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Seroprevalence of viral hepatitis in Inner Mongolia, China
~ - .... IClinical and ~ Diagnostic \.:.~t Virology ELSEVIER
Clinical and Diagnostic Virology 6 (1996) 77 78
Seroprevalence of viral hepatitis in Inner Mongolia, China Bingren Wu, Lijuan Nan, Jun Wang, Saiwen Guo, Hailing Wang, Ge Jin, Li Bai, Limin Ren Department of Virology, Anti-Epidemic Station of Inner Mongolia Autonomous Region, Huhehote, People's Republic of China Received 27 March 1995; revised 12 July 1995; accepted 25 July 1995
The current status of viral hepatitis markers in Inner Mongolia is not well studied. An understanding of the viral hepatitis types is important to enable optimal use of preventative measures, such as vaccine administration or contact prevention. We collected 1591 sera from healthy men and women between the ages of 1 and 59 years selected by cluster sampling in three different areas in Inner
Mongolia: 583 (281 male, 302 female) were from a semi-rural area of Kailou county, 602 (287 male, 315 female) were from the urban Huhehote city and 406 (194 male, 212 female) were from the pastoral Xisu county. Sera were tested with the following assays: anti-HAV, anti-HDV, and HEV by EIAs from the National Research Institute of virology in Beijing; HBsAg, anti-HBs and anti-HBc by EIAs
Table 1 Age distribution of serological markers for hepatitis A,B,C and E in 1591 healthy individuals in Inner Mongolia (1993) Age Anti-HAV (years) No. positive
HBsAg %
No. positive
Anti-HBs* %
No. positive
Anti-HBc %
No. positive
Anti-HEV %
No. positive
Anti-HCV %
No. positive
%
1-5 6-9 10-14
62 81 129
51.2 61.4 77.2
9 6 8
7.4 4.5 4.8
14 19 30
11.6 14.4 18.0
19 30 51
15.7 22.7 30.5
2 7 3
1.7 5.3 1.8
5 5 7
4.1 3.8 4.2
15-19 20-24
132 164
83.0 91.1
9 11
5.6 6.1
19 35
12.0 19.4
42 61
26.4 33.9
4 3
2.5 1.7
6 7
3.8 3.9
25-29 30-34
134 155
91.2 94.5
11 10
7.5 6.1
20 25
13.6 15.2
48 66
32.7 40.2
5 7
3.4 4.3
1 7
0.7 4.3
35-39 40-44
128 100
95.5 94.3
9 7
6.7 6.6
27 20
20.1 18.9
66 48
49.3 45.3
6 8
4.5 7.5
0 1
0.9
45-49 >50
92 164
93.8 89.6
9 11
9.2 6.0
24 31
24.5 16.9
49 87
50.0 47.5
1 9
1.0 4.9
0 3
1.6
Total
1341
84.3
100
6.3
264
16.6
567
35.6
55
3.5
42
2.6
0928-0197/96/$15.00 © 1996 Elsevier Science B.V. All rights reserved
SSDI 0928-0197(95)00151-4
78
B. bt)t el al.
('/ini{a/ am/ l)iaglto*ltc I iroloLq" 0 (1996) 77 78
Table 2 Prevalence of hepatitis B and C markers in high risk population in Inner Mongolia during 1991 1993 Blood donor with elevated A L T Group
Donor with normal ALT Blood donor with elevated ALT Drug abuse Cirrhosis Acute hepatitis Chronic hepatitis Hcc Dialyser Control
No. tested H BsAg
No. positive
27.59
No. tested anti-HCV
No. positive
100.00
No. tested
No. positive
";,
No. tested
No. positive
'}i,
87 183 44 241) 149 6 6 43
24 49 21 87 51 4 0 0
27.59 26.78 47.73 34.94 34.23 66.67
924 221 183 127 249 269 13 6 43
156 85 133 24 14 19 4 6 7
16.70 38.46 72.68 18.90 5.62 7.06 30.77 100.00 16.28
from the National Institute of Biological products in Beijing; anti-HCV by a second-generation EIA from the International Reagents Corporation in Kobe, Japan, which uses recombinant NS4 (c 100), NS 3 (c 33c) and a structural antigen from the region. We followed the instructions provided with each kit. All of the 1591 sera were tested for the following antigens or antibodies: anti-hepatitis A virus (anti-HAV); surface antigen and antibodies to hepatitis B surface and core (HBsAg, anti-HBs and anti-HBc): antibodies to hepatitis C virus (anti-HCV). A subset of 170 of the 1591 sera which had HBV markers were tested for antigens and antibodies to hepatitis D virus (HDVAg, anti-HDV). Table 1 summarizes the presence of markers for the various viruses and the age distribution of markers for hepatitis A, B, C and E. Over 80% of the sera contained antibodies to HAV, whereas only 16.6% had anti-HBs. More sera contained anti-HBc (35.6%) which is probably a reflection of the substantial HBsAg positivity (6.3%); many of these would be from chronic carriers who would also have anti-HBc. Six of 170 HBV-positive sera were also positive for anti-HDV. We also had the opportunity to test sera for HBV and HCV, collected between 1991 and 1993 from various risk groups. There were: 183 sera from intravenous drug using (IVDV) peasants (148 male, 35 female, average age 50.1 years) from Ningcheng county in eastern Inner Mongolia: patients from three city hospitals (Huhehote, Baotou
and Linghe) which included 249 with acute hepatitis (average age 31.4 years), 269 with chronic hepatitis (average age 39.8 years), 127 with liver cirrhosis (average age 43.3 years), 13 with hepatocellular carcinoma (average age 55.1 years), six on dialysis (average age 48.6 years) and 43 hospitalized without liver disease (25 male and 18 female, average age 40.7 years). An additional 221 donors (average age 28.8 years) eliminated from blood donation because of elevated liver enzymes (ALT) and 924 vocational donors (746 male and 178 female) with normal ALT levels, who were considered as at risk, were also tested. The results of anti-HCV and HBsAg testing are shown in Table 2. One can see from this random testing of risk groups that most groups with sufficient numbers to test showed a very high prevalence for HBsAg. Very high anti-HCV prevalence rates were present in drug users. Of them, 135 were intravenous and 48 were hypodermic drug users. We were surprised by the high rate: over 30% found in blood donors with elevated ALT and 16°/,, in normal blood donors and hospital inpatients without liver disease. These anti-HCV prevalence rates at 16% were much higher than 2.6% seen in the general population survey shown in Table 1. These differences may by related to cross infection among donors by using insufficiently disinfected transfusion devices. The age ranges in the two groups were similar. Further focused studies need to be performed to determine prevention strategies in Inner Mongolia.
Clinical and Diagnostic Virology 6 (1996) 77 78
Seroprevalence of viral hepatitis in Inner Mongolia, China Bingren Wu, Lijuan Nan, Jun Wang, Saiwen Guo, Hailing Wang, Ge Jin, Li Bai, Limin Ren Department of Virology, Anti-Epidemic Station of Inner Mongolia Autonomous Region, Huhehote, People's Republic of China Received 27 March 1995; revised 12 July 1995; accepted 25 July 1995
The current status of viral hepatitis markers in Inner Mongolia is not well studied. An understanding of the viral hepatitis types is important to enable optimal use of preventative measures, such as vaccine administration or contact prevention. We collected 1591 sera from healthy men and women between the ages of 1 and 59 years selected by cluster sampling in three different areas in Inner
Mongolia: 583 (281 male, 302 female) were from a semi-rural area of Kailou county, 602 (287 male, 315 female) were from the urban Huhehote city and 406 (194 male, 212 female) were from the pastoral Xisu county. Sera were tested with the following assays: anti-HAV, anti-HDV, and HEV by EIAs from the National Research Institute of virology in Beijing; HBsAg, anti-HBs and anti-HBc by EIAs
Table 1 Age distribution of serological markers for hepatitis A,B,C and E in 1591 healthy individuals in Inner Mongolia (1993) Age Anti-HAV (years) No. positive
