. RESULTS Between September 2000 and December 2007, 278 patients, mean age 61.5 years, presented with HCC to the University of California Los Angeles (UCLA) Liver Cancer Center. Hepatitis B (HBV) infection was detected in up to 68% of Chinese, Korean, and Vietnamese patients, whereas 60% of Japanese patients had Hepatitis C (HCV) infection. Compared with HCC patients who presented with symptoms, those detected by surveillance had more tumors within the Milan and University of California, San Francisco (UCSF) criteria and more patients in Child-Turcotte-Pugh class A. On the basis of a predefined UCLA treatment algorithm, 83% of patients received surgical and/or loco-regional therapies. Compared with other treatments, orthotopic liver transplantation (OLT), and radiofrequency ablation had the highest overall patient survival (P<0.0001) and OLT has the highest disease free survival rates (P<0.0001). Independent baseline predictors for: (1) patient survival were HBV [hazard ratio (HR) 0.62, P=0.005], UCSF criteria (HR 0.46, P<0.0001), Child Turcotte Pugh class A (HR 0.57, P=0.005), alphafetoprotein per log10 increase (HR 1.26, P=0.0012), and alkaline phosphatase per log10 increase (HR 2.32, P=0.02); and for (2) disease free survival were UCSF criteria (HR 0.66 P=0.007), aspartate aminotransferase per log10 increase (HR 1.50, P=0.04), and age per year increase (HR=1.02, P=0.04). The 4 Asian subgroups had similar survival rates. CONCLUSIONS HBV and Hepatitis C were associated with over 90% of HCC cases in Asian Americans. HCC detected by surveillance identified more patients eligible for surgical and loco-regional therapies, which improved the overall and disease free survival.
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Hwang JP, Mohseni M, Gor BJ, Wen S, Guerrero H, Vierling JM. Hepatitis B and hepatitis C prevalence and treatment referral among Asian Americans undergoing community-based hepatitis screening. Am J Public Health 2010; 100 Suppl 1:S118-24. [PMID: 20147697 DOI: 10.2105/ajph.2009.162776] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES We sought to identify cross-sectional hepatitis B virus (HBV) and HCV prevalence among Asian Americans at a community health fair and to assess referral rates. METHODS We determined HBV prevalence with hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), and antibodies to hepatitis B surface antigen (anti-HBs). We determined HCV prevalence with hepatitis C antibodies. Successful referral occurred when participants with HBV or HCV were contacted, medically evaluated, and given contact information of liver specialists for care. RESULTS Of 202 people screened, 118 were Asian Americans (65 Chinese and 39 Vietnamese). Twelve had chronic HBV with positive HBsAg. However, chronic HBV prevalence increased from 10.2% to 13.6% by concomitant HBsAg, anti-HBc, and anti-HBs testing. Prevalence of HCV was 6% overall but 15.4% among Vietnamese. Overall, 83% of patients with chronic HBV and 100% of patients with occult HBV or HCV were successfully referred. CONCLUSIONS Concomitant HBsAg, anti-HBc, and anti-HBs testing permits diagnosis of chronic, occult HBV infections missed by testing with HBsAg alone. Persons identified with HBV or HCV at community health fairs can be successfully referred.
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Affiliation(s)
- Jessica P Hwang
- Department of General Internal Medicine at University of Texas M D Anderson Cancer Center, Houston, USA.
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Lee H, Baik SY. Health disparities or data disparities: sampling issues in hepatitis B Virus infection among Asian American Pacific Islander studies. Appl Nurs Res 2010; 24:e9-e15. [PMID: 20974087 DOI: 10.1016/j.apnr.2009.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 12/12/2009] [Accepted: 12/21/2009] [Indexed: 11/17/2022]
Abstract
Hepatitis B virus (HBV) infection in Asian American Pacific Islanders (AAPIs) is an important health problem that must be recognized and addressed by the U.S. public health policy. However, AAPIs have been to a large degree invisible in public health data and debates and their interests have been disregarded. Moreover, an estimation of HBV infection rates reported from the National Nutritional and Health Survey Examinations III was 1.25 million; however, an estimate based on AAPI-targeted studies places the number at almost 2 million. This article discusses the perils of application of textbook methods of sampling coverage, selection, and nonresponse in studies related to AAPIs and the importance to note that some rapidly increasing racial/ethnic groups such as AAPIs have linguistic and cultural differences and these differences often cause such groups to be omitted from data collection.
