• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of epidinfectJournal HomepageSubscribeSumbitJournal Homepage
Epidemiol Infect. Oct 1996; 117(2): 313–325.
PMCID: PMC2271713

Epidemiological patterns of hepatitis B virus (HBV) in highly endemic areas.

Abstract

This paper uses meta-analysis of published data and a deterministic mathematical model of hepatitis B virus (HBV) transmission to describe the patterns of HBV infection in high endemicity areas. We describe the association between the prevalence of carriers and a simple measure of the rate of infection, the age at which half the population have been infected (A50), and assess the contribution of horizontal and perinatal transmission to this association. We found that the two main hyper-endemic areas of sub-Saharan Africa and east Asia have similar prevalences of carriers and values of A50, and that there is a negative nonlinear relationship between A50 and the prevalence of carriers in high endemicity areas (Spearman's Rank, P = 0.0086). We quantified the risk of perinatal transmission and the age-dependent of infection to allow a comparison between the main hyper-endemic areas. East Asia was found to have higher prevalences of HBeAg positive mothers and a greater risk of perinatal transmission from HBeAg positive mothers than sub-Saharan Africa, though the differences were not statistically significant. However, the two areas have similar magnitudes and age-dependent rates of horizontal transmission. Results of a simple compartmental model suggest that similar rates of horizontal transmission are sufficient to generate the similar patterns between A50 and the prevalences of carriers. Interrupting horizontal transmission by mass immunization is expected to have a significant, nonlinear impact on the rate of acquisition of new carriers.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Ghendon Y. WHO strategy for the global elimination of new cases of hepatitis B. Vaccine. 1990 Mar;8 (Suppl):S129–S138. [PubMed]
  • Beasley RP, Hwang LY, Lin CC, Chien CS. Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22 707 men in Taiwan. Lancet. 1981 Nov 21;2(8256):1129–1133. [PubMed]
  • Maynard JE, Kane MA, Hadler SC. Global control of hepatitis B through vaccination: role of hepatitis B vaccine in the Expanded Programme on Immunization. Rev Infect Dis. 1989 May-Jun;11 (Suppl 3):S574–S578. [PubMed]
  • André FE. Overview of a 5-year clinical experience with a yeast-derived hepatitis B vaccine. Vaccine. 1990 Mar;8 (Suppl):S74–S80. [PubMed]
  • Coursaget P, Yvonnet B, Chotard J, Sarr M, Vincelot P, N'doye R, Diop-Mar I, Chiron JP. Seven-year study of hepatitis B vaccine efficacy in infants from an endemic area (Senegal). Lancet. 1986 Nov 15;2(8516):1143–1145. [PubMed]
  • Coursaget P, Yvonnet B, Gilks WR, Wang CC, Day NE, Chiron JP, Diop-Mar I. Scheduling of revaccination against hepatitis B virus. Lancet. 1991 May 18;337(8751):1180–1183. [PubMed]
  • Whittle HC, Inskip H, Hall AJ, Mendy M, Downes R, Hoare S. Vaccination against hepatitis B and protection against chronic viral carriage in The Gambia. Lancet. 1991 Mar 30;337(8744):747–750. [PubMed]
  • Pearce N, Milne A, Moyes C. Hepatitis B virus: the importance of age at infection. N Z Med J. 1988 Nov 23;101(858):788–790. [PubMed]
  • McMahon BJ, Alward WL, Hall DB, Heyward WL, Bender TR, Francis DP, Maynard JE. Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state. J Infect Dis. 1985 Apr;151(4):599–603. [PubMed]
