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Journal Articles on Hepatitis B Research, Vaccination and Public Education

Emerging Scholars Scientific and Medical Advisors
Journal articles recommended by our Emerging Scholars Scientific and Medical Advisors
WHO announces new guidelines for hepatitis B treatment
Hepatitis B Foundation presents globally recognized liver disease expert with 2024 Baruch S. Blumberg Prize
Hepatitis B Foundation releases new campaign highlighting the connection between hepatitis B and liv
Hepatitis B Foundation releases report on first-ever Externally Led Patient-Focused Drug Development meeting for hepatitis B
People living with hepatitis B should have a voice in new treatment guidelines, advocates say
Hepatitis B Foundation launches training website with user-friendly courses for everyone interested in hepatitis B and D
Pennsylvania couple receives Hepatitis B Foundation’s Community Leadership Award
Hepatitis B Foundation, Blumberg Institute and PABC congratulates John Crowley of Amicus on being named BIO President and CEO
Hepatitis B Foundation extends its engagement in Africa
Sen. Steven J. Santarsiero honored at the Pennsylvania Biotechnology Center (PABC)
Hepatitis B Foundation invites providers and the public to participate in The Liver Meeting, Nov. 10-14, in Boston and online
Hepatitis B Foundation coordinates 2023 International HBV Meeting, a scientific conference held Sept. 19-23 in Kobe, Japan
Hep B United Commemorates World Hepatitis Day, July 28
Gala puts the spotlight on creating family and support for those living with hepatitis B
Global leader, physician treating people living with hepatitis B takes new role with Hepatitis B Foundation
Hepatitis B Foundation releases white paper calling health care providers into action following new hepatitis B screening and vaccination recommendations
New CDC Universal Screening Recommendations will save lives, Hepatitis B Foundation president says
Hepatitis B Foundation invites everyone to participate in the online silent auction fundraiser.
Hepatitis B Foundation president responds to Janssen decision on the company’s hepatitis B drug development program
Globally prominent advocate and physician chosen for Hepatitis B Foundation’s 2023 Community Commitment Award
Dr. Yasmin Ibrahim appointed to national Patient Engagement Collaborative
Comprehensive hepatitis B program in Vietnam provides an excellent model for other countries
Hepatitis B Foundation Announces third series of continuing education program on hepatitis B for health care providers and public health professionals
Hepatitis B Foundation hails decision by U.S. Public Health Service Corps to accept future applicants living with chronic hepatitis B infection and HIV
German scientist, inventor of new, first-in-class treatment for hepatitis D, to receive the 2023 Baruch S. Blumberg Prize
Researchers and people living with hepatitis B meet in Paris at the third Hepatitis B Community Forum
Hepatitis B Foundation mourns Bill Mason, an accomplished scientist whose discovery led to current treatments for hepatitis B
Hepatitis B Foundation raises alarm about findings from new federal viral hepatitis surveillance report
Hepatitis B Foundation strongly supports Congressional letters urging Biden administration to end discriminatory military policy
Longtime Board Chair honored by his colleagues
Hepatitis B Foundation creates two Global Community Advisory Boards
Pa DOH Highlights the Importance of Viral Hepatitis Awareness, Need for Expansion of Syringe Services
Hepatitis B Foundation, StoryCenter release new #justB stories from people with lived experience
Pediatric Hepatitis Outbreaks
Philadelphia City Council recognizes May as Hepatitis Awareness Month
Hepatitis B Foundation hosts Princeton Workshop on Liver Cancer
Annual Gala raises a record amount for the local Hepatitis B Foundation
Hepatitis D Roundtable to Address Unmet Needs of Patients
DiRx teams up with Hepatitis B Foundation to offer low-cost medications
Many more U.S. adults to get vaccinated against hepatitis B following move by U.S. Centers for Disease Control and Prevention (CDC)
Hepatitis B Foundation receives Congressional funding for a Center of Public Health Excellence
CTC Foundation of Princeton donating $100,000 to Hepatitis B Foundation
Hepatitis B Foundation senior vice president and board member speak on popular podcast
Anonymous donor provides record gift for hepatitis B research
Two hepatitis B medications available free through Hepatitis B Foundation and Rx Outreach partnership
Canadian scientist chosen for the 2022 Hepatitis B Foundation’s Blumberg Prize
Landmark vote by CDC’s Advisory Committee on Immunization Practices (ACIP) to recommend universal hepatitis B vaccination
Hepatitis B Foundation strongly endorses the Liver Illness Visibility, Education and Research (LIVER) Act of 2021
Dr. Chari A. Cohen becomes President of the Hepatitis B Foundation
New president announced for the Pennsylvania Biotechnology Center (PABC)
Major successes on Capitol Hill
CDC awards a $1.375 million, five-year grant to the Hepatitis B Foundation for expansion of Hep B United, a nationwide coalition
Hepatitis B Foundation Members Selected to Participate as Consumer Reviewers in the Congressionally Directed Medical Research Program’s Peer Reviewed Medical Research Program for the U.S. Department of Defense
Hepatitis B Foundation supports launch of new global online forum dedicated to supporting people with hepatitis B, connecting with health experts
Hepatitis B Foundation launches the first global registry of discrimination against people living with hepatitis B
Hepatitis B Foundation to hold its annual Crystal Ball Gala on April 30
Hepatitis B Foundation mourns the passing of John C. Martin, pharmaceutical industry leader
Chronic hepatitis B is far more prevalent among U.S. residents than previously reported
All of Us research program
Hepatitis B Foundation Mourns Loss of Co-Founder Paul Witte, Longtime New Hope Resident
Hepatitis B Foundation launches continuing education series on hepatitis B for health care providers and public health professionals
HBF applauds President Biden’s Memorandum denouncing racism, xenophobia, and intolerance against Asian Americans and Pacific Islanders
Hepatitis B Foundation applauds release of National Hepatitis Strategic Plan
Bristol Myers Squibb awards grant to Hepatitis B Foundation
Federal Task Force Recommendation for Hepatitis B Screening Fails to Close Gaps in Diagnosis Rates
Hepatitis B community leaders convene to address eliminating hepatitis B during COVID-19 pandemic
Pennsylvania Biotechnology Center’s Kassa named one of The 10 Best COOs of 2020
Hepatitis B Foundation announces recipient of 2021 Baruch S. Blumberg Prize
Hepatitis B Foundation co-founders chosen for major new award from the American Association for the Study of Liver Diseases
Hepatitis B Foundation applauds HHS letter on discrimination against people living with hepatitis B who are pursuing careers in health care
Hepatitis B Foundation launches new tool to assist people living with hepatitis B in making decisions on health insurance
Nobel Prize to Hepatitis B Foundation and Blumberg Institute Advisors
Work begins on a $19 million expansion of the Pennsylvania Biotechnology Center (PABC)
Hepatitis B Foundation launches B the Voice Story Bank
Hepatitis B Foundation expresses appreciation for the work of Dr. Ding-Shinn Chen with the announcement of his death
Hepatitis B Foundation and Hep B United Statement on the Federal Government's Rollback of Critical Health Care Protections
Hepatitis B Foundation stands in solidarity with black communities, calls for action against institutional racism
Two Powerful Editorials Published by the Hepatitis B Foundation
Hepatitis B Foundation Expands Hepatitis B Prevention Policy Initiatives
HBV Vaccinations Save Lives, Reduce New Infections: National Adult Hepatitis B Vaccination Awareness Day
Hepatitis B Foundation Hepatitis B Foundation Says “Thank You!” to its 100- Volunteers
Hepatitis B Foundation Announces Annual Fundraising Event to Go Virtual on April 24
Hepatitis B Foundation, Baruch S. Blumberg Institute and Pennsylvania Biotechnology Center Announce New Director of Communications and Marketing
Message from Dr. Timothy Block, Hepatitis B Foundation President
Hepatitis B Foundation Commends New Rx Outreach Program to Provide Access to Affordable Hepatitis B Medication
Hepatitis B Foundation Endorses the Liver Illness Visibility, Education, and Research (LIVER) Act of 2019
Hepatitis B Foundation Announces 2020 Baruch S. Blumberg Prize Winner
U.S. Falls Short in Reaching 2020 Goals for Hepatitis B
Hepatitis B Foundation Calls for Increased Resources for Hepatitis B Prevention in Response to CDC 2017 Surveillance Data Report
Our Voices Made a Difference: CVS Caremark to Cover Vemlidy Prescriptions
Hepatitis B Foundation Announces 2019 Baruch S. Blumberg Prize Winner
Hep B United Applauds Bipartisan Legislation to Combat the Opioid Crisis and Opioid Related Infectious Diseases
Hepatitis B Foundation Endorses the Liver Illness Visibility, Education, and Research (LIVER) Act of 2018
Hepatitis B Foundation Calls for Universal Screening for Hepatitis B
Hepatitis B Leaders Call for the Elimination of Hepatitis B
Hepatitis B Foundation Joins Forces with Grace Meng
Hepatitis B Foundation Releases New #justB Stories
Hepatitis B Foundation Strongly Supports the Strategic Plan for Trans‐NIH Research to Cure Hepatitis B
Hepatitis B Foundation Crystal Ball Gala
New Two-Dose HBV Vaccine Recommended by ACIP
Timothy M. Block, PhD, President of Hepatitis B Foundation and its Baruch S. Blumberg Institute, named a 2017 National Academy of Inventors Fellow
Hepatitis B Foundation Applauds FDA Approval of New Hepatitis B Vaccine
CDC National Progress Report on Hepatitis Elimination Reveals Rise in Acute HBV Infections and Low Birth Dose Vaccination Rates in the U.S.
Hepatitis B Foundation Announces Promotion of Chari Cohen, DrPH, MPH, to Vice President, Public Health and Programs
Hepatitis B Foundation Mourns the Loss of Pioneering Hepatitis B Physician-Scientist Dr. W. Thomas London
Hepatitis B Foundation's #justB Campaign Gives Voice to Personal Stories During May Hepatitis Awareness Month
Executive Director Retires After 25 Years of Service
Hepatitis B Foundation Bets on a Cure at the 2017 Crystal Ball
Targets to Eliminate Hepatitis B in U.S.
Fred Beans Family of Dealerships Donates $30,000..
International Leaders to Its Scientific and Medical Advisory Board
Hepatitis B Foundation Opposes the American Health Care Act
Appoints Global Expert Dr. Nat Brown
Hepatitis B Foundation Launches #justB Storytelling Campaign
Dr. Richard G. Pestell Joins the Baruch S. Blumberg Institute
Dr. Bud Tennant Leaves Behind a Distinguished Scientific Legacy
Be About It
Nationwide Hepatitis Delta Virus (HDV) Campaign
Current and Past "B Informed" Newsletters
Hepatitis B: Is a Cure Possible?
Calendar of Events
Witte Lecture
International HBV Meeting
Externally Led Patient-Focused Drug Development
Why World Hepatitis Day is July 28
NYC Marathon
Princeton Workshop 2022
Commentary on the Cure
Pajama Gala April 24, 2020
A statement regarding COVID-19 from the Hepatitis B Foundation Scientific and Medical Advisory Board (SMAB) to the hepatitis B community

Here are selected, recent peer-reviewed journal articles and other scholarly publications that were written by Hepatitis B Foundation public health researchers and collaborators.

