Risk factors for acute hepatitis B and its progression to chronic hepatitis in Shanghai, China
OPEN ACCESS- H W Zhang1,
- J H Yin1,
- Y T Li2,
- C Z Li3,
- H Ren2,
- C Y Gu1,
- H Y Wu2,
- X S Liang3,
- P Zhang1,
- J F Zhao1,
- X J Tan1,
- W Lu1,
- S Schaefer4,
- G W Cao1
- 1Department of Epidemiology, Second Military Medical University, Shanghai, China
- 2Department of Acute Infectious Diseases, Center for Disease Control and Prevention, Shanghai, China
- 3Department of Infectious Diseases, The 1st Affiliated Hospital, Second Military Medical University, Shanghai, China
- 4Abteilung für Virologie, Universität Rostock, Germany
- Professor G W Cao, Department of Epidemiology, Second Military Medical University, 800 Xiangyin Road, Shanghai 200433, China; gcao{at}smmu.edu.cn or guangwencao{at}yahoo.com
- Revised 30 July 2008
- Accepted 5 August 2008
- Published Online First 28 August 2008
Abstract
Background and aims: The major risk factors for acute hepatitis B (AHB) in China and the viral factors determining the progression from acute to chronic hepatitis B remain largely unknown.
Methods: Epidemiological studies within a population-based surveillance for AHB in adults were performed in Shanghai, China, including 294 patients, 588 matched controls and 572 family members of the patients.
Results: Invasive medical procedures, household contact with hepatitis B virus (HBV) carriers, body care and beauty treatments, and lack of HBV vaccination were independently associated with AHB. Among those risks, pedicure in bath centres emerged. Sixty-eight of 128 patients with AHB were genotyped including 33 with HBV B2 and 35 with HBV C2. Twenty-five (8.50%) of the 294 patients, including 20 with HBV C2 and 5 with HBV B2 (p = 0.013), progressed to chronic infection. Multivariate analysis showed that HBV C2 was independently associated with chronicification of AHB. Patients with HBV B2 were younger and there was a higher proportion of women than those with HBV C2. The prevalence of HBV B2 was higher in the patients than in neighbourhood chronic carriers. The chronic carriers with HBV B2 showed higher viral loads, higher hepatitis B e antigen (HBeAg) seropositivity, and with higher proportion in men than those with HBV C2, implying that sexual contact plays a role in the transmission of HBV B2. Phylogenetic analysis showed that HBV C2 was frequently involved in transmissions within households.
Conclusions: Despite lower viral load and HBeAg status in the chronic carriers, HBV C2 was more prone to causing chronic infection than was HBV B2.
Footnotes
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H-W Z and J-H Y contributed equally to this work.
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Funding: This study was financially supported by grants 2004BA718B01 and 04J008 from the Ministry of Science and Technology, China.
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Competing interests: None.
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Ethics approval: The study protocol conformed to the 1975 Declaration of Helsinki, and was approved by the Institutional Review Boards of Second Military Medical University and Center of Diseases Prevention and Control of Shanghai on 16 January 2004.
