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==Overview==
Chronic Hepatitis B ([[HBV]]) is a major global health problem.  According to the [[World Health Organization]] ([[WHO]]), more than 2 billion people have been infected with HBV.  It is a major cause of [[chronic liver disease]] worldwide, affecting an estimated 1.25 million people in the United States and more than 240 million people worldwide.<ref name="WHO-Guideline-Hepatitis-B">World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016</ref><ref name="CDC">Center for Disease Control and Prevention. Guidelines for Hepatitis Sureveillance and Case Management 2009.http://www.cdc.gov/hepatitis/Statistics/SurveillanceGuidelines.htm</ref>
 
==Epidemiology and Demographics==
==Epidemiology and Demographics==
Chronic Hepatitis B is a global public health issue. 350 million people worldwide are living with chronic Hepatitis B, including 1.2 million in the United States.  
===Prevalence===
The hepatitis B virus is very infectious; it is 50-100 times more infectious than the HIV virus.
Worldwide, the [[prevalence]] rate of HBV ranges from <2% in developed countries to ≥8% in developing countries.<ref name="pmid22273662">{{cite journal| author=Ott JJ, Stevens GA, Groeger J, Wiersma ST| title=Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. | journal=Vaccine | year= 2012 | volume= 30 | issue= 12 | pages= 2212-9 | pmid=22273662 | doi=10.1016/j.vaccine.2011.12.116 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22273662  }} </ref>  Chronic HBV affects an estimated 800,000 - 1.4 million people in the United States.<ref name="MMWR">Center for Disease Control and Prevention.Morbidity and Mortality Weekly Report. Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection 2008.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm</ref>
 
 
[[image:HBVMAP.png|600px|thumb|center|Source: https://www.cdc.gov/]]
 
 
The prevalence of HBV is greater in certain high-risk groups:<ref name="Pnkbk">Center for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hepatitis B 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>
*People who engage in high-risk sexual activity (79% of persons with newly aquired HBV infection engage in high-risk sexual activity or [[IDU]])
*[[Intravenous drug use|Injection-drug users]]
*People who might be exposed to infected blood or body fluids (e.g., occupational, household, travel, and healthcare-related)
 
16% of persons deny a specific risk factor for infection.<ref name="Pnkbk">Center for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hepatitis B 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html</ref>
 
[[image:HBVPREVALENCE.png|700px|thumb|center|Source: https://www.cdc.gov/]]
 
===Incidence===
In the United States, the overall [[incidence]] rate in 2011 was 0.9 cases per 100,000 people. A total of 2,890 cases of acute HBV were reported.<ref name="CDC">Center for Disease Control and Prevention. Guidelines for Hepatitis Sureveillance and Case Management 2009.http://www.cdc.gov/hepatitis/Statistics/SurveillanceGuidelines.htm</ref> Between 1991 and 2010, the incidence of HBV has decreased by approximately 82%.  The decrease was greatest among children, largely due to the implementation of routine [[vaccination]] in 1991.  Since 2001, fewer than 30 cases of acute HBV have been reported annually among children born in 1991 or later, the majority of whom were international adoptees or children born outside of the United States who were not fully [[vaccine|vaccinated]]. <ref name="MMWR">Center for Disease Control and Prevention.Morbidity and Mortality Weekly Report. Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection 2008.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm</ref>
 
Although the incidence of HBV is declining in the United States, it is important to note that reported cases underestimate the true incidence of HBV infection due to the [[asymptomatic]] nature of early infections and under-reporting of [[symptomatic]] cases.<ref name="GAR">World Health Organization. Global Alert Response. Hepatitis B 2002.http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html</ref>
 
Worldwide, there are over 4 million cases of acute HBV every year.<ref name="GAR">World Health Organization. Global Alert Response. Hepatitis B 2002.http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html</ref>
 
[[image:HBVCDC.png|600px|thumb|center|Source: https://www.cdc.gov/]]
 