Mondher T., Jack W., Chari C., Chris M., Helen K., Jake M., Hannah P., Ashley F. S., Robert G. G., Qin N., Hiroshi Y., Markus C., Maurizia B., Florian van B. Qing X., Dee L., Noriyuki H., Urbano S., Maria B., Angelina Villasis K., Yasushi T., Yiwei L., Ao L., Qiaoqiao C., Tetsuro I., Olaf R., Anna P., Gudrun H., Eric K.H. C. & Su W. Experience and impact of stigma in people with chronic hepatitis B: a qualitative study in Asia, Europe, and the United States. BMC Public Health 24 , Article number: 611 (2024). [ link]

Freeland, C., Lo, W., Kabagambe K., Wang S., Adda D., Graham C., Gish R., Cohen C. Urgent need for lived experience in hepatitis B guideline development. The Lancet Gastroenterology & Hepatology , Volume 0, Issue 0. [link]

Cohen C. Dangerous medicine: the story behind human experiments with hepatitis Emerging Infectious Diseases Volume 29, Number 7 - 2023 Jul. [link]

Freeland C, Bruckbauer J, Qureshi A, Huynh K, Rutland M, et al. (2023) Enhancing Hepatitis B Care Competency through Project ECHO: A Program Evaluation. Journal of Digestive Diseases and Hepatology 8: 200. DOI: 10.29011/2574-3511.100200 [link]

C. Freeland, V Sreepathi, R. W. Hass, J. M. Fenkel, J. Torgersen, K. Rothstein, C. Cohen, R.G. Gish. The importance of triple panel testing for hepatitis B and the burden of isolated anti-hepatitis B core antibodies within a community sample. Journal of Virus Eradication , 2023, 100358, ISSN 2055-6640 [link]

Wang, M., Qureshi, A., Johnson, N. Mansalay, A. Muhr A., Abatemarco D., Freeland C. A Health Belief Model Examination of Factors Related to Hepatitis B Screening Among African Immigrants in Philadelphia. Journal of Racial and Ethnic Health Disparities (2023) [link]

Freeland C, Kanu F, Mohammed Y, Nwokoro UU, Sandhu H, Ikwe H, et al. (2023) Barriers and facilitators to hepatitis B birth dose vaccination: Perspectives from healthcare providers and pregnant women accessing antenatal care in Nigeria. PLOS Global Public Health 3(6): e0001332. [link]

Huỳnh TB, Tina Nguyễn D, Vũ N, Carroll-Scott A, Wong C, Freeland C, Parvanta C. (2023) Perceived Benefits and Barriers to Implementing Occupational Health Recommendations Among Immigrant-Owned Nail Salons in the Greater Philadelphia Region. Health Promotion Practice Mar 16:15248399231160461. doi: 10.1177/15248399231160461. Epub ahead of print. PMID: 36924273. [link]

Ibrahim Y, Umstead M, Wang S, Cohen C. The Impact of Living With Chronic Hepatitis B on Quality of Life: Implications for Clinical Management. Journal of Patient Experience . 2023;10. doi:10.1177/23743735231211069 [ link ]

Freeland C, Cohen C (2023) The impact of a hepatitis B diagnosis. Gastrointestinal Nursing 2Feb2023 Volume 21, Issue Sup1 | ISSN (print): 1479-5248 | ISSN (online): 2052-2835 [ link ]

Cohen C, Evans A, Block, TM (2023) Hepatitis Viruses: Hepatitis B and Hepatitis D. In: Kaslow, R.A., Stanberry, L.R., Powers, A.M. (eds) Viral Infections of Humans . Springer, New York, NY. [ link ]

McMahon B, Cohen C, Brown RS, et al. Opportunities to Address Gaps in Early Detection and Improve Outcomes of Liver Cancer [published online ahead of print, 2023 May 5]. JNCI Cancer Spectrum 2023;7(3):pkad034. [ link ]

Ha YP , Sun Y , Wilkinson J , Wang S , Chien L , Wu M , Wang E , Freeland C (2022) Implementation and outcomes of a remote hepatitis B screening program designed to overcome COVID-19 pandemic-related disruptions to community-based screenings for Asians in Greater Philadelphia: A descriptive study Health Science Reports 8August2022 https://doi.org/10.1002/hsr2.761 [ link ]

Kheir OO, Freeland C, Abdo AE, Yousif MEM, Altayeb EA, Mekonnen HD (2022) Assessment of hepatitis B knowledge and awareness among the Sudanese population in Khartoum State Pan African Medical Journal 10.11604/pamj.2022.41.217.30390 [link]

Ibrahim Y, Cohen C, Araojo R, Merenda C, Dykstra S, et al (2022) Attitudes towards clinical trial participation among people living with chronic hepatitis B. J Transl Sci. 2022; 8:1-10. Epub ahead of print. [ link ]

Freeland C, Mendola L, Cheng V, Cohen C, Wallace J (2022) The unvirtuous cycle of discrimination affecting people with hepatitis B: a multi-country qualitative assessment of key-informant perspectives. Int J Equity in Health. 2022 May 31;21(1):77. [ link ]

Matthews PC, Jack K, Wang S, Abbott J, Bryce K, Cheng B, Ghosh I, Story A, Chen J, Munoz C, Bell J, Riddell S, Goldring A, Goddard C, Moraras K, Cohen C, Brown K, Lazarus JV, Elsharkawy AM (2022) A call for advocacy and patient voice to eliminate hepatitis B virus infection. Lancet Gastroenterol Hepatol. 2022 Apr;7(4):282-285. [ link ]

Silliman M, Alber M, Gib S, Gee M, Conover S, Chan C, Cohen C, Freeland C, Racho R (2022) Comparing lengths and inclusion of information in storytelling videos: Implications for hepatitis B education. PEC Innovation. Online ahead of print. [ link ]

Huynh TB , Nguyen DT , Vu N , Freeland C (2021) Development of health and safety training for Vietnamese American nail salon owners and workers medRxiv [ link ]

C Freeland, M Kamischke, M Jackson, S Bodor, T Block, C Cohen, et al (2021). Common concerns, barriers to care, and the lived experience of individuals with hepatitis B: a qualitative study. BMC Public Health [link]

Gish RG, Brosgart C, Lok A, Wong R, Block T, Cohen C, et al (2021) An Updated Assessment of Chronic Hepatitis B Prevalence among Foreign-Born Persons Living in the United States. Hepatology [ link ]

Wang S, Cohen C, Tang A, Graham C (2021). Hepatitis B Virus Elimination in the U.S.: Time to Dismantle Barriers and Implement Solutions. Current Hepatology Solutions [ link ]

Razavi H, Block, T, Cohen, C, et al (2020). The case for simplifying and using absolute targets for viral hepatitis elimination goals. Journal of Viral Hepatitis [ link ]

Moraras K, Block J, Shiroma N, Cannizzo A, Cohen C (2020). Protecting the Rights of Health Care Students Living With Hepatitis B Under the Americans With Disabilities Act. Public Health Reports . [ link ]

Tu T, Block JM, Wang S, Cohen C, Douglas MW (2020). The lived experience of chronic hepatitis B: a broader view of its impacts and why we need a cure. Viruses [link]

Freeland C, Bodor S, Perera U, Cohen C Barriers to Hepatitis B Screening and Prevention for African Immigrant Populations in the United States: A Qualitative Study. Viruses 2020:12(3), 305. [link]

Alber JM, Cohen C, Racho R, Freeland C, Ghazvini S, Tolentino B, Almeida R, & Silliman M (2020) Exploring the impact of storytelling on storytellers in a hepatitis B health communication context. Patient Education & Counseling . [link]

Alber JM, Cohen C, Bleakley A, Ghazvini S, Tolentino B, Almeida R, & Chance BL (2019). Comparing the effects of different story types and speakers in hepatitis B storytelling videos. Health Promotion Practice . [link]

Alber JM, Cohen C, Nguyen G, Ghazani S, Tolentino B (2018). Exploring communication strategies for promoting hepatitis B prevention among young Asian American adults. Journal of Health Communication ; 16:1-7. [link]

Freeland C, Cohen C, Collier M (2018). Public health response to hepatitis B exposure: A case study on gaps and opportunities to improve postexposure care. Infectious Disease in Clinical Practice ; 26(4):185-186. [link]

Cohen, C, Alber, JM, Bleakley, A, Grossman, S, Freeland, C, Alarcon, K, Merchant, R (2018). Social media for hep B awareness: Young adult and community leader perspectives. Health Promotion Practice . Advanced online publication. [link]

Alter H, Block T, Brown N, Brownstein A, Brosgart C, Chang K-M, Chen P-J, Chisari F, Cohen C, et al. (2018). A Research Agenda for Curing Chronic Hepatitis B Virus Infection. Hepatology ; 67(3):1127-1131. [link]

Block T, Alter H, Brown N, Brownstein A, Brosgart C, Chang K-M, Chen P-J, Cohen C, et al. (2017). Research priorities for the discovery of a cure for chronic hepatitis B: Report of a workshop. Antiviral Research ; 150:93-100. [link]

