Introduction Chronic HBV (cHBV) is a frequent cause of cirrhosis and liver cancer. Many infected individuals are unaware of their condition. Migrants from countries with high prevalence of cHBV, such as China and the Far East (seroprevalence 7–12%), are a high risk group for cHBV. Targeted HBV screening and vaccination is recommended by the AASLD1 and the European Liver Patients Association (ELPA)2 in high risk groups including subjects born in endemic areas. However, there are no current UK guidelines.
Aim To apply AASLD and ELPA recommendations to British-Chinese community of North East (NE) England.
Method Members of the NE Chinese community were invited to attend screening sessions at the Newcastle Chinese Healthy Living Centre [charity registration no. 1125227]. Dry blood spots were obtained by finger prick and tested for HBsAg and HBcAb (Abbott ARCHITECT). HBsAg positive individuals were advised to undergo confirmatory testing and be referred for specialist assessment.
Results 575 subjects were screened in 10 sessions (mean age 49±17 years, 61% female). 53 (9%) were HBsAg positive (48% female) indicating cHBV. 10 of these reported being previously diagnosed with HBV, but were not under follow-up. The prevalence of HBsAg positivity was 7.5% when previously diagnosed individuals were excluded. 80 (14%) subjects had past infection with HBV (HBsAg negative, HBcAb positive). Individuals with past HBV were significantly older than HBsAg positive and HBsAg, HBcAb negative subjects (p<0.001). The prevalence of HBsAg positivity was highest in subjects born in Vietnam (17.4%, 4/23), followed by China (11.5%, 24/157), Hong Kong (8.3%, 18/288), the UK (6.7%, 5/75) and other (6.2%, 2/32). Only 12% of subjects reported previous vaccination against HBV. To date, 25 of the HBsAg positive individuals have been seen in our clinic. 1 was HBeAg positive (immunotolerant) and 24 were HBeAg negative. Of these, 3 have active disease (including 1 cirrhotic) and have been started on treatment. 14 have inactive cHBV and 7 are undergoing observation to determine disease activity. No cases of co-infection with HCV, HIV or Delta were found.
Conclusion 1. Undiagnosed cHBV is common in the British-Chinese community of NE England, including subjects born in the UK. 2. A proportion had active cHBV requiring treatment. 3. If these results were applied to the entire UK British-Chinese population targeted screening should lead to approximately 32 250 newly diagnosed cases of cHBV. 4. These results provide evidence for a UK HBV screening and vaccination program for the British-Chinese community.
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Funding This study was supported by a Gilead UK and Ireland Fellowship and LIVErNORTH.