===Age===
 
In many low-risk regions of the world, the highest incidence of HBV is observed in teenagers and young adults. In [[endemic]] regions of Africa and Asia, most infections occur in infants and children.<ref name="GAR">World Health Organization. Global Alert Response. Hepatitis B 2002.http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html</ref> In 2011, the highest rates of HBV were observed among people aged 30–39 years (2.00 cases/100,000 people), and the lowest rates of HBV were observed among adolescents and children aged <u><</u>19 years (0.04 cases/100,000 people).<ref name="CDC">Center for Disease Control and Prevention. Guidelines for Hepatitis Sureveillance and Case Management 2009.http://www.cdc.gov/hepatitis/Statistics/SurveillanceGuidelines.htm</ref>


Approximately 15%-25% of people with chronic Hepatitis B develop serious liver problems, which can include liver damage, cirrhosis, liver failure, or liver cancer.
===Gender===


Hepatitis B is caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. In 2003, an estimated 73,000 people were infected with HBV. People of all ages get hepatitis B and about 5,000 die per year of sickness caused by HBV. HBV is spread when blood from an infected person enters the body of a person who is not infected. Healthcare personnel who have received hepatitis B vaccine and developed immunity to the virus are at virtually no risk for infection. For a susceptible person, the risk from a single needlestick or cut exposure to HBV-infected blood
In 2011, the rate of HBV in the United States was 1.7 times higher among males than among females (1.18 cases and 0.69 cases per 100,000 people, respectively).<ref name="CDC">Center for Disease Control and Prevention. Guidelines for Hepatitis Sureveillance and Case Management 2009.http://www.cdc.gov/hepatitis/Statistics/SurveillanceGuidelines.htm</ref>
ranges from 6-30%. The annual number of occupational infections has decreased 95% since hepatitis B vaccine became available in 1982, from >10,000 in 1983 to <400 in 2001.


*Number of new infections per year has declined from an average of 260,000 in the 1980s to about 60,000 in 2004.
===Race===
*Highest rate of disease occurs in 20-49-year-olds.
*Greatest decline has happened among children and adolescents due to routine hepatitis B vaccination. 
*Estimated 1.25 million chronically infected Americans, of whom 20-30% acquired their infection in childhood.


In the United States, Asian and Pacific Islanders(APIs) make up less than 5% of the total population, but account for more than 50% of Americans living with chronic Hepatitis B. Despite the high rates of infection, many APIs are not tested for Hepatitis B and are unaware of their infection. As a result, chronic Hepatitis B and associated liver cancer in APIs is one of the most serious health disparities in the United States.
The incidence of HBV infection in the United States differs significantly by race and ethnicity, with the highest rates observed among African-Americans. Rates are higher among Hispanics than non-Hispanics.
<ref name="CDC">Center for Disease Control and Prevention. Guidelines for Hepatitis Sureveillance and Case Management 2009.http://www.cdc.gov/hepatitis/Statistics/SurveillanceGuidelines.htm</ref>


* In the United States, nearly 70% of APIs were born or have parents born in countries where Hepatitis B is common.
===Developed Countries===
* Hepatitis B-related liver cancer incidence is highest among APIs and is a leading cause of cancer deaths in this population.
* The death rate from Hepatitis B among APIs is 7 times greater than deaths among whites.
* Knowledge of Hepatitis B varies greatly in the API community and many misconceptions exist. The lack of knowledge and awareness of the disease significantly contributes to the low testing rates in the API population.
* Limited English proficiency can be a significant barrier to seeking and receiving Hepatitis B related care and services.


===Mode of Transmission in Different Parts of the World ===
Countries and regions with the highest standards of living, including North America, Western and Northern Europe, Australia, and parts of South America, have the lowest prevalence of HBV infection.<ref name="GAR">World Health Organization. Global Alert Response. Hepatitis B 2002.http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html</ref> The carrier rate in these regions is less than 2%, and less than 20% of the population is infected with HBV.<ref name="GAR">World Health Organization. Global Alert Response. Hepatitis B 2002.http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html</ref> In the United States, chronic HBV is responsible for approximately 3,000 annual deaths from associated [[chronic liver disease]]. 47 - 70% of United States residents with chronic HBV were born in other countries.  While the prevalence of chronic HBV infection among younger, vaccinated, foreign-born United States residents is decreasing, the rate of [[liver cancer]] deaths continues to be high among certain foreign-born United States populations.  The rate of [[liver cancer]] deaths is highest among Asians/Pacific Islanders, which reflects the high prevalence of chronic HBV in this population.<ref name="MMWR">Center for Disease Control and Prevention.Morbidity and Mortality Weekly Report. Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection 2008.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm</ref>
[[Image:HBV prevalence 2005.png|thumb|center|350px|Prevalence of Hepatitis B virus as of 2005.]]