Cohen C, Evans AA, Huang P, London WT, Block J, Chen G (2016). Hepatitis B knowledge among key stakeholders in Haimen City, China: Implications for addressing chronic HBV infection. Hepatology, Medicine and Policy , 1(4):2-9. [link]

Jorgensen C, Chen S, Carnes CA, Block J, Chen D, Caballero J, Moraras K, Cohen C (2016). “Know Hepatitis B:” A Multilingual Communications campaign Promoting Testing for Hepatitis B Among Asian Americans and Pacific Islanders. Public Health Reports , 2016 Supplement 2, v131: 35-40. [link]

McMahon B, Block J, Block T, Cohen C, Evans AA, Hosangadi A, London WT, Sherman M, et. al. (2015). Hepatitis-Associated Liver Cancer: Gaps and Opportunities to Improve Care. JNCI J Natl Cancer Inst , 108(4):1-6. [link]

Gish RD, Cohen CA, Block JM, Brosgart CL, Block TM, Clary R, Le LT, Ninburg MH, Sandt L, Kowdley KV (2015). Data supporting updating estimates of the prevalence of chronic hepatitis B and C in the United States. Hepatology , 62(5):1339-1341. [link]

Evans AA, Cohen C, Huang P, Qian L, London WT, Block JM, Chen G (2015). Prevention of perinatal hepatitis B transmission in Haimen City, China: Results of a community public health initiative. Vaccine ; epub ahead of print, pii: S0264-410X(15)00111-5. doi: 10.1016/j. Vaccine 2015.01.054. [link]

Weerasinghe I, Bannister N, Huang V, Cohen C, Caballero J, Wang S (2015). The role of the patient-centered medical home in addressing hepatitis B perinatal transmission. AAPI Nexus , 12(1,2): 140-160. [link]

Chen G, Block JM, Evans AA, Huang P, Cohen C (2014). Gateway to Care campaign: a public health initiative to reduce the burden of hepatitis B in Haimen City, China. BMC Public Health , 14:754-759. [link]

Beckett GA, Block JM, Cohen C, McMahon BJ (2014). The role of primary care physician assistants in managing chronic hepatitis B. Journal of the American Association of Physician Assistants , 27(3):51-54. [link]

Nguyen GT, Cohen C, Evans A, Bautista R (2014). Broadening the scope for national database sampling: a critical need. American Journal of Public Health , 104(2):e3. [link]

Cohen C, Caballero J, Martin M, Weerasinghe I, Ninde M, Block J (2013). Eradication of Hepatitis B: A Nationwide Community Coalition Approach to Improving Vaccination, Screening, and Linkage to Care. Journal of Community Health , 38(5):799-804. [link]

Evans AA, London WT, Gish RG, Cohen C, Block WT (2013). Chronic HBV Infection Outside Treatment Guidelines: Is Treatment Needed? Antiviral Therapy , 18(2):229-235. [link]

Apuzzio J, Block JM, Cullison S, Cohen C, Leong SL, London WT, McHugh JA, Neubauer RL, Perrillo R, Squires R, Tarrant D, McMahon BJ (2012). Chronic Hepatitis B in Pregnancy: A Workshop Consensus Statement on Screening, Evaluation, and Management, Part 1. The Female Patient , 37(4):22-27.

McHugh JA, Cullison S, Apuzzio J, Block JM, Cohen C, Leong SL, London WT, McNellis RJ, Neubauer RL, Perrillo R, Squires R, Tarrant D, McMahon BJ (2011). Chronic hepatitis B infection: A workshop consensus statement and algorithm. Journal of Family Practice , Online Exclusive. 60(9):E1-E8. [link]

Evans AA, Cohen C, London WT (2011). Hepatitis B Virus in the United States. Annals of Internal Medicine , 155(3):205. [link]

Cohen C, McMahon BJ, Block JM, Brosgart CL, Gish RG, London WT, Block TM (2011). Is chronic hepatitis B being undertreated in the United States? Journal of Viral Hepatitis , 18:377-383. [link]

Cohen C, Evans A, London WT, Block J, Conti M, Block T (2008). Underestimation of chronic hepatitis B virus infection in the United States of America. Journal of Viral Hepatitis , 15(1):12–13. [link]

Jessop A, Cohen C, Burke M, Conti M, Black M (2004). Hepatitis support groups: Meeting the information and support needs of hepatitis patients. Journal of Gastroenterology Nursing , 27(4):163-169. [link]

IRIS MABRY-HERNANDEZ, MD, MPH, Medical Officer, U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality

NOLAN O'DOWD, MD, General Preventive Medicine Resident, Johns Hopkins Bloomberg School of Public Health

Am Fam Physician. 2021;103(8):493-494

Related U.S. Preventive Services Task Force Recommendation Statement: Screening for Hepatitis B Virus Infection in Adolescents and Adults: Recommendation Statement

Author disclosure: No relevant financial affiliations.

A 15-year-old adolescent, J.M., presents for a well-child examination. J.M. was born in Central America before moving to the United States eight years ago with their family. J.M. reports that their older sibling, who lives at home, was diagnosed with hepatitis B virus (HBV) infection last month. J.M. is not sexually active, has no history of drug use, and wonders whether they should be tested for HBV.

Case Study Questions

1 . According to the U.S. Preventive Services Task Force (USPSTF), which one of the following is an appropriate next step for this patient?

A. Check J.M.'s immunization records, and screen for HBV only if J.M. was not vaccinated as a child.

B. Do not screen for HBV because J.M. is not at high risk.

C. Do not screen for HBV because J.M. is younger than 18 years.

D. Screen for HBV because all adolescents and adults should be screened periodically for HBV.

E. Screen for HBV because J.M. is at high risk.

2 . According to the USPSTF, which of the following are high-risk groups for whom HBV screening should be considered?

A. All people who were not vaccinated against HBV as infants.

B. Men who have sex with men.

C. Household contacts of people with HBV infection.

D. Sex partners of people with HBV infection.

3 . According to the USPSTF, which one of the following countries has a high prevalence of HBV infection?

C. United States.

D. Austria.

1. The correct answer is E . The USPSTF recommends screening for HBV infection in adolescents and adults who are at high risk of infection. The patient is considered to be at high risk because they have a household contact with HBV infection. The patient's immunization records do not affect whether screening should occur because Central America is not a region with a high prevalence of HBV infection. 1 Age does not affect the decision to screen high-risk patients for HBV infection.

2. The correct answers are B, C, and D . Among people who were not vaccinated against HBV as infants, only those whose parents were born in regions with a very high prevalence of HBV should be screened. Men who have sex with men and household contacts or sex partners of persons with HBV infection are considered high-risk groups for HBV infection. 2 Other important high-risk groups include people born in countries with a high prevalence of HBV infection (≥ 2%) and people with current or past injection drug use.

3. The correct answer is A . Regions with a high prevalence of HBV infection are Asia, Africa, the Pacific Islands, and parts of South America; Uganda is in a region with a high prevalence of HBV infection. Regions that generally do not have a high prevalence of HBV infection include Europe, North America, and Central America. A complete list of countries in each region and the prevalence of HBV infection is available at https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/hepatitis-b .

This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website ( https://www.uspreventiveservicestaskforce.org ). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hepatitis-b- virus-infection-screening#fullrecommendationstart .

Krist AH, Davidson KW, Mangione CM, et al. Screening for hepatitis B virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2020;324(23):2415-2422.

Chou R, Blazina I, Bougatsos C, et al. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2020;324(23):2423-2436.

This series is coordinated by Joanna Drowos, DO, contributing editor.

A collection of Putting Prevention Into Practice published in AFP is available at https://www.aafp.org/afp/ppip.

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Patient Case Presentation

Our patient, Mr. Smith, is a 43 year old caucasian male who came in today with complaints of fatigue, anorexia, malaise, nausea, vomiting, abdominal pain, and low grade fever for the past month, and recently has been alarmed by the discoloration of his skin and sclera turning yellow. He states that his urine has become dark and stool has become clay colored.

Past Medical History: Blood transfusion in 1992 due to major blood loss in a motor vehicle accident, arthralgia, peripheral neuropathy, hospitalization due to drug overdose in 2010. Patient states that he is fully up to date on vaccination.

Social History : Patient is an injectable drug user for the past 12 years and is currently sexually active with multiple male partners and states he uses protection “sometimes”. His current occupation is a car mechanic.

Family History: Mother: history of hyperlipidemia and diabetes father died of myocardial infarction, no other siblings or family history available .

pictured: jaundice on an individual’s eye; “Jaundice.” Assignment Point , 5 Oct. 2017, www.assignmentpoint.com/science/medical/jaundice.html.

Hepatitis B Surveillance 2020

What is Hepatitis B

Hepatitis B is a vaccine-preventable liver disease caused by the hepatitis B virus (HBV). HBV is transmitted when blood, semen, or another body fluid from a person infected with the virus enters the body of someone who is uninfected.

What is Hepatitis B?

Hepatitis B in 2020

Acute hepatitis b, chronic hepatitis b, hepatitis b facts & figures.

This can happen through sexual contact; sharing needles, syringes, or other drug-injection equipment; or from the gestational parent to baby during pregnancy or at birth.

For some persons, hepatitis B is an acute, or short-term, illness; for others, it can become a long-term, chronic infection. Chronic hepatitis B can lead to serious health problems, including cirrhosis, liver cancer, and death.

Treatments are available, but no cure exists for hepatitis B. The best way to prevent hepatitis B is by being vaccinated.

There were 2,157 new cases of acute hepatitis B reported during 2020

There were 14,000 estimated acute hepatitis B infections during 2020

There were 11,635 cases of newly reported chronic hepatitis B during 2020

There were 5 newly reported cases of chronic hepatitis B per 100,000 people during 2020

During 2020, 44 states reported 2,157 acute hepatitis B cases resulting in an estimated 14,000 infections. After a decade of stable rates, the rate of acute hepatitis B abruptly decreased by 32% after 2019. This decrease may be related to fewer people seeking healthcare and being tested for hepatitis B during the COVID-19 pandemic .

