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Seroprevalence of Hepatitis B Surface Antigen and Hepatitis B E Antigen Among Childbearing-Age Women in Mianyang, China

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Seroprevalence of Hepatitis B Surface Antigen and Hepatitis B E Antigen Among Childbearing-Age Women in Mianyang, China Original Article Seroprevalence of hepatitis B surface antigen and hepatitis B e antigen among childbearing-age women in Mianyang, China Min Wang1, Hong Li2, Yulin Ji3, Yuanji Ma4, Liping Wang5, Tao Ren6, Fengsu Hou1, Ping Yuan1 1 Department of Epidemiology and Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China 2 Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China 3 Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China 4 Department of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, China 5 Jiangyou County Center for Disease Control and Prevention, Mianyang, Sichuan, China 6 Fucheng District Center for Disease Control and Prevention, Mianyang, Sichuan, China Abstract Introduction: Few studies have focused on hepatitis B virus (HBV) infection among childbearing-age women. This study explored hepatitis B surface antigen (HBsAg) seroprevalence and hepatitis B e antigen (HBeAg) seroprevalence and their associated factors among childbearing- age women. Methodology: A cross-sectional, population-based study was conducted between June 2013 and October 2013 in Mianyang; women 15–49 years of age were enrolled using a multistage cluster sampling design. Participants completed questionnaires about demographic characteristics and potential factors associated with HBV infection, and provided blood samples for screening HBsAg and HBeAg. The analysis methods included descriptive statistics, Chi-square test, and multivariate logistic regression. Results: Among 62,007 childbearing-age women, 5.66% were HBsAg positive. The HBsAg seroprevalence rates were 7.28% in women 40– 44 years of age, 7.0% in Fucheng women, 5.70% in Han women, 6.59% in married women, and 6.60% in agriculture workers. Multivariate models identified having HBsAg-positive family members, and having no self-reported immunization history to be positively associated with HBsAg positivity; being a healthcare worker was negatively associated with HBsAg positivity. Among 3,499 HBsAg-positive childbearing- age women, 9.97% were HBeAg positive. The HBeAg seroprevalence rates were 46.54% in women 15–19 years of age, 10.82% in Fucheng women, 38.51% in single women, and 42.86% in students. Multivariate models identified living in Fucheng and younger age to be positively associated with HBeAg positivity. Conclusions: These findings could provide scientific evidence for the Chinese government to plan efficient health care services and prevention initiatives, and to allocate health resources reasonably for this population. Key words: childbearing-age women; hepatitis B surface antigen; hepatitis B e antigen; seroprevalence; China. J Infect Dev Ctries 2015; 9(7):770-779. doi:10.3855/jidc.6938 (Received 28 March 2015 – Accepted 15 April 2015) Copyright © 2015 Wang et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction 40%–50% of HBV-related deaths worldwide [1,3]. It HBV infection remains a challenging global health was estimated that even for residents with health problem, affecting more than two billion people insurance, the direct cost caused by HBV infection worldwide [1]. There are still more than 350 million exceeded 40% of resident’s disposable household chronic HBV infection carriers worldwide, who face a income in China [4]. lethal risk of developing hepatic decompensation, HBV infection is not just a risk for childbearing- cirrhosis, and hepatocellular carcinoma (HCC) [2]. In age women; women with HBV infection can transmit China, the improvements in socioeconomic status and the HBV to their newborns, to children or other hygienic conditions, the introduction of general household members, and to sexual partners or spouses vaccination, as well as complete sterilization of by vertical, horizontal, or sexual transmission [5]. medical instruments, have led to a decline in the Vertical transmission is the predominant transmission prevalence of HBV infection [3]. However, it still mode in China [5] and China still accounts for the remains as high as 7.18%, and 300,000 people die largest annual number of perinatal HBV infections, from HBV-related diseases annually, accounting for estimated to be 84,121 in the World Health Wang et al. – HBsAg/HBeAg in childbearing-age women J Infect Dev Ctries 2015; 9(7):770-779. Organization (WHO) Western Pacific Region [6]. seroprevalence and its associated factors among Horizontal transmission is an important transmission HBsAg-positive childbearing-age women in mode during early childhood [7]. Children, especially