Hepatitis B virus and persistent antigenemia in adolescents

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I-iEALTH CARE 19M;9:374-377

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tion with I-IBV is known to cause significant morbidity and mortality including h~~a~~s~ cirrhosis, carcinoma (2). In the United and ly O.l%-0.5% of the general popState

that time, several high-risk have been identified. The

Hepatitis B virus (HW) infection is the leading type of hepatitis reported in the United States (¶). Infecr&ssreprintrquesisto: David K. tlerger, M.D., Gouwneur Hasp&l, Rm. 799,227 Madison St., New York, NY looO2. Fnrm the DqWments ofPadiatricsand Patholqy, Gouvemew Hospital and New York Uniuedy Mediad Center, New York, New York. ‘This ptIp was psmted At the annual meeting of the Ambuhtory h&t& ksciatkm in Anaheim. CA, April 30,1987. h%nuu@t acceptad September 14,1987.

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modialysis patients (3,6). Several studies have evaluated Indocbine ugee teenagers for HW marker rates (Y-9). ever, marker rates among other adolescent groups in the general U.S. population are not known. As te spread of I-IBV infection is now preventabIe by the use of passive and active hmutization (3,lO=13) with 2 safe (14) and cost-effective (15) waccine, it is important to identify groups who may benefit. The purpose of this paper is to report the prevalence of HI3V markers anct persistent antigenemia in otherwise healthy teenagers attending our adolescent clinic. The goal was to identify counsel them about their infective state, and offer HEW vaccine to appropriate at-risk Pam@ members and intimate contacts.

From January through December I986, data were collected on patients entering a medically oriented,

by Ekvkr

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QSociety for Adolescent Medicine, 1988 Publishing Co., Inc., 52 Vanderbilt Ave., New YC& NY mw

September1988

municipal outpatient adolescent clinic in the Lower East Side of New York City. Adolescents, 13-l9 years old, attending the clinic were routinely evaIuated with a comprehensive intake history, physical examiflation, and screening laboratory tests. ’ On history, questions specifically related to risk factors for HBV infection were asked prospectively using a standardized questionnaire. These questions inchrded ethnicity, birthplace, years living in the United States, sexual activity status, number of Iifetime sexual partners, sexual contact with an IV drug user, i&it IV drug use, exposure to a person with hepatitis, known liver disease or renal dialysis, rejection as a blood donor, or past blood transfusion. When appropriate, the following laboratory tests were performed: complete blood count (CBC), urinalysis and culture, Rubella titer, tuberculin test, Pap smear, rapid plasma reagin, gonococcal culture, and chlamydia specimen. AII teens were screened for hepatitis B surface antigen (HBsAg) and, either or both, antibody to hepatitis B surface antigen (antiHBs) or antibody to hepatitis B core antigen (antiHBc). The HBV marker determinations were performed using the commercial enzyme-linked immunoassay @LISA) method (Abbott Laboratories, North Chicago, IL). Teens who were initially FIBsAg-positive had liver-function tests performed, were counseled about their infective state, and had HBV marker tests repeated in 4-6 months. Persistent antigenemia (carrier) was defined as being HBsAg-positive (antigenemic) on two separate occasions at least 4 months apart. Carriers were counseled, and the testing of family members and sexual partners was encouraged. The routine hospital consent procedure for adolescents was followed. AR significance testing was performed using the x2 analysis for two-variable problems.

Results During the l-year study period, 313 adoIescents

were screened for HBV markers. There were 224 (72%) females and 89 (28%) males. The ethnic distribution was 218 (70%) Hispanic, 44 (14%) Asian, and 51 (16%) black. Among Hispanics, 170 (78%) were Puerto Rican and 48 (22%) were from the Dominican Republic. AR 44 Asians were of Chinese descent: 25 (57%) were from mainland China, nine (20%) from Hong Kong, four (9%) from Taiwan, and six (14%) from the United States. AR blacks were

HEPATITISB VIRUS MARKERSIN ADOLESCENTS

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TabIe 1. Prevalenceof HBV Markersand Persistent Antigenemiain Hispanics by Nationality, Birthplace, and Sexual Actiwty Status HBV marker

Persistent

positive(95) antigenemia (%) Hispanjc (n = 218) Nationality Puerto Rican (n = 170) Dominican Republic (n=48) Biihplace Foreign-born (n = 60) U.S.-born (n = 158) Sexual activity status Sexuallyactive (n = 110) Nonsexually active (n=108)

14(6.4)

3(! 4)

8 (4.7) 6 (12.5)

3 (1.8) 0 (0)

5 (8.3) 9 (5.6)

0 (0) 3 (1.9)

6 :5.4) 8 (2.4)