Hepatitis B Prevention

Hepatitis B vaccination prevents hepatitis B. Reported cases of acute hepatitis B decreased after CDC recommended routine child vaccination in 1991. The decrease continued until 2011, levelled off, and then declined again from 2019 through 2020 likely due to the COVID-19 pandemic.

To decrease hepatitis B incidence, CDC published the 2022 universal hepatitis B adult vaccination recommendation calling for all people aged 19 through 59 years to receive hepatitis B vaccine whether they have risk factors or not.

Fast Facts about Acute Hepatitis B in 2020

The number of reported acute hepatitis B cases decreased 32% from 2019 through 2020

76% of all acute hepatitis B cases were persons aged 30-59 years

States in the Appalachian region have rates of acute hepatitis B higher than the US average

Rates of acute hepatitis B were highest among non-Hispanic White and non-Hispanic Black persons

During 2020, a total of 11,635 newly identified cases of chronic hepatitis B were reported to CDC, corresponding to a rate of 5.0 cases per 100,000 people.

The rate of newly reported chronic hepatitis B cases among Asian/Pacific Islander persons (17.6 cases per 100,000 people) was almost 12 times the rate among non-Hispanic White persons (1.5 cases per 100,000 people).

Fast Facts about Chronic Hepatitis B in 2020

During 2020, the rate of newly reported chronic hepatitis B was almost 12x higher among Asian/Pacific Islander persons than among non-Hispanic White persons

88% of newly reported chronic hepatitis B cases occurred in persons 30 years and older

Figure 2.1. Number of reported cases of acute hepatitis B virus infection and estimated infections — United States, 2013-2020
Figure 2.2. Rates of reported acute hepatitis B virus infection†, by state or jurisdiction — United States, 2019-2020
Figure 2.3. Rates of reported cases of acute hepatitis B virus infection, by state or jurisdiction — United States, 2020
Figure 2.4. Rates of reported cases of acute hepatitis B virus infection, by age group — United States, 2005-2020
Figure 2.5. Rates of reported cases of acute hepatitis B virus infection, by sex — United States, 2005-2020
Figure 2.6. Rates of reported cases of acute hepatitis B virus infection, by race/ethnicity — United States, 2005-2020
Figure 2.7. Availability of information on risk behaviors or exposures associated with reported cases of acute hepatitis B virus infection — United States, 2020
Figure 2.8. Rates of deaths with hepatitis B virus infection listed as a cause of death among residents, by state or jurisdiction — United States, 2020
Table 2.1. Numbers and rates of reported cases of acute hepatitis B virus infection, by state or jurisdiction — United States, 2016-2020
Table 2.2. Numbers and rates of reported cases of acute hepatitis B virus infection, by demographic characteristics — United States 2016-2020
Table 2.3. Reported risk behaviors or exposures among reported cases of acute hepatitis B virus infection — United States, 2020
Table 2.4. Number of newly reported cases of perinatal hepatitis B virus infection, by state or jurisdiction — United States, 2020
Table 2.5. Number and rate of newly reported cases of chronic hepatitis B virus infection, by state or jurisdiction — United States, 2020
Table 2.6. Number and rate of newly reported cases of chronic hepatitis B virus infection, by demographic characteristics — United States, 2020
Table 2.7. Numbers and rates of deaths with hepatitis B virus infection listed as a cause of death among residents, by state or jurisdiction — United States, 2016-2020
Table 2.8. Numbers and rates of deaths with hepatitis B virus infections listed as a cause of death among residents, by demographic characteristics — United States, 2016-2020
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Published: 23 April 2022

Hepatitis B and pregnancy: understanding the experiences of care among pregnant women and recent mothers in metropolitan Melbourne

Marvad Ahad 1 ,
Jack Wallace 1 , 2 , 3 ,
Yinzong Xiao 1 , 4 , 5 ,
Caroline van Gemert 1 , 5 ,
Gabrielle Bennett 4 ,
Jonathan Darby 4 , 5 ,
Paul Desmond 4 , 5 ,
Samuel Hall 4 ,
Jacinta Holmes 4 , 5 ,
Tim Papaluca 4 ,
Susanne Glasgow 4 ,
Alexander Thompson 4 , 5 ,
Margaret Hellard 1 , 5 , 6 , 7 , 8 ,
Joseph Doyle 1 , 7 &
Jessica Howell 1 , 4 , 5 , 6

BMC Public Health volume 22 , Article number: 817 ( 2022 ) Cite this article

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Pregnant women are a priority group for hepatitis B testing. Guideline-based care during antenatal and post-partum periods aims to prevent mother-to-child transmission of hepatitis B virus and lower the risk of liver complications in mothers. This qualitative study explored knowledge of hepatitis B and experiences of hepatitis B related care among pregnant women and mothers.

Semi-structured interviews were conducted with thirteen women with hepatitis B who were attending antenatal or post-partum hepatitis B care. The interviews were thematically analysed to assess knowledge and understanding of hepatitis B. Participants were recruited from specialist clinics in metropolitan Melbourne between August 2019 and May 2020.

Four major themes were identified from interviews: (1) knowledge and understanding of hepatitis B, (2) treatment pathways, (3) accessing hepatitis B related care, and (4) disclosing status to friends. Most participants displayed an understanding of hepatitis B transmission, including mother to child transmission. The main motivator of post-partum attendance was reassurance gained concerning their child’s health. Sources of hepatitis B information included doctors, online information and family. Participants identified parents and siblings as sources of support and reported an unwillingness to disclose hepatitis B status to friends.

Conclusions

Women attending antenatal or post-partum care reported having overall positive experiences, particularly regarding reassurance of their child’s health, but displayed misconceptions around horizontal transmission. Knowledge gained from these results can contribute to the development of targeted models of care for pregnant women and mothers with young children to ensure their successful linkage to care.

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Introduction

An estimated 257 million people globally are chronically infected with hepatitis B virus (HBV) and the most common route of acquisition is from mother to child during birth [ 1 ]. Without regular monitoring and timely treatment, people with chronic hepatitis B are at risk of death from liver cirrhosis and liver cancer [ 2 ]. In Australia, an estimated 1% of the population are living with hepatitis B, the majority of whom were born overseas in hepatitis B endemic countries (61%), most commonly in North-East Asia (21%) or South-East Asia (17%), where an estimated 30% to 50% have acquired infection perinatally [ 3 , 4 ]. Among women giving birth in Australia, hepatitis B prevalence varies widely by country of birth between 0.2% and 11%, with a significantly higher prevalence among women born overseas [ 5 ].

Vertical transmission, or mother to child transmission (MTCT), of HBV occurs via exposure to blood perinatally and is a key risk factor in hepatitis B infection globally [ 1 , 6 , 7 ]. Rates of MTCT need to be reduced if elimination targets are to be met [ 1 ]. As a response to targets set to increase diagnosis and treatment of viral hepatitis, priority populations in Australia were identified in the Third National Hepatitis B Strategy (2018–2022), which included pregnant women alongside people from culturally and linguistically diverse communities [ 8 ]. Addressing the barriers to hepatitis B care that Australia faces is critical for eliminating gaps in the cascade of care, ensuring that diagnosis rate goals are met, and that all those diagnosed receive appropriate treatment and management.

To address this, Australia has implemented routine screening of pregnant women for active hepatitis B infection and universal infant vaccination, which resulted in a decrease in newly acquired HBV cases [ 9 , 10 , 11 ]. However, gaps still exist in the cascade of hepatitis B care, including the linkage to care of women with hepatitis B during the postpartum period [ 12 , 13 ] The cascade of care for mothers includes initial screening in pregnancy, referral in the third trimester and post-partum follow up for mothers. While routine screening of pregnant women for hepatitis B infection represents an ideal opportunity to link women with hepatitis B into specialist care, there is an observed loss to follow up in the post-partum period [ 14 ].

Barriers to accessing specialist care and being maintained in care have been investigated for key population groups, including people from culturally and linguistically diverse communities in Australia . However, there is limited research on the potential barriers to specialist care for pregnant women and recent mothers as a key population. Within this population, there are two care needs that must be considered; firstly, the short-term care needs of the infant and, secondly, the mother’s long-term disease management needs.

An understanding of the experiences of women currently linked into hepatitis B related care could help to inform medical models of care for mothers in order to improve continued engagement in hepatitis B care. An exploratory qualitative design was employed with the aims to, firstly, explore women’s knowledge of hepatitis B and, secondly, explore their experiences in accessing hepatitis B related care during pregnancy and in the post-partum period.

This study employed qualitative semi-structured interviews (Additional file 1 : Appendix A) to explore women’s experiences in accessing hepatitis B related care during pregnancy and the post-partum period. The study used the consolidated criteria for reporting qualitative research (COREQ) in its development, implementation and reporting (Additional file 1 : Appendix B) [ 15 ].

Participants and recruitment

Women diagnosed with hepatitis B over the age of 18 years who were pregnant or had given birth within the preceding 18 months were recruited from specialist liver clinics in two tertiary hospitals in Melbourne, Australia. Recruitment was from August 2019 to May 2020. Potential participants were identified from medical records at specialist clinics and the interviewer then contacted the attending doctor to invite patients to participate in the study. Refusal to participate was not recorded. Face to face interviews held prior to March 2020 were conducted at the service that participants attended, either before or after their specialist consultation. One participant was recruited from the infectious diseases clinic and twelve from the specialist liver clinics. From March 2020 onwards, all interviews were conducted by telephone due to the COVID-19 pandemic that resulted in all outpatient hospital clinic appointments being conducted via telehealth.

Thirteen women aged 24–35 years were interviewed, three of whom were pregnant at the time of interview and ten had given birth in the last 18 months from time of recruitment. Repeat interviews were not performed. Twelve interviews were conducted in English, and one with an accredited Burmese phone interpreter. Participants 1 through 8 were interviewed at the relevant health service face to face, while participants 9 through 13 were interviewed via phone due to COVID-19 restrictions. Table 1 includes characteristics of participants, including cultural background as stated by participants.

