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Worldwide
Worldwide about 350 million people are chronic carriers of the hepatitis B virus (HBV)1
Worldwide prevalence of HBV carriers:
- HIGH endemic regions-- 5-20% carrier rate
- Asia, Pacific Islands
- Amazon Basin
- Alaskan natives
- Eastern Europe
- Middle East
- Africa
- LOW endemic regions--1-4% carrier rate
- U.S.A.
- Western Europe
- Australia
World-wide epidemiology of HBeAg-negative chronic hepatitis B and associated precore and core promoter variants2
Hepatitis B is a serious disease that is endemic in many parts of the world. A significant proportion of patients with chronic hepatitis B (CHB) are infected with a variant form of the hepatitis B virus (HBV) which decreases or abolishes the production of hepatitis B e-antigen (HBeAg). The purpose of this literature review is to describe the epidemiology of HBeAg-negative CHB (e-CHB) worldwide. A literature search was conducted to identify studies pertaining to e-CHB and underlying variants (precore and core promoter). Fifty studies were included in our analysis. The median prevalence of e-CHB among patients with chronic HBV infection was 33% in the Mediterranean, 15% in Asia Pacific, and 14% in the USA and Northern Europe. The pre core stop codon variant was detected in a median of 60% (range 0-100%) of HBeAg-negative patients overall, 92% in the Mediterranean, 50% in Asia Pacific and 24% in the USA and Northern Europe.
United States
- Approximately 5% of Americans have been infected with Hepatitis B (HBV) and 1.25 million have chronic HBV infection
- The number of new infections has declined from an average of 260,000 infections in the 1980s to about 78,000 in 2001
- There are over 1.25 million HBV carriers, 20 to 30% of whom acquired the infection in childhood
- 3,000-4,000 deaths annually from cirrhosis and 1,000 deaths from hepatioma are HBV
General Facts
- The highest rate of new infections are in the age group 20 - 49 year olds.
- The greatest decline in new infections is among children and adolescents under 15 years of age because of routine immunization
- 50-60% of people infected with HBV are asymptomatic, yet infectious
- Who will develop chronic Hepatitis B after infection?
- 2-6% of persons infected as older children or adults
- 30% of children infected at the age of 1-5 years
- 90% of infants infected at birth
- Over several decades about 1/3 of chronically infected people develop some form of liver disease
- Death from chronic liver disease occurs in 15-25% of chronically infected persons
- Chronic HBV carriers are at much higher risk for long term complication, such as cancer
- Hepatitis B is responsible for 5,000 deaths annually, including 3,000 - 4,000 from cirrhosis and approximately 1,000 - 1,500 from primary liver cancer
- One out of every 250 people is a carrier of hepatitis B and can pass it on to others, often unknowingly
- There were approximately 80,000 estimated new infections of hepatitis B in the United States in 1999
- Up to 90% of pregnant women who are carriers of the hepatitis B virus could transmit the virus to their children. Vaccinations of the newborns would prevent them from becoming carriers
- Due to the screening of pregnant women for HBV and vaccinations of newborns with the hepatitis B vaccine, there has been a decline in that number of infected newborns
- Hepatitis B is 100 times more infectious than HIV, the virus that causes AIDS. There are 500 million hepatitis B viral particles in one teaspoon of blood compared to 5-10 HIV particles
- The estimated medical and work loss cost per year of hepatitis B is $700 million
- One out of every 20 people will be infected with hepatitis B in his/her lifetime
- Approximately 5,000 liver transplants were performed in 2000. Because of the shortage of organs, it is estimated that nearly 1,700 prospective recipients died in 2001 while waiting for a liver for transplantation. There are currently over 18,000 people waiting for a liver transplant
- You are at a high risk of hepatitis B infection if you:
- have sex with someone infected with HBV;
- have sex with more than one partner;
- are a man and have sex with a man;
- live in the same house with someone who has lifelong HBV infection;
- have a job that involves contact with human blood;
- shoot drugs;
- are a patient or work in a home for the developmentally disabled;
- have hemophilia;
- travel to areas where hepatitis B is common
- Asian and Pacific Islanders have the highest rate for hepatitis B infection
Disease Burden from Hepatitis B in the United States
| |
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| Number of Acute Clinical Cases Reported 3 |
7,844 |
8,036 |
| Estimated Number of Acute Clinical Cases 4 |
22,000 |
22,000 |
| Estimated Number of New Infections 4 |
78,000 |
81,000 |
| Number of Persons with Chronic Infection 5 |
1.25 million |
| Estimated Annual Number of Chronic LiverDisease Deaths † |
5,000 |
| Percent Ever Infected ‡ |
4.9% |
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Centers for Disease Control and Prevention, Division of Viral Hepatitis
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Sources:
- Illinois Health Education Consortium - Hepatitis B
- World Health Organization Department of Vaccines and Biologicals Vaccine Assessment and Monitoring TeamGeographic prevalence of HBV.