The primary method of transmission reflects the prevalence of chronic HBV infection in a given area. In low prevalence areas such as the continental [[United States]] and Western [[Europe]], where less than 2% of the population is chronically infected, injection drug abuse and unprotected sex are the primary methods, although other factors may be important.<ref>{{cite journal | title=Patient-to-patient transmission of hepatitis B virus associated with oral surgery | author=Redd JT, Baumbach J, Kohn W, ''et al.'' | journal=J Infect Dis | year=2007 | volume=195 | issue=9 | pages=1311&ndash;4 | url=http://www.journals.uchicago.edu/JID/journal/issues/v195n9/36695/36695.web.pdf }}</ref> In moderate prevalence areas, which include Eastern Europe, Russia, and Japan, where 2-7% of the population is chronically infected, the disease is predominantly spread among children. In high prevalence areas such as China and South East Asia, transmission during childbirth is most common, although in other areas of high endemicity such as Africa, transmission during childhood is also a significant factor.<ref> name="pmid12616449">{{cite journal |author=Alter MJ |title=Epidemiology and prevention of hepatitis B |journal=Semin. Liver Dis. |volume=23 |issue=1 |pages=39-46 |year=2003 |pmid=12616449 |doi=10.1055/s-2003-37583}}</ref>  The prevalence of chronic HBV infection in areas of high endemicity is at least 8%.
===Developing Countries===


Roughly 16-40% of unimmunized sexual partners of individuals with hepatitis B will be infected through sexual contact. The risk of transmission is closely related to the rate of viral replication in the infected individual at the time of exposure.
Regions with the highest prevalence of HBV include Sub-Saharan Africa, Southeast Asia, and the Pacific Basin (excluding Japan, Australia, and New Zealand).  Higher rates of chronic HBV are also found in southern parts of Eastern and Central Europe, the Amazon Basin, the Middle East, and India.  In these areas, about 70 - 90% of the population becomes HBV-infected before the age of 40, and 8 - 20% of people are HBV carriers. In countries such as China, Senegal, and Thailand, infection rates are very high in infants, and continue through early childhood.  In Panama, New Guinea, Solomon Islands, Greenland, and in populations such as Alaskan Indians, infection rates in infants are relatively low but increase rapidly during early childhood.<ref name="GAR">World Health Organization. Global Alert Response. Hepatitis B 2002.http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html</ref> The prevalence of HBV is decreasing in many regions including North Africa, the Middle East, Latin America, and Southeast Asia.<ref name="pmid22273662">{{cite journal| author=Ott JJ, Stevens GA, Groeger J, Wiersma ST| title=Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. | journal=Vaccine | year= 2012 | volume= 30 | issue= 12 | pages= 2212-9 | pmid=22273662 | doi=10.1016/j.vaccine.2011.12.116 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22273662  }} </ref>


== References ==   
== References ==   
{{Reflist|2}}
{{Reflist|2}}


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jolanta Marszalek, M.D. [2]

Overview

Chronic Hepatitis B (HBV) is a major global health problem. According to the World Health Organization (WHO), more than 2 billion people have been infected with HBV. It is a major cause of chronic liver disease worldwide, affecting an estimated 1.25 million people in the United States and more than 240 million people worldwide.[1][2]

Epidemiology and Demographics

Prevalence

Worldwide, the prevalence rate of HBV ranges from <2% in developed countries to ≥8% in developing countries.[3] Chronic HBV affects an estimated 800,000 - 1.4 million people in the United States.[4]


Source: https://www.cdc.gov/


The prevalence of HBV is greater in certain high-risk groups:[5]

  • People who engage in high-risk sexual activity (79% of persons with newly aquired HBV infection engage in high-risk sexual activity or IDU)
  • Injection-drug users
  • People who might be exposed to infected blood or body fluids (e.g., occupational, household, travel, and healthcare-related)