Data collection

Demographic information was collected, including maternal age, weeks’ gestation or age of child, contact number, and residential address for distribution of participant information and consent form via mail. Semi-structured interviews were used to collect data using interview prompts based on existing literature and review by co-investigators (Additional file 1 : Appendix A). The interview prompts were related to hepatitis B knowledge (including treatment and transmission), sources of information, and previous and current experiences of hepatitis B related health care. The digitally recorded interviews were conducted in a private room at the health service or over the phone. Semi-structured interviews ranged between 13 and 35 min in length, with a mean length of 17 min. Interviews were audio recorded by Dictaphone and field notes were made both during and after interviews by the interviewing researcher.

Data collection stopped after data saturation. Verbal and written consent was provided prior to the interview, after participants were provided with a participant information and consent form, with an option to withdraw their consent at any time.

Data analysis

Audio files were transcribed by the interviewer and the resulting transcripts were de-identified. Data from interviews were analysed using Braun and Clarke’s criteria for thematic analysis to ensure that data collection and analysis was conducted comprehensively [ 16 , 17 ]. Data analysis was conducted by one researcher, the interviewing researcher, with guidance from senior researchers. Coding of transcripts began after the first interview and continued as subsequent interviews were conducted. Codes were derived from the data inductively, without the use of a pre-existing coding framework using NVivo12 software (QSR International Pty Ltd. Version 12, 2018). The data was coded inclusively; text surrounding the code of interest was included for context. The data was coded for patterns, frequency, sequence and causation. In the following analytic phase, codes were sorted into potential themes based on their relationship to the research question and to each other. Visual representations were used to form working themes. These themes were then refined, a detailed analysis on each theme was conducted, and themes presented.

This project received ethics approval from the Alfred Health Research Ethics Committee (HREC 149/19).

Major themes

Four major themes were inductively identified from participant interviews: (1) knowledge and understanding of hepatitis B, (2) treatment pathways, (3) accessing hepatitis B related care, and (4) disclosing status to friends.

Theme 1: Knowledge and understanding of hepatitis B

The majority of participants reported knowing how transmission of hepatitis B occurred. Most participants identified contact with blood as a means of transmission, while a few were unsure whether transmission could occur by contact with blood. Most of the interviewed women were aware of mother to child transmission, with some being aware of mother to child transmission before their pregnancy. One participant expressed that, while she did not know anything at all about hepatitis B, the one thing she wanted to know was how she came to acquire it.

Some participants expressed confusion over whether hepatitis B transmission could occur through sharing of food or cutlery, with one participant expressing confidence in her knowledge of this. A few women noted that while they had previously thought transmission could occur through sharing of food or cutlery, accurate information about transmission had been provided by her specialist during pregnancy. Provision of this information made a substantial change in one woman’s perception of herself:

Before knowing that [hepatitis B could not be transmitted through sharing food] I just felt very diseased and very gross. I didn’t want to share anything with anyone because I didn’t want to give it to anyone, but after knowing it makes you more at ease. (Participant 6)

Most of the interviewed women reported searching for hepatitis B information online. Wanting to know more about hepatitis B than what was explained by doctors was the main motivator for online searches. However, women expressed uncertainty over the credibility of information they found online and reported asking doctors for confirmation or advice. As is explained by a woman who was unsure if transmission could occur via sharing of food:

I tried to see if it could transfer from people to people by sharing drinks and food, but I couldn’t find that information… because I didn’t have the right person to talk to, I was still fifty-fifty percent until I saw the doctor here. (Participant 5)

In contrast, some women claimed that searching for information online was unnecessary as they felt they had received enough information from doctors, while others avoided searching for additional information so as not to increase their concern.

Family was also cited as a source of new information and support, with women saying that their parents provided support even if they did not significantly know about hepatitis B. All women reported being comfortable in speaking to their close family, which they defined as partners, parents, and siblings about hepatitis B. For those who had hepatitis B during their childhood or adolescence, discussion about family support included the role of parents and their experiences earlier in life.

My dad had this disease and according to my childhood in my case, we should drink lots of water … and we should eat healthy food. (Participant 12)

Some women were concerned about having children, and those with sisters who were also living with hepatitis B and who had children, reported their sisters’ experiences during pregnancy as valuable particularly in relation to transmission.

When we were little, I was thinking “If I have a baby, the baby will carry it on as well.” And at that time, we were young, so I was thinking, “I will never have kids”… But until a few years ago when my sister had a baby and in the hospital in Vietnam… so it gave me hope as well that I want to have a baby.” (Participant 5)

Theme 2: Treatment pathways

The majority of women interviewed said they knew that hepatitis B treatment was available. All participants expressed wanting to know more about treatment when asked. When discussing treatment, participants often included explanations of lowering viral load or viral levels, which in most cases included mention of a hepatitis B “carrier”.

They [the doctors] said I’m just a carrier in their words—so it’s just a little bit infection it’s not like I literally got it. (Participant 1)

During discussion of general knowledge of hepatitis B, women expressed uncertainty over their word choice, stating they were unsure if the terms used were ‘correct’ or ‘professional’. Others used words typically found in a biomedical context, particularly when discussing transmission and treatment, such as ‘viral load’, ‘asymptomatic’, ‘natural antibodies’, and ‘antigens’. Participants’ word choice when sharing their hepatitis B knowledge may be a reflection of their main sources of information, in this case, doctors.

Issues related to general health status were raised by participants during discussion of treatment. Participants reported exercise, a healthy diet, and lowering alcohol consumption as key health promoting interventions suggested by doctors, both overseas and in Australia. Discussion of alcohol consumption was linked to concerns of the long-term risk of liver cancer, as explained by one woman:

When I was young, I was drinking a lot. … But later on, when I was thinking, “Well I can’t keep going like this because one day if it turns out [as] cancer”. (Participant 5)

In some cases, women reported hearing of potential benefits of herbal medicines from their family, while most claimed to be unsure of their efficacy. One woman recounted her brother’s use of turmeric as treatment for hepatitis B:

One of my brothers said, because he is a pharmacist, he told us that the other brother has hepatitis B [and] decided not to go through the medical treatment. … my mum gave like turmeric every day and it was really really helpful and he’s fine now. (Participant 7)

Theme 3: Accessing hepatitis B care

This third theme concerned women’s experiences of accessing hepatitis B related care during and after their pregnancies. In interviews, women identified specialists as their main source of hepatitis B related information and recounted their experiences of accessing care throughout their life, including before, during and after pregnancy. Their overall experiences with specialists were positive, with women saying their doctors were important sources of information and their pregnancy provided them with the opportunity to learn more about hepatitis B.

Actually, I am very happy to go through this because the first thing is, if I was not pregnant, I wouldn’t remember [about hepatitis B] … Probably a lot of people have a problem, but they don’t know. (Participant 1)

Even though women were attending consultations for their own care, the main concern during pregnancy for participants was the health of their child; most expressed worries about transmitting hepatitis B to their child. Women disclosed that they were satisfied to hear from specialists that transmission could be prevented. Participants also reported that receiving clear and useful information from doctors helped to reduce their worries about their child’s health. One woman explained her initial reluctance to start antiviral therapy:

… at first, I was like hesitant—reluctant—to start the medication because I thought it might affect the baby. But after they explained everything to me, they convinced me to start the medication… (Participant 8)

Women also recounted positive experiences during the post-partum period at the liver clinics, except for two cases, where participants explained not being provided with the result of their child’s blood test which was not linked to the institution to which they were attending for their own care. However, follow up of children was still mentioned by participants when discussing their own experiences. The reassurance gained from specialist sessions concerning their child’s health was described as the main motivator for attendance by women.

The importance of continuing to attend appointments during pregnancy was raised during discussion. Participants mentioned that doctors would encourage attendance and mention the benefits of future monitoring for mothers with hepatitis B beyond their pregnancy.

I was very looked after and if there were any concerns, they made sure that I was monitored and [they were] really friendly, very positive. (Participant 9)

Factors presented as difficulties for attending appointments included distance, parking, not feeling like attending, and for one participant who due to her visa type needed to pay for the cost of consultations. Women placed emphasis on the friendliness of staff and the atmosphere of the waiting areas at the service location they attended. This is exemplified by a participant who cited a reason for not attending her previous clinic:

Parking was a pain and the place just looked really scary I didn’t like going there very much… ’cause you’re like in a room full of people that you know also have different things as well—and hospitals just look scary. (Participant 6)

Approximately half of the interviews were conducted by telephone due to the limiting of face to face health service provision as a result of COVID-19 restrictions. Several of the women rescheduled appointments given the disruptions due to the pandemic and preferred using telehealth as it was more flexible. Only two participants expressed preferring attending in person.

With COVID happening, my last appointment got moved to a telephone appointment, which was so much better. […] it was really good just not having to go the extra distance because I live 45 minutes out of the city at the moment and distance—so having to save me doing that drive with a child is awesome. (Participant 9)

Theme 4: Disclosing status to friends

All women interviewed said they would not usually disclose their hepatitis B status to friends as they feared social exclusion as a result of misconceptions about transmission. Another reason provided was that an individual’s health was a private concern which is not discussed between friends.

I don’t normally tell my friends that I am a hep B carrier because I don’t know how they would think of me […] they might not know much about hepatitis B like me, so they may avoid being close to me… (Participant 4)

While friends living with hepatitis B were sources of information for some women, others said they kept sharing of information to a minimum or they preferred not to talk about it at all. Some were comfortable in discussing hepatitis B with their friends in general without disclosing their own status. Participants expressed that they felt responsible for protecting others, which was linked to the misconception that HBV is transmitted by sharing of food. This is explained by one woman who, despite now knowing that transmission cannot occur by sharing of food, continued to feel this responsibility. She describes the mental burden of worrying about potentially infecting others:

I believed that if we shared drinks or shared foods we may catch it as well. I didn’t want to affect my friends… I didn’t want them to catch whatever I got. […] I’m just afraid with people, knowing that I’ve got something that can’t be treated or no treatment—it’s like a kind of disability thinking. (Participant 5)

The connotations of the word ‘hepatitis’ were said by some to include a relationship between HIV and hepatitis B, which made them question what their friends would think if they were to share this information with them. The possibility that friends may not understand how hepatitis B was transmitted also made women hesitant to tell their friends.

