| Background and significanceHepatitis B virus (HBV) infection is one of the important public health issues worldwide. According estimation reported 2014 by WHO, approximately 78 million people worldwide died from HBV-related acute or chronic liver diseases each year. HBV infection is highly prevalent in China. Estimated from a national survey in 2006, currently 93 million people are with HBV chronic infection in China, and among them 20 million suffer chronic hepatitis.A national program of hepatitis B vaccine immunization for neonates and infants started in 1992 in China. The HBsAg positive rate of children under 5 years old dropped from 9.67% in 1992 to 0.96% in 2006 in China, but HBsAg positive rate was still as high as 8.57% in people aged 15-59. In Beijing, HBsAg positive rate of children under 5 years old dropped from 1.74% in 1992 to 0.00% in 2006, during the same period the reduction of HBsAg positive rate was only from 6.43% in 1992 to 4.31% in 2006 for people aged 15-59. All above indicates that adult HBsAg positive rate decreased much lower than children widely immunized by hepatitis B vaccine.In 2014 a sero-epidemiological survey on hepatitis B among adults was conducted combined with Community Diagnosis Survey (CDS) in 43 communities in Chaoyang District, Beijing, to observe the prevalence of HBsAg and anti-HBs and the risk factors of HBV infection in Chaoyang District, and to explore the possibility and feasibility to screen adult HBV infectors in the CDS and to provide HB vaccine for susceptible adults in communities.ObjectivesTo observe the prevalence of HBsAg and anti-HBs and the risk factors of HBV infection in adults in Chaoyang District, Beijing; And to explore the possibility and feasibility of hepatitis B vaccination for adults with both HBsAg and anti-HBs tests negative (hereafter, called double-negative) in the communities.MethodsThis study includes (1) a sero-epidemiological survey on hepatitis B among adults, and (2) a study to observe organization of the survey, delivery of the HBV sero-test results and implementation of HBV 0-1-6 vaccination for voluntary, double-negative adults.1. The sero-epidemiological surveyA questionnaire-based interview was performed to the adults residents aged 18 or over either through inviting participants to a project site in the community or through a door-to-door visit to participants by community social workers in 43 communities in Chaoyang district, with each community about 3000 participants.5ml venous blood was taken for HBsAg and anti-HBs test using ELISA reagents by community health centers. Laboratory reagents were provided by Beijing WanTai Biotechnology Company.Data from communities in which at least 1,000 adults were tested by January 15, 2015, was analyzed using SAS 9.3 data analysis software.logistic regression models were used for univariate and multivariate regression analysis. P<0.05 was considered as statistical significance.2. The study on organization of the survey, delivery of the HBV sero-test results and implementation of HBV 0-1-6 vaccination for voluntary, double-negative adults.(1) Three communities were selected to collect information about how to organizethe survey, how to deliversero-test results to participants and how to mobilize double negative peopleto vaccine through field observations or face to face/telephone interviews to community workers. A summary and comparisons were made about the process of survey and vaccination in the three communities. (2) Using vaccination data reported to Chaoyang Center for Disease Control and Prevention (Chaoyang CDC) during Dec.2013 to Jan.2015 to analyze community distribution of completion of vaccination.Results1. Social and demographic characteristics of the participantsDuringthe period of Dec.2013 to Jan.2015,35 (83.33%) out of 42 community health centers in Chaoyang district completed at least 1000 questionnaires with HBsAg or anti-HBs testing at each community. Among them,20 (20/42,47.62%) communities completed 2500 or more adults; 16 are urban and 19 are suburb-rural communities. We use data from the above 35 communities in this paper.A total of 78100 participants from the 35 communities were included in the analysis. The mean age of the participants was 53 yearsold; 54.25% were in rural communities; 42.43% were male; 40.87% were retirees, and 17.81% were commercial and service individuals; 73.12% were residents Beijing-registered. Among participants Beijing-registered,66.83% were older than 50 years-old, while 65.29% participants’ household registered in other provinces aged less than 50 years old.2.The HBV sero-epidemiological characteristicsThe crude prevalence of HBsAg was 2.24%(95% CI:2.13%-2.34%) in 35 communities. The highest age-specific HBsAg prevalence was 3.00%(95% CI: 2.56%-3.44%) for those at age of 40-44 and the lowest was 1.69%(95% CI: 1.29%-2.09%) at age of 18-24, respectively; the gender difference of HBsAg positive rate was relatively smaller (2.45% in male vs.2.07% in female, P<0.01). There was a significant difference between HBsAg prevalences by occupations(x2=58.77, P<0.01), A large variation of community-based HBsAg prevalence was identified with the highest of 10.68%(95% CI:9.43%-11.94%) and lowest of 0.24%(95% CI:0.13%-0.38%). HBsAg prevalence of rural communities was higher than that in urban communities (2.44% vs.1.99%, P<0.01). HBsAg positive rate was significantly lower for residents Beijing-registered compared with that for participants with household registered in other provinces (1.97% vs.2.98%, P<0.01).The overall positive rate of anti-HBs in 35 communities was 30.85%(95% CI: 30.53%-31.18%), and the highest age-specific anti-HBs rate was 38.10%(95% CI: 36.58%-39.61%) for age of 18-24, and lowest age-specific anti-HBs rate was 28.88%(95% CI:27.62%-30.15%) for age 75 and over. There was 66.96%(95% CI:66.69%-67.35%) of the participants with both HBsAg and anti-HBs tested negative, and no significant variation of this proportion was found across age groups. But much large variations were found across communities for the anti-HBs positive rates and the proportions of double-negative participants.3. Social and demographic factors related to HBsAg prevalenceMultivariate logistic regression analysis showed male, aged above age of 35, rural communities, household registered in other provinces, a history of hepatitis B infection and a family history of hepatitis B were independent risk factors for HBsAg positive rate.After multivariate logistic regression adjustment, adjusted HBsAg positive ratesacross communities were still significantly differentwith a range from 0.23%-3.73% for 32 communities, and one community’s HBsAg positive rate almost 0%, and the other community’s HBsAg positive rate 9.85%.4. Based on the information from observation and interviews in three communities, we found the process of project implementation was different across communities in terms of recruitment of participants, performance of survey, the delivery of testing results and organization of vaccination. By Jan.2015,3 lout of 35 communities reported number of eligible adults who were vaccinated. The average first dose vaccination rate was 27.20% of double negative adults. There were 15 communities that delivered a third dose. The average 3-dose completion rate was 7.07% in the 15 communities. Compared with suburb-rural communities, vaccination rates in urban communities were lower on average for all first, second and third dose.There was no relationship between number of double-negative adults per community and community vaccination rate.ConclusionThe overall prevalence of HBsAg has been at a moderately low level among adults in Chaoyang district, Beijing, with a relatively higher prevalence for people age above 35 of age, and people with household registered in other provinces. Explanation on the large variation of prevalence of HBsAg and anti-HBs across communities need to be further explored.Independent risk factors for HBsAg positive rate included male, aged above 35, live in suburb-rural communities, with household registered in other provinces, a history of hepatitis B infection, and a family historyof hepatitis B.The three-dose HBV vaccination ratefor double-negative adults was as low as about 7% after a period of 9-14 months project work. |
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