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Affiliation(s)
- Haeok Lee
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125-3393, USA.
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Quang YN, Vu J, Yuk J, Li CS, Chen M, Bowlus CL. Prevalence of hepatitis B surface antigen in US-born and foreign-born Asian/Pacific Islander college students. J Am Coll Health 2010; 59:37-41. [PMID: 20670927 PMCID: PMC2982672 DOI: 10.1080/07448481.2010.486811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED The prevalence of chronic hepatitis B (HBV) among college-age US-born Asian and Pacific Islanders (A/PI) is not well known. OBJECTIVES To compare the prevalence of hepatitis B surface antigen (HBsAg) seropositivity in US-born to A/PI-born students at a public university. PARTICIPANTS Undergraduate who self-identified themselves as A/PI. RESULTS Of 145 US-born A/PI, 1.4% (confidence interval [CI] = 0.0%, 3.3%) tested positive for HBsAg compared to 3.3% (CI = 0.5%, 6.1%) of the 152 A/PI-born students. Approximately 1/3 of all students were unaware of their HBV vaccination status. CONCLUSIONS HBsAg prevalence among A/PI undergraduates, including US-born, is considerably higher (3 to 11 times) than the mainstream US population (0.3% to 0.5%) and supports the Centers for Disease Control and Prevention (CDC) recommendations for testing all persons of A/PI ancestry, including US-born persons whose parents were born in regions with HBsAg prevalence of >or=8%. Awareness of HBV vaccination status was relatively low and vaccination did not assure that individuals were HBsAg negative.
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Affiliation(s)
- Yen N. Quang
- Department of Internal Medicine, University of California Davis School of Medicine, Davis, CA
| | - Joanne Vu
- Department of Internal Medicine, University of California Davis School of Medicine, Davis, CA
| | - Jihey Yuk
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Davis, CA
| | - Chin-Shang Li
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis School of Medicine, Davis, CA
| | - Moon Chen
- Division of Hematology and Oncology, University of California Davis School of Medicine, Davis, CA
| | - Christopher L. Bowlus
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Davis, CA
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Huang YW, Liao YT, Chen W, Chen CL, Hu JT, Liu CJ, Lai MY, Chen PJ, Chen DS, Yang SS, Kao JH. Vitamin D receptor gene polymorphisms and distinct clinical phenotypes of hepatitis B carriers in Taiwan. Genes Immun 2009; 11:87-93. [PMID: 19693091 DOI: 10.1038/gene.2009.65] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vitamin D exhibits immunomodulatory and antiproliferative effects through vitamin D receptor (VDR) in chronic infections and cancers. We genotyped the BsmI (rs1544410), ApaI (rs7975232) and TaqI (rs731236) polymorphisms of VDR gene in 250 Taiwanese chronic hepatitis B virus (HBV) carriers who were categorized into six phenotypes. After adjustment for age and sex, the frequencies of the VDR B/b, B/a, B/T, B/a/T in patients with hepatitis flare(s) were lower than those without (7 vs 20%, P=0.009; 1 vs 9%, P=0.004; 3 vs 10%, P=0.007; 1 vs 9%, P=0.005, respectively); in contrast, T/t, A/T, A/t, b/A/t were higher in flare(s) (8 vs 3%, P=0.003; 49 vs 34%, P=0.027; 2 vs 1%, P=0.004; 0.5 vs 0%, P=0.001, respectively). In addition, B/b, B/B, T/t, b/A, B/a, B/A, B/T, B/t, A/t, b/A/T, B/a/T, B/A/T, B/A/t, b/A/t were higher in patients positive for HBeAg. The distribution of VDR genotypes was comparable between patients with and without hepatocellular carcinoma (HCC). VDR gene polymorphisms are associated with distinct clinical phenotypes in Taiwanese HBV carriers but not with HCC development.