Some people may think that “Oh hep B is like HIV!”, you know? “You can get it so easily”—or some people think that if you eat together, they may get it as well. (Participant 4)

Pregnancy provides a unique opportunity to engage and understand the experiences of women with chronic hepatitis B infection. However, until this work very little research has been undertaken in this area. In this study of firsthand recent experiences of pregnancy, four themes were identified from data collected from women attending hepatitis care, including: (1) knowledge and understanding of hepatitis B, (2) treatment pathways, (3) accessing hepatitis B related care, and (4) disclosing status to friends. Importantly, participants displayed a basic understanding of hepatitis B as a transmissible virus, however, there were certain areas of uncertainty despite their engagement in care. A main driver of attendance was to prevent harm to their baby; and most participants reported positive experiences of care. Nevertheless, our findings suggest that specialist clinics could provide better education, support, and counselling to this group.

Participants displayed a basic understanding of hepatitis B as a transmissible virus, however they still expressed worries regarding horizontal transmission. Misconceptions of transmission through the sharing of food have been identified in the literature among the wider population of people with chronic hepatitis B [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. While participants in this study understood that transmission could not occur by sharing of food, their knowledge did not override their anxiety of transmitting it to others. Most participants were aware of MTCT of hepatitis B and knew that transmission to infants could be prevented. Women expressed concerns regarding potential transmission of hepatitis B to their child both before and during their pregnancy, which was alleviated by reassurance received from specialists while attending the clinic, with particular mention of child immunisation.

The importance of ongoing monitoring and maintaining a healthy lifestyle were discussed in conversations about treatment, as presented in the second theme. Participants reported searching about hepatitis B online when seeking information beyond what was provided by specialists, supporting findings from international quantitative studies on hepatitis B knowledge of mothers where healthcare professionals and the internet were identified as the main sources of hepatitis B information [ 25 , 26 , 27 ]. However, the data gathered showed that women prefer hearing from doctors, as they could not be confident of the validity of online information. This opens an opportunity for the promotion of information from a reputable community source that women could rely on.

The third theme derived from the data collected related to the accessing of hepatitis B care during pregnancy and after birth. Participants related positive experiences at their respective clinics, placing an emphasis on the health of their child. Studies in the USA and the UK have identified HBV follow up with mothers after birth to be suboptimal and a lack of a formal referral mechanism was observed [ 28 , 29 , 30 ]. In Australia, follow-ups of mothers post-delivery was found to be either lacking or not well documented [ 6 , 31 ]. Ten of the thirteen participants interviewed in this study were attending appointments after birth at the time of interviewing. In two cases, participants recounted experiencing difficulties in the follow-up process regarding their child. The data shows that women brought up discussion of their child’s health when discussing both their own hepatitis B related care. This highlights a continued emphasis on the child’s health as the main motivator for post-partum appointment attendance, reflecting an underlying area of concern from mothers. Currently, the two care pathways for mother and child for hepatitis B related care are separate. This leads to the question of how to best retain mothers in care and whether the development of a model of care targeted to mothers would lead to increased engagement in specialist care for women during the post-partum period.

The fourth theme dealt with disclosure of hepatitis B status to friends. Stigma and marginalisation of people with hepatitis B is widely reported, which usually occurs after a person discloses their infection [ 32 ]. All participants reported they would not typically disclose their hepatitis B status to their friends given their concern over the effect on existing relationships, including the risk of social exclusion, which has been found in other studies [ 18 , 33 ]. Immediate family members were noted by several participants as a source of information and support and highlights emerging literature on the supportive role of families in blood borne viruses [ 34 ].

Strengths, limitations, and future directions

A strength of this study was that it focussed on a key population on which little research has been undertaken previously. Qualitative inquiry in this area allowed for understanding the experiences of care during pregnancy and after birth from the perspectives of women themselves. Additionally, an inductive approach to thematic analysis allowed for themes to be derived directly from the first-hand experiences of the women who participated in the study,

Limitations of this study include the possibility of recruitment bias given that recruited participants were already linked into care and actively attending specialist clinic appointments for their own hepatitis B care. Actual barriers to attendance may be different from the perceived barriers shared by women who were linked into care and attending appointments. Additionally, while confidential, interviewed participants may have been concerned that results may impact their relationship with the service provider. Twelve of thirteen interviews were conducted in conversational English, and one by phone interpreter. As previous studies have identified limited English proficiency as one of the barriers to receiving adequate HBV education during pregnancy, future qualitative studies should include non-English speaking participants [ 6 ].

Additionally, future qualitative studies should engage pregnant women and recent mothers who are not currently linked into care. The data gained from this study could also be used for the development of quantitative studies concerning hepatitis B knowledge of pregnant women or assessment of engagement in care.

Women living with hepatitis B had positive experiences of antenatal and post-partum hepatitis B specialist care, especially regarding reassurance of their baby’s health, their own health and the importance of ongoing monitoring. Findings from this study suggest that specialist clinics could support better education and support for pregnant women and recent mothers with hepatitis B. Diagnosis and engagement in care is currently suboptimal in Australia and is a challenge in the field. As a poorly researched area, the themes identified in this explorative qualitative study show further avenues that need to be explored in order to improve hepatitis B care services for mothers post-partum. Further investigation could inform the design of specialist medical services to improve their accessibility and ensure successful linkage to care of mothers.

Availability of data and materials

The datasets generated during and analysed during the current study are not publicly available due to limitations of ethical approval involving the participant data and anonymity, but are available from the corresponding author on reasonable request.

Abbreviations

Hepatitis B virus

Mother to child transmission

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Acknowledgements

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Marvad Ahad, Jack Wallace, Yinzong Xiao, Caroline van Gemert, Margaret Hellard, Joseph Doyle & Jessica Howell

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MA led the study, conducted the qualitative interviews, analysed the data and wrote the manuscript. JW provided qualitative expertise for the study and co-wrote and approved the manuscript. JD and JH conceived the study design, mentored MA for conduction of the study and co-wrote and approved the manuscript. YZ, CG, GB, JDa., PD, SH, JHol., TP, SG, AT, and MH provided expertise and reviewed and approved the manuscript.

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JH has received speaker fees and investigator-initiated grants from Gilead Sciences. JD reports funding to his institution for investigator-initiated research from Gilead Sciences and Abbvie; and consultancies from Gilead Sciences and Abbvie. MH receives funding from Gilead Sciences and Abbvie for investigator-initiated research. AT has received consulting fees from Gilead, Abbvie, Roche, BMS, Merck, Immunocore, Janssen, Assembly Biosciences, Arbutus, Eisai, Ipsen and Bayer, speaker fees from Gilead Sciences, and investigator-initiated grants from Gilead Sciences. Burnet Institute acknowledges support from the Victorian Government Operational Infrastructure Fund.

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Additional file 1: appendix a..

Semi-structured interview guide. Appendix B. COREQ (COnsolidated criteria for REporting Qualitative research) Checklist.

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Ahad, M., Wallace, J., Xiao, Y. et al. Hepatitis B and pregnancy: understanding the experiences of care among pregnant women and recent mothers in metropolitan Melbourne. BMC Public Health 22 , 817 (2022). https://doi.org/10.1186/s12889-022-13112-0

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Prevalence of viral hepatitis infection in India: A systematic review and meta-analysis

Dhasarathi kumar.

Research Scholar, School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India

Roshni M. Peter

1 Department of Community Medicine, SRM Medical College and Research Centre, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India

Alex Joseph

2 Division of Epidemiology, School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India

Kalpana Kosalram

3 Division of Health Policy and Management, School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India

Harpreet Kaur

4 Scientist F, ICMR Headquarters, Department of Infectious Diseases, Tribal Health Research, New Delhi, India

BACKGROUND:

Nowadays, Viral Hepatitis can be comparable to the big three communicable diseases: tuberculosis, HIV/AIDS, and malarial infections. The main purpose of this study was to summarize the prevalence of viral Hepatitis in India from peer-reviewed articles published from February 2000 to February 2021.

MATERIALS AND METHODS:

We conducted a systematic search on Science Direct, Scopus, Medline, PubMed, Web of Science, Google Scholar, and other open access journals. We evaluated all relevant papers that looked into the prevalence of viral Hepatitis systematically. Finally, 28 studies on viral Hepatitis published from February 2000 to February 2021 have been selected. These studies have been conducted across the northern, southern, central, eastern, and western regions of India.

Twenty-eight full-text publications were obtained and evaluated consisting of 45,608 research participants. Hepatitis A was found to range from 2.1% to 52.5%. Hepatitis B was found in a wide range of individuals, ranging from 0.87% to 21.4% of the population. Hepatitis C was found to range from 0.57% to 53.7%. The majority of the children were affected by hepatitis A, and 47.4% of third-trimester pregnant mothers were affected by hepatitis E. Diabetes, hospital admission, history of jaundice, history of surgeries, and heterosexual contact were the leading modes of acquiring HBV and HCV infections. As a result of its great magnitude, this disease poses a severe threat to the national healthcare system.

CONCLUSION:

Effective public health measures are urgently needed to minimize the burden of viral Hepatitis and eliminate the disease.

Introduction

Viral Hepatitis is one of the major global public health issues, and every year millions of individuals suffer from it.[ 1 ] Viral Hepatitis caused 1.34 million fatalities worldwide in 2015, with the majority of viral Hepatitis deaths owing to chronic liver disease or primary liver cancer (mortality due to cirrhosis: 720,000; hepatocellular carcinoma (HCC): 470,000). The death rate from viral Hepatitis has continued to climb over time.[ 2 ] Nowadays, viral Hepatitis can be comparable to the big three communicable diseases: tuberculosis, HIV/AIDS, and malarial infections.[ 3 ] Viral Hepatitis can be caused by any of the known five hepatotropic viruses, namely Hepatitis A Virus (HAV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Hepatitis D Virus (HDV), and Hepatitis E Virus (HEV).[ 4 ] Based on the 2017 global Hepatitis report, a large number of individuals do not have access to screening and treatment for Hepatitis, consequently leading to Chronic Liver Disease (CLD) and cancer mortality due to Hepatitis.[ 5 ] The World Health Organization (WHO) is urging countries to take quick action to increase the knowledge, diagnosis/testing, and treatment services for Hepatitis. According to a WHO report, one in twenty individuals are living with viral Hepatitis.

