Abstract
BackgroundThe goal of this study was to determine the prevalence and risk factors for horizontal transmission of hepatitis B infection due to intravenous drug abuse (IVDA), tattooing, blood transfusion, and combinations of these risk factors.MethodsAll people detained in 19 prisons were invited to participate. Subjects underwent a physical examination and completed a questionnaire. Blood samples were collected and screened for hepatitis B surface antigen and Venereal Disease Research Laboratory (VDRL) reactivity.ResultsA total of 16 204 prisoners were invited to participate. The response rate was 92.6% and the mean age was 29.73 years. The overall prevalence of HBsAg positivity was 21.7%. Among 3333 subjects with a history of blood transfusion, the carrier rate was 23.19%. Among the 3071 subjects with a history of IVDA and the 6908 subjects with tattoos, the carrier rate was 26.4% and 29.3%, respectively. IVDA appeared to be the strongest risk factor among the 3, with an adjusted odds ratio (AOR) of 1.54 (95% confidence interval, 1.27–1.86), followed by tattooing (1.40, 1.23–1.55), and blood transfusion (1.27, 1.05–1.61). When blood transfusion was combined with either of the other 2 risk factors, the risk increased multiplicatively, and the combination of the 3 factors increased the AOR to 2.76 (2.20–3.47). The prevalence of a positive VDRL test result was 1.01%.ConclusionsThe prevalence of HBV antigenemia in prisoners was high and was associated with BT, IVDA, and tattooing. A national vaccination program against HBV should be considered for prisoners and other people with these risk factors.
Highlights
IntroductionChronic HBV carriers are a human reservoir, and transmission is known to occur by percutaneous exposures, including blood transfusion, tattooing, surgical procedures, acupuncture, plasma derivative therapy, and by non-percutaneous routes, such as intrafamilial and sexual contact.[1,2] Several studies have shown that people with a history of intravenous drug abuse (IVDA) are at high risk of infection with HBV.[3,4,5] few studies have investigated the joint effect of more than 2 major risk factors of HBV infection, probably because it is difficult to collect a sufficient number of infected cases.[1]Taiwan is an endemic area of hepatitis B virus (HBV) infection, with an HBV surface antigen (HBsAg) carrier rate of 15% to 20% in the general population
We examined the prevalence rates of HBV surface antigen (HBsAg) in a very large sample, in which more than 3000 participants had at least 1 of the risk factors of interest
The possibility of horizontal transmission was suggested in the present study by the fact that HBsAg carrier prevalence among prisoners with a history of BT, intravenous drug abuse (IVDA), or tattooing was higher than 23%, which was significantly higher than both the prevalence for prisoners without any of such exposures (12.8%) and that noted in previous general population surveys (18.7%).[6]
Summary
Chronic HBV carriers are a human reservoir, and transmission is known to occur by percutaneous exposures, including blood transfusion, tattooing, surgical procedures, acupuncture, plasma derivative therapy, and by non-percutaneous routes, such as intrafamilial and sexual contact.[1,2] Several studies have shown that people with a history of intravenous drug abuse (IVDA) are at high risk of infection with HBV.[3,4,5] few studies have investigated the joint effect of more than 2 major risk factors of HBV infection, probably because it is difficult to collect a sufficient number of infected cases.[1]Taiwan is an endemic area of hepatitis B virus (HBV) infection, with an HBV surface antigen (HBsAg) carrier rate of 15% to 20% in the general population. Because IVDA, blood transfusion, and tattooing, or combinations of these risk factors, may still be major routes for the horizontal spread of these viruses, it is important to examine the infection rates of Prevalence and Determinants of Hepatitis B Surface Antigenemia people with a combination of these major risk factors, to ensure future control of hepatitis B. There is a high prevalence of tattooing, IVDA, and blood transfusions required because of injuries from criminal actions. The goal of this study was to determine the prevalence and risk factors for horizontal transmission of hepatitis B infection due to intravenous drug abuse (IVDA), tattooing, blood transfusion, and combinations of these risk factors. A national vaccination program against HBV should be considered for prisoners and other people with these risk factors
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