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Hepatitis D: not a rare disease anymore: global update for 2017–2018
  1. Dan-Ting Shen1,
  2. Dong-Ze Ji2,
  3. Hai-Yan Chen1,
  4. Hemant Goyal3,
  5. Shiyang Pan1,
  6. Hua-Guo Xu1
  1. 1 Department of laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  2. 2 Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  3. 3 Department of Internal Medicine Macon, Mercer University School of Medicine, Georgia, USA
  1. Correspondence to Dr Shiyang Pan and Dr Hua-Guo Xu, Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; sypan{at}, huaguoxu{at}

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We sincerely appreciate Stockdale and colleagues1 for their critical consideration of our article. Herein, we tried to answer their concerns about the methodology of our meta-analysis.2

We used hepatitis D virus (HDV) antibody (both IgM and IgG) seropositivity as a measure of overall burden of HDV seroprevalence. Although anti-HDV IgM Ab assays may fail to detect low titres of antibodies and underestimate HDV seroprevalence,3 patients with a negative anti-HDV IgM results are less likely to progress into clinical disease.4 Majority of the included studies in our article used anti-HDV antibody assays and only two mentioned the use of RNA assays for the prevalence of HDV. Therefore, considering the wide application of the anti-HDV antibody assay as a measure of HDV seroprevalence,5 we used the similar method in our meta-analysis.

We do not think it would be correct to extrapolate the prevalence of HBsAg based on our estimates of HDV seroprevalence among general population and mixed population (HBsAg carriers without risk factors such as intravenous drug use and high-risk sexual behaviours). This is because the general population and the mixed …

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  • D-TS and D-ZJ contributed equally.

  • Contributors D-TS and D-ZJ are cofirst authors. H-GX and D-TS designed the study. All the authors contributed to the generation, collection, assembly, analysis and/or interpretation of data. D-TS and D-ZJ wrote the manuscript. H-GX and HG revised the manuscript. All the authors have read and approved the final manuscript.

  • Funding This work was supported by the National Natural Science Foundation of China (81302531), the Natural Science Foundation of Jiangsu Province of China (SBK2018022334), the Talents Planning of Six Summit Fields of Jiangsu Province (2013-WSN-037), the Postgraduate Research and Practice Innovation Program of Jiangsu Province (KYCX17_1287, SJCX18_0435), the National Key Clinical Department of Laboratory Medicine of China in Nanjing, theKey Laboratory for Laboratory Medicine of Jiangsu Province (ZDXKB2016005) and the Priority Academic Program Development of Jiangsu Higher Education Institutions.

  • Disclaimer The funder of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the manuscript. The corresponding author had full access to all the data in the study and has final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Patient consent for publication Not required.

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