16% of persons deny a specific risk factor for infection.[5]

Source: https://www.cdc.gov/

Incidence

In the United States, the overall incidence rate in 2011 was 0.9 cases per 100,000 people. A total of 2,890 cases of acute HBV were reported.[2] Between 1991 and 2010, the incidence of HBV has decreased by approximately 82%. The decrease was greatest among children, largely due to the implementation of routine vaccination in 1991. Since 2001, fewer than 30 cases of acute HBV have been reported annually among children born in 1991 or later, the majority of whom were international adoptees or children born outside of the United States who were not fully vaccinated. [4]

Although the incidence of HBV is declining in the United States, it is important to note that reported cases underestimate the true incidence of HBV infection due to the asymptomatic nature of early infections and under-reporting of symptomatic cases.[6]

Worldwide, there are over 4 million cases of acute HBV every year.[6]

Source: https://www.cdc.gov/

Age

In many low-risk regions of the world, the highest incidence of HBV is observed in teenagers and young adults. In endemic regions of Africa and Asia, most infections occur in infants and children.[6] In 2011, the highest rates of HBV were observed among people aged 30–39 years (2.00 cases/100,000 people), and the lowest rates of HBV were observed among adolescents and children aged <19 years (0.04 cases/100,000 people).[2]

Gender

In 2011, the rate of HBV in the United States was 1.7 times higher among males than among females (1.18 cases and 0.69 cases per 100,000 people, respectively).[2]

Race

The incidence of HBV infection in the United States differs significantly by race and ethnicity, with the highest rates observed among African-Americans. Rates are higher among Hispanics than non-Hispanics. [2]

Developed Countries

Countries and regions with the highest standards of living, including North America, Western and Northern Europe, Australia, and parts of South America, have the lowest prevalence of HBV infection.[6] The carrier rate in these regions is less than 2%, and less than 20% of the population is infected with HBV.[6] In the United States, chronic HBV is responsible for approximately 3,000 annual deaths from associated chronic liver disease. 47 - 70% of United States residents with chronic HBV were born in other countries. While the prevalence of chronic HBV infection among younger, vaccinated, foreign-born United States residents is decreasing, the rate of liver cancer deaths continues to be high among certain foreign-born United States populations. The rate of liver cancer deaths is highest among Asians/Pacific Islanders, which reflects the high prevalence of chronic HBV in this population.[4]

Developing Countries

Regions with the highest prevalence of HBV include Sub-Saharan Africa, Southeast Asia, and the Pacific Basin (excluding Japan, Australia, and New Zealand). Higher rates of chronic HBV are also found in southern parts of Eastern and Central Europe, the Amazon Basin, the Middle East, and India. In these areas, about 70 - 90% of the population becomes HBV-infected before the age of 40, and 8 - 20% of people are HBV carriers. In countries such as China, Senegal, and Thailand, infection rates are very high in infants, and continue through early childhood. In Panama, New Guinea, Solomon Islands, Greenland, and in populations such as Alaskan Indians, infection rates in infants are relatively low but increase rapidly during early childhood.[6] The prevalence of HBV is decreasing in many regions including North Africa, the Middle East, Latin America, and Southeast Asia.[3]

References

  1. World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016
  2. 2.0 2.1 2.2 2.3 2.4 Center for Disease Control and Prevention. Guidelines for Hepatitis Sureveillance and Case Management 2009.http://www.cdc.gov/hepatitis/Statistics/SurveillanceGuidelines.htm
  3. 3.0 3.1 Ott JJ, Stevens GA, Groeger J, Wiersma ST (2012). "Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity". Vaccine. 30 (12): 2212–9. doi:10.1016/j.vaccine.2011.12.116. PMID 22273662.
  4. 4.0 4.1 4.2 Center for Disease Control and Prevention.Morbidity and Mortality Weekly Report. Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection 2008.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm
  5. 5.0 5.1 Center for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hepatitis B 2012.http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html
  6. 6.0 6.1 6.2 6.3 6.4 6.5 World Health Organization. Global Alert Response. Hepatitis B 2002.http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html

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