  • Coursaget P, Yvonnet B, Chotard J, Vincelot P, Sarr M, Diouf C, Chiron JP, Diop-Mar I. Age- and sex-related study of hepatitis B virus chronic carrier state in infants from an endemic area (Senegal). J Med Virol. 1987 May;22(1):1–5. [PubMed]
  • Beasley RP, Hwang LY, Lin CC, Stevens CE, Wang KY, Sun TS, Hsieh FJ, Szmuness W. Hepatitis B immune globulin (HBIG) efficacy in the interruption of perinatal transmission of hepatitis B virus carrier state. Initial report of a randomised double-blind placebo-controlled trial. Lancet. 1981 Aug 22;2(8243):388–393. [PubMed]
  • Stevens CE, Beasley RP, Tsui J, Lee WC. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med. 1975 Apr 10;292(15):771–774. [PubMed]
  • Stevens CE, Neurath RA, Beasley RP, Szmuness W. HBeAg and anti-HBe detection by radioimmunoassay: correlation with vertical transmission of hepatitis B virus in Taiwan. J Med Virol. 1979;3(3):237–241. [PubMed]
  • Iwarson S, Hermodsson S. Hepatitis-associated antigen (HAA) in acute viral hepatitis. Serological and clinical studies. Scand J Infect Dis. 1971;3(2):93–101. [PubMed]
  • Tassopoulos NC, Papaevangelou GJ, Sjogren MH, Roumeliotou-Karayannis A, Gerin JL, Purcell RH. Natural history of acute hepatitis B surface antigen-positive hepatitis in Greek adults. Gastroenterology. 1987 Jun;92(6):1844–1850. [PubMed]
  • Nielsen JO, Dietrichson O, Elling P, Christoffersen P. Incidence and meaning of persistence of Australia antigen in patients with acute viral hepatitis: development of chronic hepatitis. N Engl J Med. 1971 Nov 18;285(21):1157–1160. [PubMed]
  • Edmunds WJ, Medley GF, Nokes DJ, Hall AJ, Whittle HC. The influence of age on the development of the hepatitis B carrier state. Proc Biol Sci. 1993 Aug 23;253(1337):197–201. [PubMed]
  • Kashiwagi S, Hayashi J, Ikematsu H, Nomura H, Kajiyama W, Shingu T, Hayashida K, Kaji M. Transmission of hepatitis B virus among siblings. Am J Epidemiol. 1984 Oct;120(4):617–625. [PubMed]
  • Toukan AU, Sharaiha ZK, Abu-el-Rub OA, Hmoud MK, Dahbour SS, Abu-Hassan H, Yacoub SM, Hadler SC, Margolis HS, Coleman PJ, et al. The epidemiology of hepatitis B virus among family members in the Middle East. Am J Epidemiol. 1990 Aug;132(2):220–232. [PubMed]
  • Prince AM. An antigen detected in the blood during the incubation period of serum hepatitis. Proc Natl Acad Sci U S A. 1968 Jul;60(3):814–821. [PMC free article] [PubMed]
  • McMahon BJ, Parkinson AJ, Helminiak C, Wainwright RB, Bulkow L, Kellerman-Douglas A, Schoenberg S, Ritter D. Response to hepatitis B vaccine of persons positive for antibody to hepatitis B core antigen. Gastroenterology. 1992 Aug;103(2):590–594. [PubMed]
  • Deinhardt F. Predictive value of markers of hepatitis virus infection. J Infect Dis. 1980 Mar;141(3):299–305. [PubMed]
  • Whittle H, Inskip H, Bradley AK, McLaughlan K, Shenton F, Lamb W, Eccles J, Baker BA, Hall AJ. The pattern of childhood hepatitis B infection in two Gambian villages. J Infect Dis. 1990 Jun;161(6):1112–1115. [PubMed]
  • Tabor E, Bayley AC, Cairns J, Pelleu L, Gerety RJ. Horizontal transmission of hepatitis B virus among children and adults in five rural villages in Zambia. J Med Virol. 1985 Feb;15(2):113–120. [PubMed]
  • Bowry TR. Seroepidemiology of hepatitis B in an urban population of Nairobi, Kenya. J Infect Dis. 1983 Dec;148(6):1122–1122. [PubMed]
  • Hyams KC, al-Arabi MA, al-Tagani AA, Messiter JF, al-Gaali AA, George JF. Epidemiology of hepatitis B in the Gezira region of Sudan. Am J Trop Med Hyg. 1989 Feb;40(2):200–206. [PubMed]