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Affiliation(s)
- Y-W Huang
- Liver Unit, Cathay General Hospital Medical Center, Taipei, Taiwan
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Abstract
Asia comprises more than 40 countries encompassing a wide geographic area with a very large population. Many of these countries have low-income economies together with high endemicity of chronic hepatitis B virus (HBV) infection, which is usually acquired perinatally or during early childhood. The well elucidated natural history of chronic HBV infection, together with the extensive research and the longest experience in the use of therapeutic agents in Asia have provided a great opportunity for Asian patients to benefit from recent advancements. However, treatment of chronic HBV infection is a complex task that requires individualized assessment, thus representing a great challenge for general physicians. The inherent problems of the drugs currently available, together with a lack of awareness of the disease among patients, government, and healthcare practitioners are obstacles to proper management of HBV. The most critical challenge and obstacle is the high cost of medical care and antiviral drugs. Lack of adequate reimbursement for treatment and diagnostic testing makes adherence to treatment guidelines impossible. Hence lamivudine is still widely used in Asia. To address these challenges, the ongoing awareness campaigns, active screening programs, educational activities are needed but must be enhanced. Cost-cutting measures and international support are essential to improve the difficult situation in this part of the world.
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Affiliation(s)
- Yun-Fan Liaw
- Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Tung Hwa North Road, Taipei, Taiwan.
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Affiliation(s)
- Jia-Horng Kao
- Hepatitis Research Center, Graduate Institute of Clinical Medicine, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
Hepatitis B virus (HBV) remains a significant problem worldwide. Despite years of research on this disease, the treatment and management of children with chronic HBV remains a veritable challenge. Although it is less evident in developed countries, HBV still affects immigrants and adopted children from endemic countries. This article discusses the role of the pediatric nurse practitioner in the management of children with chronic hepatitis B in the primary care setting.
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Abstract
Hepatitis B virus(HBV) infection is one of the major global public health problems. Based on the second National Health and Nutrition Examination Survey (NHANES II), it is estimated that 1.25 million people are HBV infected in the United States. However, Asian and Pacific Islander Americans (APIAs) were underrepresented in this survey, and studies on the community HBV screening reported 6-15% of HBV infection in this special population. This article systematically reviews recent research advances in the possible barriers of hepatitis B care in APIAs that can be classified into three major categories, i.e., provider-, patient-, and resource-related barriers. The article also provides an overview of multiple approaches to effectively reduce these barriers so that we can evolve better strategy and deliver appropriate care to this special population and eventually reduce health disparity of CHB in APIAs.
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Affiliation(s)
- Ke-Qin Hu
- Division of Gastroenterology and Hepatology, University of California, Irvine School of Medicine, Irvine, California, USA
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Abstract
In countries with a high prevalence of chronic hepatitis B, perinatal transmission from mother to infant accounts for the majority of cases of chronic hepatitis B. Passive-active immunoprophylaxis with hepatitis B immunoglobulin and hepatitis B vaccine at birth is 95% efficacious in reducing the risk of HBV transmission but is less effective in HBeAg-positive mothers with very high serum HBV DNA levels. In the last 4 weeks of pregnancy lamivudine may provide additional protection in pregnant women who have high-level viremia. Further studies are needed to evaluate the use of nucleos(t)ide analogues to treat chronic hepatitis B during pregnancy.
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Affiliation(s)
- Maya Gambarin-Gelwan
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College of Cornell University, 1305 York Avenue, 4th floor, New York, NY 10021, USA.
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