- American Liver Founation
Sources and Methodology:
- Kao JH, Chen DS. Global control of hepatitis B virus infection. Lancet Infect Dis 2002 Jul;2(7):395-403. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
- Funk ML, Rosenberg DM, Lok AS. World-wide epidemiology of HBeAg-negative chronic hepatitis B and associated precore and core promoter variants. J Viral Hepat 2002 Jan;9(1):52-61 Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
- Number of Acute Clinical Cases Reported: For hepatitis A and hepatitis B, the number of cases reported to the National Notifiable Disease Surveillance System (NNDSS). Cases of hepatitis C are also reported to NNDSS (3,866 cases in 2001) but are unreliable for monitoring trends in hepatitis C because these reports include cases based only on a positive laboratory test for anti-HCV, most of which represent chronic HCV infection. (CDC. Summary of Notifiable Diseases, United States, 2000, MMWR 2002;49(53)
- Estimated Number of Clinical Cases and New infections: The ratio of reported acute cases to the total number of newly acquired infections occurring was estimated by catalytic modeling of seroprevalence data (from the National Health and Nutrition Examination Survey (NHANES III)) . Incidence estimates adjusted for underreporting and asymptomatic infections were then calculated by multiplying the number of cases reported (for hepatitis A and hepatitis B, NNDSS data are used; for hepatitis C, Sentinel Counties Study of Viral Hepatitis data are used) by these ratios. HAV: Armstrong GL et al, Pediatrics 2002, 109(5):839-845; HCV: Armstrong GL et al. Hepatology 2000, 31:777-782.
- Number of Persons with Chronic Infection: HBV: Margolis HS, Coleman PJ, Brown RE, et al. Prevention of hepatitis B virus transmission by immunization: An economic analysis of current recommendations. JAMA 1995; 274(15): 1201 - 1208. HCV: Alter MJ et al. Prevalence of hepatitis C virus infection in the United States, 1988 through 1994. NEJM 1999; 341:556-562.
- †. Estimated Annual Number of Chronic Liver : Estimated number of chronic liver disease deaths are for the year 1990. HBV: Centers for Disease Control and Prevention. Protection against Viral Hepatitis. MMWR 1990; 39(RR-2). HCV: Centers for Disease Control and Prevention. Recommendations for the prevention and control of hepatitis C virus infection and HCV-related chronic disease. MMWR 1998; 47(RR-19):1-39.
- ‡. Percent ever infected: Prevalence estimates for HAV, HBV and HCV come from the Third National Health and Nutrition Examination Survey HAV: CDC. Prevention of Hepatitis A through active or passive immunization. MMWR 1999; 48: RR-12. HBV: McQuillan GM, et al. Prevalence of hepatitis B virus infection in the United States: The National Health and Nutrition and Examination Surveys, 1976 through 1994. AJPH 1999; 89(1)14-18. HCV: Alter MJ et al. Prevalence of hepatitis C virus infection in the United States, 1988 through 1994. NEJM 1999; 341:556-562.
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