  • Feret E, Larouze B, Diop B, Sow M, London WT, Blumberg BS. Epidemiology of hepatitis B virus infection in the rural community of Tip, Senegal. Am J Epidemiol. 1987 Jan;125(1):140–149. [PubMed]
  • Prozesky OW, Szmuness W, Stevens CE, Kew MC, Harley EJ, Hoyland JA, Scholtz JE, Mitchell AD, Shabangu A, Kunene E, et al. Baseline epidemiological studies for a hepatitis B vaccine trial in Kangwane. S Afr Med J. 1983 Nov 26;64(23):891–893. [PubMed]
  • Chung DC, Ko YC, Chen CJ, Wu CC, Chen ER, Liaw YF, Hwang SJ. Seroepidemiological studies on hepatitis B and D viruses infection among five ethnic groups in southern Taiwan. J Med Virol. 1988 Dec;26(4):411–418. [PubMed]
  • Lingao AL, Domingo EO, West S, Reyes CM, Gasmen S, Viterbo G, Tiu E, Lansang MA. Seroepidemiology of hepatitis B virus in the Philippines. Am J Epidemiol. 1986 Mar;123(3):473–480. [PubMed]
  • Hu M, Schenzle D, Deinhardt F, Scheid R. Prevalence of markers of hepatitis A and B in the Shanghai area. J Infect Dis. 1983 Feb;147(2):360–360. [PubMed]
  • Mazzur S, Bastiaans MJ, Nath N. Hepatitis B virus (HBV) infection among children and adults in the Solomon Islands. Am J Epidemiol. 1981 May;113(5):510–519. [PubMed]
  • Boutin JP, Sainte Marie FF, Cartel JL, Cardines R, Girard M, Roux J. Prevalence of hepatitis B virus infection in the Austral archipelago, French Polynesia: identification of transmission patterns for the formulation of immunization strategies. Trans R Soc Trop Med Hyg. 1990 Mar-Apr;84(2):283–287. [PubMed]
  • Torres JR, Mondolfi A. Protracted outbreak of severe delta hepatitis: experience in an isolated Amerindian population of the Upper Orinoco basin. Rev Infect Dis. 1991 Jan-Feb;13(1):52–55. [PubMed]
  • Schweitzer IL. Vertical transmission of the hepatitis B surface antigen. Am J Med Sci. 1975 Sep-Oct;270(2):287–291. [PubMed]
  • Anderson RM, May RM. Vaccination against rubella and measles: quantitative investigations of different policies. J Hyg (Lond) 1983 Apr;90(2):259–325. [PMC free article] [PubMed]
  • Grenfell BT, Anderson RM. The estimation of age-related rates of infection from case notifications and serological data. J Hyg (Lond) 1985 Oct;95(2):419–436. [PMC free article] [PubMed]
  • Margolis HS. Prevention of acute and chronic liver disease through immunization: hepatitis B and beyond. J Infect Dis. 1993 Jul;168(1):9–14. [PubMed]
  • Gebreselassie L. Prevalence of specific markers of viral hepatitis A and B among an Ethiopian population. Bull World Health Organ. 1983;61(6):991–996. [PMC free article] [PubMed]
  • Milne A, Allwood GK, Moyes CD, Pearce NE, Lucas CR. Prevalence of hepatitis B infections in a multiracial New Zealand community. N Z Med J. 1985 Jul 10;98(782):529–532. [PubMed]
  • Sobeslavský O. Prevalence of markers of hepatitis B virus infection in various countries: a WHO collaborative study. Bull World Health Organ. 1980;58(4):621–628. [PMC free article] [PubMed]
  • Beasley RP, Trepo C, Stevens CE, Szmuness W. The e antigen and vertical transmission of hepatitis B surface antigen. Am J Epidemiol. 1977 Feb;105(2):94–98. [PubMed]
  • Beasley RP, Hwang LY, Lee GC, Lan CC, Roan CH, Huang FY, Chen CL. Prevention of perinatally transmitted hepatitis B virus infections with hepatitis B immune globulin and hepatitis B vaccine. Lancet. 1983 Nov 12;2(8359):1099–1102. [PubMed]