Mianyang, China. those 0–3 years of age, usually stay with their mothers and thus face a higher risk of being infected by their Methodology infectious mothers. Almost 80%–90%, 20%–30%, and Between June 2013 and October 2013, a cross- less than 5% of individuals who are infected during sectional, large population-based study was conducted. the perinatal period, early childhood, and adulthood The study included women between 15 and 49 years will become chronic carriers, respectively [8]. A of age residing in Mianyang city, which is located in systematic review also shows that HBV infection at an the northwest region of Sichuan Province, China. Of early age is not only a known risk factor for chronic note, a city in China most often is a region that can HBV infection, but also increases the risk of include multiple counties/districts (equivalent to developing liver cirrhosis and HCC [9]. In China, counties), towns/sub-districts (equivalent to towns), chronic HBV infection is the dominant risk factor for and villages/residential communities (equivalent to HCC [10]. Thus, for childbearing-age women, villages). Mianyang city is not a major, highly modern measures should be taken to protect them from being urban area like Sichuan’s capital, Chengdu City. In infected, and to cut off vertical transmission and early 2010, its per capita gross domestic product (GDP) of childhood horizontal transmission prospectively. 20,053 yuan (approximately 3,303 US dollars) was the Mothers with HBV infection can transmit the HBV sixth in Sichuan Province [18]. to their newborns vertically. For these newborns, post- exposure prophylaxis with hepatitis B vaccine and Study population and sampling strategy hepatitis B immune globulin (HBIG) within 24 hours All participants who were enrolled in this study of birth have been recommended to tremendously were permanent residents of Mianyang city and had reduce the prevalence of HBV infection [3]. However, provided informed consent. Target study populations the incidence of immunoprophylaxis failure still were selected from a list of residents, using a random remains [11]. Both HBsAg-positive and HBeAg- multistage cluster sampling approach. First, two positive mothers more easily transmit the viruses to counties/districts were selected from nine their newborns than do mothers who are only HBsAg counties/districts in Mianyang city: Fucheng district positive [12,13]. This emphasizes again that measures and Jiangyou county. Second, towns/sub-districts in focusing on childbearing-age women should be taken selected counties/districts were divided into three to cut off vertical transmission efficiently and different levels based on economic status, which was prospectively. defined according to the current year’s GDP obtained Although HBsAg seroprevalence and its risk from the data published by the local Bureau of factors have already been investigated in various Statistics. In each of the three levels, seven towns/sub- groups (general population [14], blood donors [15], districts were randomly selected. Third, within each healthcare workers [16], and pregnant women [17]), town/sub-district, all villages or residential few studies have focused on HBsAg seroprevalence communities were selected. Finally, proportional and its associated factors among childbearing-age random sampling was used to select 60% of permanent women. Furthermore, HBeAg seroprevalence and its residents in each village or residential community as associated factors among HBsAg-positive the study populations. childbearing-age women in China remains largely unknown, and efficient strategies to control HBV Procedure, questionnaire, serological testing, and infection among childbearing-age women are lacking. quality control Thus, for purposes of planning efficient healthcare After providing informed consent, each participant services and prevention initiatives, as well as completed a face-to-face interview and had blood allocating health resources reasonably for drawn. The face-to-face structured interviews were childbearing-age women, it is necessary to investigate conducted by interviewers who were a members of the the prevalence of HBV infection among this field research team. The interviewers were trained and population. qualified for this study. After completing the face-to- We conducted this study to explore HBsAg face interview, each participant provided a 5 mL blood seroprevalence and its associated factors among sample for serological testing. Participants received childbearing-age women, and further explored HBeAg 771 Wang et al. – HBsAg/HBeAg in childbearing-age women J Infect Dev Ctries 2015; 9(7):770-779. some compensation for their time after completing the residence regions (Fucheng district or Jiangyou entire study.
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