HAV and HEV are enterically transmitted pathogens that produce sporadic infections as well as outbreaks of Acute Viral Hepatitis (AVH).[ 1 ] HAV is a single-stranded RNA virus and it is mostly transmitted through the fecal-oral pathway.[ 6 ] In India, HAV infection is common among children, and it generally leads to mild anicteric Hepatitis. The majority of children under the age of two (85%) and nearly half of those aged two to five years (50%) have nonspecific symptoms and are usually anicteric.[ 2 ] HAV infection disease severity increases with the patient's age and the prevalence of existing chronic liver diseases.[ 4 , 7 ]

Chronic HBV affects 240 million persons worldwide and chronic HCV affects 130–150 million.[ 1 , 4 ] Chronic Hepatitis affects approximately 400 million individuals worldwide, with the Asia-Pacific area serving as the hub of the epidemic.[ 1 ] HBV and HCV are mainly transmitted through the parenteral route and are known to cause chronic Hepatitis, which can progress to serious consequences such as liver cirrhosis and HCC.[ 8 ]

HBV and HCV infections are more alike, which include distribution, hepatotropism, disease transmission, and at last leading to chronic infection which may end in liver cirrhosis and HCC.[ 4 , 9 ] HBV and HCV infections do not have a standard of care due to the individual category of infected subjects so it is difficult to cure.[ 10 ] Thus, studying the magnitude becomes a crucial component in prevention of HBV and HCV. The current review aimed to summarize the prevalence of viral Hepatitis in India from peer-reviewed articles published from February 2000 to February 2021.

Objectives of the study

To study the overall prevalence of viral Hepatitis in India from peer-reviewed articles published from February 2000 to February 2021.

To review the determinant factors of viral Hepatitis in the Indian region with the included article.

Operational definitions

Hepatitis: According to Centers for Disease Control and Prevention (CDC) “Hepatitis is an inflammatory disease of the liver caused.”

Funnel plot: “A funnel plot is a simple scatter plot of the intervention effect estimates from individual studies against some measure of each study's size or precision.”[ 11 ] Funnel plot is a graphical representation used to detect systematic heterogeneity and publication bias.

Materials and Methods

Study design and setting.

Systematic review and meta-analysis: Selected studies have been conducted across northern, southern, central, eastern, and western regions of India.

Study period

Studies published from February 2000 to February 2021 were considered for systematic review and meta-analysis.

Study participants

We included studies of the general population, community studies on children, pregnant women, type 2 diabetes patients, and Voluntary Blood Donors (VBD).

Study selection/Information source

We conducted a systematic search in key databases of scientific articles using Web of Science, Scopus, Medline, PubMed, Science Direct, Cochrane Library, websites of international medical associations/public health journals, Embase, Google Scholar, and other open access journals.

Literature search strategy

With the help of MeSH terms, Boolean operators, and appropriate keywords, suitable articles were identified for the systematic review. MeSH Terms: magnitude AND (“virology” [MeSH Terms] OR “virology” OR “viral”) AND (“Hepatitis” [MeSH Terms] OR “Hepatitis” OR “Hepatitis a” [MeSH Terms] OR “Hepatitis a”) AND (“infections” [MeSH Terms] OR “infections” OR “infection”) AND “India” [MeSH Terms] OR “India”.

Data collection tool and technique

We thoroughly reviewed all relevant articles published in India that estimated the prevalence of viral Hepatitis. Titles and abstracts of the relevant research paper were identified from the scientific database, and searches were done by three independent researchers onscreen. Hypothetically significant studies were selected. Inclusion and exclusion criteria are given below. The full-text paper was collected wherever possible, even from the open access journal.

Inclusion criteria of the studies

Inclusion criteria included studies that studied the magnitude of viral Hepatitis infection. The study should be from the Indian region, published in the English language, and should include an India-based epidemiological study. Studies published from February 2000 to February 2021 were considered. Various types of epidemiological study designs, such as cross-sectional, case–control, prospective/retrospective investigations, and longitudinal studies, were employed in selected studies. The current review did not have any restrictions on age and type of population. Systematic screening of the relevant papers was done. After the screening process, we reviewed the full papers and extracted the data for meta-analysis. Nine studies were included for meta-analysis [refer to Table 1 ].

Basic characteristics and summary of results of included studies (Source: Secondary research data)

Exclusion criteria of the studies

Other language articles, case reports, conference papers and abstracts, preprints, and review papers were excluded. The studies that did not meet the inclusion criteria were excluded from this systematic review.

Quality assessment and data extraction

The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of nonrandomized studies.[ 12 ] Two different scales of a NOS checklist were used to assess the quality of individual studies.[ 13 , 14 ] Selected studies clearly stated the aim and/or objective of the study, clearly mentioned study design, clearly defined participants, appropriate sample size, missing and replacement of data and data management, and clearly discovered and reported the characteristics of the participants. The information was gathered by DK, KK, and RM and cross-checked by AJ and HK.

Three independent reviewers carried out the data extraction procedure with the help of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.[ 15 ] The NOS was used to assess the quality of studies that were chosen. Data extraction was done by five of the three independent researchers using the Cochrane collaboration data extraction form or data collection form.[ 9 ] Each paper was assigned to another researcher and the extraction was verified by them. Information regarding the title, aim, and objectives, methodology details such as study design, the sample size, the place where the study was conducted, the respondent's details, and the key results and conclusions of the studies were extracted by the researcher. The risk of bias in an individual study was assessed based on the quality of studies and the NOS.[ 11 , 12 ]

Ethical consideration

Being a larger part of the project, the current review was approved by the Institutional Review Board (IRB) of SRM School of Public Health, SRMIST, Kattankulathur, and Tamil Nadu on March 7, 2019. Ethical code is P0/2019/001 (IRB protocol number). Data and study information were gathered from previously published studies that have ethical clearance. The current review is a part of the project and under this, we provide training and enhance the community's knowledge regarding viral Hepatitis.

Data analysis

Finally 28 studies has been selected, the overall magnitude of viral Hepatitis was analyzed and reported. Among these selected studies, only nine studies were used for meta-analysis since they found the co-infection of HBV and HCV. Meta-analyses were carried out using the R programming language (R -version 3.6.1). Meta-analysis was used to look into the co-infection of HBV and HCV within the study population. Because few studies have been conducted in numerous locations, we were unable to locate subgroup analyses. The result was provided as a pooled prevalence for the overall studies, with 95% confidence intervals (95% CI). Selected study proportions were calculated as a pooled effect with a 95% CI. The publication bias was assessed using a funnel plot, which was then confirmed using Egger and Harbord statistical tests. Statistical significance was set at P < 0.05 for all computations except heterogeneity testing between studies.[ 16 , 17 ]

Synthesis of results

According to the PRISMA flowchart [ Figure 1 ], an electronic search generated a total of 2334 citations. The article were reviewed based on titles and abstracts, and non-relevant studies were excluded based on the exclusion criteria. After the exclusion, 28 articles were selected for further investigations. Only 28 publications out of all the studies matched the inclusion criteria; hence they were included in the descriptive synthesis of results. Only nine papers were included in the meta-analysis; the remainder were eliminated because they did not match the meta-analysis inclusion criteria.

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Object name is JEHP-12-103-g001.jpg

PRISMA studies (Source: Secondary research data)

Study selection

The quality of chosen studies was assessed using the NOS. The studies that were included were chosen based on the inclusion criteria.

Study characteristics

We found and evaluated 28 full-text publications with a total of 45,608 research subjects.

In total, nine studies reported co-infection of HBV and HCV. Table 2 shows the descriptive characteristics. The pooled sample size in the analysis was 25,326. The pooled proportion for the outcome was <0.001% (95% CI: <−0.001% to 0.001%) [ Figure 2 ].

Summary results of nine studies that were included for meta-analysis (Source: Secondary research data)

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Object name is JEHP-12-103-g002.jpg

Forest plot of co-infection of hepatitis infection (Source: Secondary research data)

We found substantial homogeneity among the studies, reporting outcomes with I 2 = 19.52% ( P -value <0.05) [ Table 3 ]. Table 4 shows the regression test for the funnel plot asymmetry. Egger's test for publication bias was significant with a P value <0.002 (95% CI: 1.47 to 5.24). We could not find the possible impact of publication bias on the shape of the funnel plot [ Figure 3 ].

Random-effects model (k=9) and heterogeneity statistics (Source: Secondary research data)

Tau 2 Estimator: Restricted Maximum-Likelihood

Regression test for funnel plot asymmetry and fail-safe N analysis (Drawer analysis) (Source: Secondary research data)

Fail-safe N calculation using the Rosenthal approach

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Object name is JEHP-12-103-g003.jpg

Funnel plot of co-infection of HBV and HCV (Source: Secondary research data)

Table 1 shows the descriptive characteristics, overall prevalence and risk factors of Hepatitis in selected studies: Overall, 45,608 individuals were recruited in the 28 included studies. In terms of study design, the majority of the studies were hospital-based and cross-sectional, followed by retrospective/prospective studies and one case–control study and one longitudinal study. In terms of sex distribution, most of the studies were conducted on both sexes. All studies defined the age and sex distribution of the population. In terms of population, studies were conducted on the community (general population), blood donors, volunteers, pregnant women, drug users, and patients with inflammatory bowel disease, patients with chronic liver disease, hemodialysis patients, and HIV-positive patients.

Most of the children affected by HAV and HEV alone account for 47.4% of third-trimester pregnancy mothers. Other types of parenteral exposure-such as contact with abraded skin of an HBV-infected individual and maternal infection during pregnancy-were the main routes of HBV transmission in India.[ 45 ] As per the study done by Barde et al .,[ 23 ] the proportion of co-infections was higher in adults than children. Acharya et al .[ 46 ] described HAV-related liver disease as uncommon in India and noted that it occurred mainly in children. Pregnant women and patients with CLD constitute the high-risk groups to contract HEV infection. Grewal US et al .,[ 28 ] stated that the main risk factors of acquiring HBV and HCV infection are unsafe blood transfusion and drug addiction.

