Epidemiology, transmission, and prevention of hepatitis B virus infection
- Eng-Kiong Teo, MD
Eng-Kiong Teo, MD
- Changi General Hospital, Singapore
- Anna SF Lok, MD
Anna SF Lok, MD
- Professor of Medicine
- University of Michigan Medical School
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Rafael Esteban, MD
Rafael Esteban, MD
- Section Editor — Hepatitis B
- Professor of Medicine
- Hospital General Valle Hebrón
Hepatitis B virus (HBV) infection is a global public health problem. It is estimated that there are 248 million HBV carriers in the world, of whom roughly 600,000 die annually from HBV-related liver disease [1,2]. The implementation of effective vaccination programs in many countries has resulted in a significant decrease in the incidence of acute hepatitis B infection. Nevertheless, HBV infection remains an important cause of morbidity and mortality.
The spectrum of clinical manifestations of HBV infection varies in both acute and chronic disease. During the acute phase, manifestations range from subclinical or anicteric hepatitis to icteric hepatitis and, in some cases, fulminant hepatitis. During the chronic phase, manifestations range from an asymptomatic carrier state to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Extrahepatic manifestations also can occur with both acute and chronic infection.
This topic review will discuss the epidemiology, modes of transmission, and prevention of HBV infection. The clinical manifestations and natural history of HBV infection, as well as hepatitis B vaccination, are discussed in detail separately. (See "Clinical manifestations and natural history of hepatitis B virus infection" and "Hepatitis B virus vaccination".)
EPIDEMIOLOGY OF CHRONIC HBV
It is estimated that approximately 2 billion people worldwide have evidence of past or present infection with hepatitis B virus (HBV), and 248 million individuals are chronic carriers (ie, positive for hepatitis B surface antigen [HBsAg]) [2,3]. The overall prevalence of HBsAg is reported to be 3.6 percent; however, it varies depending upon the geographic area. The prevalence of chronic HBV ranges from <2 percent in low prevalence areas (eg, United States, Canada, Western Europe) to 2 to 7 percent in intermediate prevalence areas (eg, Mediterranean countries, Japan, Central Asia, Middle East, and parts of South America) to ≥8 percent in high prevalence areas (eg, Western Africa, South Sudan) (table 1) [2-4].
The wide range in the prevalence of patients with chronic HBV in different parts of the world is largely related to differences in the age at infection, which is inversely related to the risk of chronicity. The rate of progression from acute to chronic HBV infection is approximately 90 percent for perinatally-acquired infection , 20 to 50 percent for infections between the age of one and five years [6,7], and less than 5 percent for adult-acquired infection .
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- EPIDEMIOLOGY OF CHRONIC HBV
- TRANSMISSION OF HBV
- Mother-to-child transmission
- Paternal transmission
- Sexual transmission
- Percutaneous inoculation
- Nosocomial infection
- Transplant recipients
- Other modes of transmission
- Pre-exposure vaccination
- Post-exposure prophylaxis
- - Initial management
- - Follow-up testing
- Management of special populations
- - Mother-to-child transmission
- - Sexual exposure
- - Percutaneous
- - Healthcare providers
- - Transplant recipients
- SUMMARY AND RECOMMENDATIONS