  • Bortolotti F, Cadrobbi P, Crivellaro C, Bertaggia A, Alberti A, Realdi G. Chronic hepatitis type B in childhood: longitudinal study of 35 cases. Gut. 1981 Jun;22(6):499–504. [PMC free article] [PubMed]
  • Alward WL, McMahon BJ, Hall DB, Heyward WL, Francis DP, Bender TR. The long-term serological course of asymptomatic hepatitis B virus carriers and the development of primary hepatocellular carcinoma. J Infect Dis. 1985 Apr;151(4):604–609. [PubMed]
  • McMahon BJ, Alberts SR, Wainwright RB, Bulkow L, Lanier AP. Hepatitis B-related sequelae. Prospective study in 1400 hepatitis B surface antigen-positive Alaska native carriers. Arch Intern Med. 1990 May;150(5):1051–1054. [PubMed]
  • Bortolotti F, Cadrobbi P, Crivellaro C, Guido M, Rugge M, Noventa F, Calzia R, Realdi G. Long-term outcome of chronic type B hepatitis in patients who acquire hepatitis B virus infection in childhood. Gastroenterology. 1990 Sep;99(3):805–810. [PubMed]
  • Tong MJ, Thursby MW, Lin JH, Weissman JY, McPeak CM. Studies on the maternal-infant transmission of the hepatitis B virus and HBV infection within families. Prog Med Virol. 1981;27:137–147. [PubMed]
  • Schweitzer IL, Mosley JW, Ashcaval M, Edwards VM, Overby LB. Factors influencing neonatal infection by hepatitis B virus. Gastroenterology. 1973 Aug;65(2):277–283. [PubMed]
  • Shiraki K, Yoshihara N, Kawana T, Yasui H, Sakurai M. Hepatitis B surface antigen and chronic hepatitis in infants born to asymptomatic carrier mothers. Am J Dis Child. 1977 Jun;131(6):644–647. [PubMed]
  • Okada K, Yamada T, Miyakawa Y, Mayumi M. Hepatitis B surface antigen in the serum of infants after deliver from asymptomatic carrier mothers. J Pediatr. 1975 Sep;87(3):360–363. [PubMed]
  • Greenfield C, Osidiana V, Karayiannis P, Galpin S, Musoke R, Jowett TP, Mati P, Tukei PM, Thomas HC. Perinatal transmission of hepatitis B virus in Kenya: its relation to the presence of serum HBV-DNA and anti-HBe in the mother. J Med Virol. 1986 Jun;19(2):135–142. [PubMed]
  • Lau YL, Chow CB, Leung TH. Changing epidemiology of measles in Hong Kong from 1961 to 1990--impact of a measles vaccination program. J Infect Dis. 1992 Jun;165(6):1111–1115. [PubMed]
  • Marinier E, Barrois V, Larouze B, London WT, Cofer A, Diakhate L, Blumberg BS. Lack of perinatal transmission of hepatitis B virus infection in Senegal, West Africa. J Pediatr. 1985 May;106(5):843–849. [PubMed]
  • Barin F, Perrin J, Chotard J, Denis F, N'Doye R, Diop Mar I, Chiron JP, Coursaget P, Goudeau A, Maupas P. Cross-sectional and longitudinal epidemiology of hepatitis B in Senegal. Prog Med Virol. 1981;27:148–162. [PubMed]
  • Tsega E, Tsega M, Mengesha B, Nordenfelt E, Hansson BG, Lindberg J. Transmission of hepatitis B virus infection in Ethiopia with emphasis on the importance of vertical transmission. Int J Epidemiol. 1988 Dec;17(4):874–879. [PubMed]
  • Botha JF, Ritchie MJ, Dusheiko GM, Mouton HW, Kew MC. Hepatitis B virus carrier state in black children in Ovamboland: role of perinatal and horizontal infection. Lancet. 1984 Jun 2;1(8388):1210–1212. [PubMed]
  • Haukenes G, Shao JF, Mbena E, Rustad S. Hepatitis B virus markers in the population of Dar es Salaam, Tanzania. J Infect. 1987 Sep;15(2):183–188. [PubMed]
  • Wong VC, Lee AK, Ip HM. Transmission of hepatitis B antigens from symptom free carrier mothers to the fetus and the infant. Br J Obstet Gynaecol. 1980 Nov;87(11):958–965. [PubMed]
  • Wong VC, Ip HM, Reesink HW, Lelie PN, Reerink-Brongers EE, Yeung CY, Ma HK. Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis-B vaccine and hepatitis-B immunoglobulin. Double-blind randomised placebo-controlled study. Lancet. 1984 Apr 28;1(8383):921–926. [PubMed]