HBsAg %
No. positive
Anti-HBs* %
No. positive
Anti-HBc %
No. positive
Anti-HEV %
No. positive
Anti-HCV %
No. positive
%
1-5 6-9 10-14
62 81 129
51.2 61.4 77.2
9 6 8
7.4 4.5 4.8
14 19 30
11.6 14.4 18.0
19 30 51
15.7 22.7 30.5
2 7 3
1.7 5.3 1.8
5 5 7
4.1 3.8 4.2
15-19 20-24
132 164
83.0 91.1
9 11
5.6 6.1
19 35
12.0 19.4
42 61
26.4 33.9
4 3
2.5 1.7
6 7
3.8 3.9
25-29 30-34
134 155
91.2 94.5
11 10
7.5 6.1
20 25
13.6 15.2
48 66
32.7 40.2
5 7
3.4 4.3
1 7
0.7 4.3
35-39 40-44
128 100
95.5 94.3
9 7
6.7 6.6
27 20
20.1 18.9
66 48
49.3 45.3
6 8
4.5 7.5
0 1
0.9
45-49 >50
92 164
93.8 89.6
9 11
9.2 6.0
24 31
24.5 16.9
49 87
50.0 47.5
1 9
1.0 4.9
0 3
1.6
Total
1341
84.3
100
6.3
264
16.6
567
35.6
55
3.5
42
2.6
0928-0197/96/$15.00 © 1996 Elsevier Science B.V. All rights reserved
SSDI 0928-0197(95)00151-4
78
B. bt)t el al.
('/ini{a/ am/ l)iaglto*ltc I iroloLq" 0 (1996) 77 78
Table 2 Prevalence of hepatitis B and C markers in high risk population in Inner Mongolia during 1991 1993 Blood donor with elevated A L T Group
Donor with normal ALT Blood donor with elevated ALT Drug abuse Cirrhosis Acute hepatitis Chronic hepatitis Hcc Dialyser Control
No. tested H BsAg
No. positive
27.59
No. tested anti-HCV
No. positive
100.00
No. tested
No. positive
";,
No. tested
No. positive
'}i,
87 183 44 241) 149 6 6 43
24 49 21 87 51 4 0 0
27.59 26.78 47.73 34.94 34.23 66.67
924 221 183 127 249 269 13 6 43
156 85 133 24 14 19 4 6 7
16.70 38.46 72.68 18.90 5.62 7.06 30.77 100.00 16.28
from the National Institute of Biological products in Beijing; anti-HCV by a second-generation EIA from the International Reagents Corporation in Kobe, Japan, which uses recombinant NS4 (c 100), NS 3 (c 33c) and a structural antigen from the region. We followed the instructions provided with each kit. All of the 1591 sera were tested for the following antigens or antibodies: anti-hepatitis A virus (anti-HAV); surface antigen and antibodies to hepatitis B surface and core (HBsAg, anti-HBs and anti-HBc): antibodies to hepatitis C virus (anti-HCV). A subset of 170 of the 1591 sera which had HBV markers were tested for antigens and antibodies to hepatitis D virus (HDVAg, anti-HDV). Table 1 summarizes the presence of markers for the various viruses and the age distribution of markers for hepatitis A, B, C and E. Over 80% of the sera contained antibodies to HAV, whereas only 16.6% had anti-HBs. More sera contained anti-HBc (35.6%) which is probably a reflection of the substantial HBsAg positivity (6.3%); many of these would be from chronic carriers who would also have anti-HBc. Six of 170 HBV-positive sera were also positive for anti-HDV. We also had the opportunity to test sera for HBV and HCV, collected between 1991 and 1993 from various risk groups. There were: 183 sera from intravenous drug using (IVDV) peasants (148 male, 35 female, average age 50.1 years) from Ningcheng county in eastern Inner Mongolia: patients from three city hospitals (Huhehote, Baotou
and Linghe) which included 249 with acute hepatitis (average age 31.4 years), 269 with chronic hepatitis (average age 39.8 years), 127 with liver cirrhosis (average age 43.3 years), 13 with hepatocellular carcinoma (average age 55.1 years), six on dialysis (average age 48.6 years) and 43 hospitalized without liver disease (25 male and 18 female, average age 40.7 years). An additional 221 donors (average age 28.8 years) eliminated from blood donation because of elevated liver enzymes (ALT) and 924 vocational donors (746 male and 178 female) with normal ALT levels, who were considered as at risk, were also tested. The results of anti-HCV and HBsAg testing are shown in Table 2. One can see from this random testing of risk groups that most groups with sufficient numbers to test showed a very high prevalence for HBsAg. Very high anti-HCV prevalence rates were present in drug users. Of them, 135 were intravenous and 48 were hypodermic drug users. We were surprised by the high rate: over 30% found in blood donors with elevated ALT and 16°/,, in normal blood donors and hospital inpatients without liver disease. These anti-HCV prevalence rates at 16% were much higher than 2.6% seen in the general population survey shown in Table 1. These differences may by related to cross infection among donors by using insufficiently disinfected transfusion devices. The age ranges in the two groups were similar. Further focused studies need to be performed to determine prevention strategies in Inner Mongolia.