2.(1.t?) 1 (0.9)

from the United States. Forty-five percent of the study group were Medicaid eligible. The prevalence of at least one HBV marker in the 313 adolescents was 11.8% (37/3l3). The overall prevalence Of persistent antigenemia was 4.8% (15/ 313). There were significant differences in marker and antigenemia rates among the three ethnic groups. Table 1 shows HBV marker and persistent antigenemia rates for Hispanics by nationality, birthplace, and sexual activity status. Hispanics had a marker rate of 6.4% (141218)and a persistent antigenemia rate of 1.4% (3/218). The marker rate for Dominican Republic teens, 12.5% (6/48), was significantly greater than for Puerto Rican teens. 4.7% (8/ 170, pCO.05). The difference in marker rates for U.S.born Hispanics, 5.6% (g/158), vs. foreign-born Hispanics, 8.3% (5&O), was not statistically significant. Among Hispanic adolescents, 50% (110) stated they were sexually active. The mean number of Iifetime sexual partners among the sexually active group was two for males (range, l-10+) and one for females (range, I-5). The marker rate for sexually active teens, 5.4% (6/110), was not significantly different from that of nonsexually active teens, 7.4% (8/W). Asians had a marker rate of 50% (22M) and a persistent antigenemia rate of 27.2% (12&Q, both significantly greater than other teens in the study @CO.OOl).As shown in Table 2, when evaluated by years living in the United States, both marker and antigenemia rates were highest in the most recent immigrants. For years living in the United States less than 1, l-5,6-13, and greater than 10, the ratios for positive HBV marker to scremed patients were ?:9 (78%), lo:18 (56%), 3:7 (43%), and 210 (20%). re-

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Table 2. Prevalence of HBV Markersand Persistent Antigenemiain Asians Based on Years pting in the united states Persistent HEWmarker (56) positive(46) antigenemia Asian(n=44) yearsin unitedstates I0 (?I= 10)

22 (W 7 (77.7) 10 (55.6) 3 (Q-8) 2 (20)

12 (27.2) 4 (44.4) 6 (33.3) 1 (14.3) 1 (10)

is three times the estimated nemia in the general U.S. were mdependent of the status and whether they e Centers for Di apparent lack of impact dence of HBV infection vided is that high-risk

and spectively;

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prevalence

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Among the 51 black teens; markers, and none were antigenemic. The marker adolescents was significantly lower than teens (pCO.02). Among all teens, 4.8% (15/313) had persistent microscopic hematuria without an identifiable etiology. Hematuria in teens with persistent antigenemia (U 15) was not significantly different than hematuria in teens without persistent antigenemia (W298). Howprevalence of hematuria in patients with marker (#37) was significantly greater than in patients without markers (91276, p
Discussion Caribbean Hispanics have not been previously identified as at risk for HBV infection. Only one article sted that women of Caribbean descent should E considered a target group for prenatal HBsAg screening (17). In our study, Hispanic teens from Puerto Rico and the Dominican Republic had an overall HBV marker rate of 6.4% and a persistent antigenemia rate of 1.4%. Although the antigenemia rate may appear low in this group, at minimum, it

rate and a W-20% antigememia rate Chinese adolescents in our study ha rates, with a 50% marker rate an& a 27.2% antigenemia rate. The data demonstrate a trend that the longer Asian teens have lived in the United States, the less likely they are to have a ever, using x2 analysis with a the small sample size, this did not reach, statistic s rates for Asian teens

t microscopic

hematuria

without

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tion may develop persistent microscopic hematuria secondary to membranous glomerulonephritis (16). In our study, only two of six teens with both an marker and hematuria were gesting possible glomerulone uria was not significantly reBut persistent h antigenemia, but was signifilated to patients cantly more frequent in patients with any NW marker. However, in such a small sample, the association between HBV marker-positive patients and persistent hematuria may be spurious. On history, 3.5% of the adolescents had a risk factor for exposure to HBV infection. The HBV marker-positive rate for teens with a risk factor was not significantly different than for teens without a risk factor. This suggests that a positive or negative history for risk factor, including sexual activity status, may not be helpful in predicting adolescents with markers. To prevent the spread of HBV infection among susceptible contacts, at-risk groups and carriers must be identified. Although the nits of antigenemia in Hispanic teens is significantly lower than in Asian Chinese teens, it is at least three times that of the

EPA

VIRlJS

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eds. Viral hepatitis. Phila stitute Press: 1978:297-320. 5, Sch

7. 8. 9. 10.

ners, we rem

B with vaccine: Report efficacy trial among homosexual men. hiteen Med 1982;97:,362-6.

COAiTOl Ann

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11. Chim, Julia Goon, The authors th a Yung their as abeth Ramirez, Wendy counseling and data collection, a Seitz for editorial assistance.

12.

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14. port of an ~~te~agency grou @ease Control. Viral hepatiitis _ 1984. Francis DP, Maynard JE. Transmission and outcome of hepatitis A, B, and non-A, non-1B: A review. Epidemiologic Rev

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17. Robinson WS, Lu&vick LL The virus of hepatitis B (part 1). N Er~gl J Med 1976;295:1168-75. 5. Robinson WS, Lutwick LI. The virus of hepatitis W Engi J IMed 1976;295:1232-6. 6. Szumness W, Marley tI, Ikram H, et al. §oc~odemogpa~i~ic aspects of the e~~derno~o~ of hepatitis B. in: Vv3s 6, Cohen

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patitis in pregnancy.

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