  • Okada K, Yamada T, Miyakawa Y, Mayumi M. Hepatitis B surface antigen in the serum of infants after deliver from asymptomatic carrier mothers. J Pediatr. 1975 Sep;87(3):360–363. [PubMed]
  • Suvatte V, Assateerawatts A. Vertical transmission of the hepatitis B surface antigen in Thailand. Southeast Asian J Trop Med Public Health. 1980 Dec;11(4):582–587. [PubMed]
  • Nayak NC, Panda SK, Zuckerman AJ, Bhan MK, Guha DK. Dynamics and impact of perinatal transmission of hepatitis B virus in North India. J Med Virol. 1987 Feb;21(2):137–145. [PubMed]
  • Biswas SC, Gupta I, Ganguly NK, Chawla Y, Dilawari JB. Prevalence of hepatitis B surface antigen in pregnant mothers and its perinatal transmission. Trans R Soc Trop Med Hyg. 1989 Sep-Oct;83(5):698–700. [PubMed]
  • Hyams KC, Osman NM, Khaled EM, Koraa AA, Imam IZ, el-Ghorab NM, Dunn MA, Woody JN. Maternal-infant transmission of hepatitis B in Egypt. J Med Virol. 1988 Feb;24(2):191–197. [PubMed]
  • Reniers J, Vranckx R, Ngantung W, Sugita E, Meheus A. Prevalence and determinants of hepatitis B virus markers in pregnant women in West Java, Indonesia. J Trop Med Hyg. 1987 Oct;90(5):249–253. [PubMed]
  • Al-Nakib B, el-Mekki A, Al-Kandari S, Nordenfelt E, Al-Nakib W. Hepatitis B virus perinatal transmission among Arab women. Ann Trop Paediatr. 1986 Dec;6(4):239–241. [PubMed]
  • Goudeau A, Yvonnet B, Lesage G, Barin F, Denis F, Coursaget P, Chiron JP, Diop Mar I. Lack of anti-HBc IgM in neonates with HBsAg carrier mothers argues against transplacental transmission of hepatitis B virus infection. Lancet. 1983 Nov 12;2(8359):1103–1104. [PubMed]
  • Chen DS, Sung JL, Lai MY, Sheu JC, Yang PM, Lee SC, Chen SH, Chang MH, Ko TM, Lee TY. Inadequacy of immunoglobulin M hepatitis B core antibody in detecting acute hepatitis B virus infection in infants of HBsAg carrier mothers. J Med Virol. 1985 Aug;16(4):309–314. [PubMed]
  • Shiraki K, Yoshihara N, Sakurai M, Eto T, Kawana T. Acute hepatitis B in infants born to carrier mother with the antibody to hepatitis B e antigen. J Pediatr. 1980 Nov;97(5):768–770. [PubMed]
  • Hwang LY, Roggendorf M, Beasley RP, Deinhardt F. Perinatal transmission of hepatitis B virus: role of maternal HBeAg and anti-HBc IgM. J Med Virol. 1985 Mar;15(3):265–269. [PubMed]
  • Lee AK, Ip HM, Wong VC. Mechanisms of maternal-fetal transmission of hepatitis B virus. J Infect Dis. 1978 Nov;138(5):668–671. [PubMed]
  • Panda SK, Gupta A, Datta R, Nayak NC. Transplacental transmission of hepatitis B virus. Lancet. 1986 Oct 18;2(8512):919–920. [PubMed]
  • Panda SK, Bhan MK, Guha DK, Gupta A, Datta R, Zuckerman AJ, Nayak NC. Significance of maternal and infant serum antibodies to hepatitis B core antigen in hepatitis B virus infection of infancy. J Med Virol. 1988 Mar;24(3):343–349. [PubMed]
  • Derso A, Boxall EH, Tarlow MJ, Flewett TH. Transmission of HBsAg from mother to infant in four ethnic groups. Br Med J. 1978 Apr 15;1(6118):949–952. [PMC free article] [PubMed]
  • De Virgiliis S, Frau F, Sanna G, Turco MP, Figus AL, Cornacchia G, Cao A. Perinatal hepatitis B virus detection by hepatitis B virus-DNA analysis. Arch Dis Child. 1985 Jan;60(1):56–58. [PMC free article] [PubMed]

Articles from Epidemiology and Infection are provided here courtesy of Cambridge University Press

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...