The overall prevalence of HAV ranged from 2.1% to 52.5%. The overall prevalence of HBV ranged from 0.87% to 21.4%. The overall prevalence of HCV ranged from 0.19% to 53.7%. The overall prevalence of HEV ranged from 10.54% to 68.42%. A systematic review by Desikan et al .[ 47 ] showed the high prevalence of HBV-HCV co-infection in chronic liver patients, followed by HIV-positive patients, followed by persons who injected drugs, and kidney disease patients. A study by Nelson et al .[ 48 ] showed that Injecting Drug Users (IDUs) had anti-HCV rather than HIV infection. A study by Bhate et al .[ 39 ] showed that being a healthcare worker ( P = 0.001) and having a tattoo ( P = 0.03) were significantly associated with HBsAg-positive in the community. Studies done by Khan et al .,[ 37 ] and Prakash et al .,[ 44 ] also showed that blood transfusion was a significant risk factor for both HBV and HCV. A hospital-based study done by Agarwal et al .[ 27 ] showed that blood transfusion and sexual contact was a statistically significant risk factor for HCV infection ( P < 0.05). A study done by Mittal et al .[ 36 ] showed that persons who had received multiple blood transfusions and had a history of Hepatitis among family members were at higher risk of acquiring HBV. Sexual behavior, childhood transmission, reusable syringes, blades, during blood transfusion, previous history of Hepatitis B, tattooing, and being health care workers were found to be associated risk factors for Hepatitis B.

The prevalence of Hepatitis B was higher before the implementation of HBV universal vaccination program and it has been decreased from 12.80% between 1996 and 2001 to 11.11% between 2012 and 2017. The prevalence was also higher in rural areas (17.35%) than in urban areas (11.11%), and a few Indian studies have stated that Chronic Hepatitis B (CHB)/HBV is hyperendemic among tribes, with a prevalence of 22%.[ 49 ] A population-based study by Shanmugam et al .[ 50 ] showed a similar prevalence of HBV and HCV, which were 1.3% and 0.3%, respectively. The current review shows the prevalence of 1.43% for HBsAg and 0.57% for HCV among the blood donors, which is similar to a study done by Khan et al .[ 51 ] Jain et al .'s[ 32 ] study showed that HEV was the major cause of acute hepatic failure, and fecal contamination of drinking water and food was a significant risk factor.[ 33 ]

Jafari et al .[ 52 ] reported combined odds ratios (ORs) for the association between tattooing and HBV (1.48 [1.30–1.68]). Populations engaged in high-risk behaviors has highest correlation between tattooing and risk of HBV (OR = 1.64, 95% CI: 1.32–2.03), which is agreeable with Bhate et al .'s[ 39 ] study.

According Candotti et al .,[ 53 ] HBV is a “transfusion-transmitted infection”, which is comparable with multiple studies under this review, namely, Grewal et al .,[ 28 ] Khan et al .[ 37 ] Prakash.,[ 44 ] and a hospital-based study conducted by Agarwal et al .[ 27 ] A study by Mittal et al .,[ 36 ] agreed that those who had multiple blood transfusions and a family history of Hepatitis were more likely to contract HBV.

According to a study of Pakistani Punjabi patients with CLD who were tested for HBV, significant risk factors for HBV transmission included barber risk (23.60%), blood transfusion risk (4.04%), history of injection (26.19%), reuse of syringes (26.60%), dental risk (11.20%), and surgical procedure risk (4.26%).[ 54 ] This is similar to the current review in which sexual behavior, reusable syringes, blades, and blood transfusion were found to be associated risk factors for HBV.

The persistence of unsafe injection-linked HIV and HCV transmission that could be stopped with proven and cost-effective measures remains one of the great failures of the global responses to these diseases.[ 55 ] HBV and HCV were considered difficult to cure due to the individual category of infected subjects.[ 6 ] The data also reinforces the need for establishing effective prevention programs, which could lead to a reduction in the prevalence of viral Hepatitis.[ 25 ] Therefore, a country-specific prevalence estimate of HBV/HCV co-infection would be required for making evidence-based policies related to screening programs, resource distribution, and general prevention and treatment strategies for HBV-HCV co-infection.

Limitations and recommendations

Strengths: Selected studies were analyzed and cross-validated via NOS and the selected papers were also checked based on the STROBE guidelines and current systematic review followed PRISMA guidelines.

Limitations: Heterogeneity between the selected studies was the limitation of this review. Even though selected studies were conducted in various regions and types of populations, it led to heterogeneity. We could not find a subgroup analysis, since only a few studies were done in multiple locations. Study participants were belong to the Indian region, so this review cannot be generalized to global population. Studies included in the review were epidemiological studies, so only prevalence and some relationships could be exposed. The temporality of the relationship was not established.

Conclusions

The overall prevalence of HAV ranges from 2.1% to 52.5%. The overall prevalence of HBV ranges from 0.87% to 21.4%. The overall prevalence of HCV ranges from 0.19% to 53.7%. The overall prevalence of HEV ranges from 10.54% to 68.42%. To our knowledge, the overall burden of viral Hepatitis in India has not been estimated for the last decade; thus, the current study will contribute to national-level representation. This existing systematic review paves the way to develop evidence-based results and combat viral Hepatitis. Viral Hepatitis is clearly an important public health problem and burden in India. As described by its high prevalence, this problem is a significant challenge to the national health care system. There is an urgent need for effective public health interventions to reduce the burden and eliminate the problem.

Registration and protocol: The current review has a number of observational study designs. Due to this, the review was not registered under PROSPERO.

Data availability statement: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Contributorship statement: The conceptualization of the current study was done by AJ and HK. The data extraction was done by DK, KK, and RM. Formal analysis was done by DK. Writing of the original draft was done by DK, KK, and RM. Supervision, review, editing, and cross-validation were done by AJ and HK.

Abbreviations

AIDS: Acquired immunodeficiency syndrome; AVH: Acute viral hepatitis; Anti-HBC: Antibody to Hepatitis B core antigen; BCC: Behavior change communication; BKV: BK virus; GBD: Global Burden of Disease; CMV: Cytomegalovirus; CHB: Chronic hepatitis B; CLD: Chronic liver disease; FHF: Fulminant hepatic failure; HAV: Hepatitis A virus; HBV: Hepatitis B virus; HBsAg: Hepatitis B surface antigen; HCV: Hepatitis C virus; HDV: Hepatitis D virus; HEV: Hepatitis E virus; HIV: Human immunodeficiency virus; HCC: Hepatocellular cancer; ICMR: Indian Council of Medical Research; IgM: Immunoglobulin M; SDG: Sustainable Development Goal; T2DM: Type 2 diabetes mellitus; MoFH: Ministry of Health and Family Welfare; NOS: Newcastle-Ottawa Scale; NVHCP: National Viral Hepatitis Control Program; OLP: Oral lichen planus; OR: Odds ratio; VBD: Voluntary blood donors; and 95% CI: 95% Confidence intervals

Financial support and sponsorship

The study conducted was funded by the Indian Council of Medical Research (ICMR) with the sanction number of Tribal/CFP/20/2018-ECD-II.

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

The authors acknowledge with thanks for the help received from the Indian Council of Medical Research (ICMR) and the faculty of the School of Public Health, SRMIST. We also acknowledge Dr. Arulmani Thiyagarajan for his valuable contributions.

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Case Report: Application of hepatitis B virus (HBV) deep sequencing to
We obtained written consent from this patient both for enrolment into the Oxford Hepatitis Cohort Study, and for his specific agreement to publication of this individual case report. Data availability. ... From clinical experience, we know of one case with acute hepatitis B, the patient had previous serological records supporting HBV naivety ...
Screening for Hepatitis B Virus Infection in Adolescents and Adults
Answers. 1. The correct answer is E. The USPSTF recommends screening for HBV infection in adolescents and adults who are at high risk of infection. The patient is considered to be at high risk ...
Hepatitis B virus: Case studies
The management of hepatitis B virus (HBV) infection is complex and depends upon multiple factors including clinical variables (eg, the presence or absence of liver inflammation and/or cirrhosis), the patient's immunologic response to infection (eg, hepatitis B e antigen status), virologic factors (eg, HBV DNA level and genotype), and risk ...
Patient Case Presentation
Patient Case Presentation. Our patient, Mr. Smith, is a 43 year old caucasian male who came in today with complaints of fatigue, anorexia, malaise, nausea, vomiting, abdominal pain, and low grade fever for the past month, and recently has been alarmed by the discoloration of his skin and sclera turning yellow.
PDF Training workshop on Hepatitis B and hepatitis C screening, diagnosis
Persons with chronic hepatitis B (CHB) need follow up and monitoring before, during and after discontinuation of antiviral therapy. We are first going to re-cap some important concepts. Before starting treatment, the person should be evaluated for host liver injury, viral status and presence or absence of cirrhosis.
Hepatitis B
Hepatitis B is an infection of the liver caused by the hepatitis B virus. The infection can be acute (short and severe) or chronic (long term). Hepatitis B can cause a chronic infection and puts people at high risk of death from cirrhosis and liver cancer. It can spread through contact with infected body fluids like blood, saliva, vaginal ...
2020 Hepatitis B
Chronic Hepatitis B. During 2020, a total of 11,635 newly identified cases of chronic hepatitis B were reported to CDC, corresponding to a rate of 5.0 cases per 100,000 people. The rate of newly reported chronic hepatitis B cases among Asian/Pacific Islander persons (17.6 cases per 100,000 people) was almost 12 times the rate among non-Hispanic ...
Hepatitis B and pregnancy: understanding the experiences of care among
Pregnant women are a priority group for hepatitis B testing. Guideline-based care during antenatal and post-partum periods aims to prevent mother-to-child transmission of hepatitis B virus and lower the risk of liver complications in mothers. This qualitative study explored knowledge of hepatitis B and experiences of hepatitis B related care among pregnant women and mothers.
Case Report: Reactivation of chronic hepatitis B during treatment with
Antiviral therapy for chronic hepatitis B (CHB) has modified the clinical evolution of the disease with an improvement in terms of morbidity, mortality and quality of life. ... Contributors: BC and OS provided care of the patient in the case study. BC is the attending physician; he managed the patient's care from point of initial diagnosis, and ...
Full article: Clinical outcomes of treatment-naïve HBeAg-negative
Chronic hepatitis B virus (HBV) infection is a global health threat resulting in approximately 800,000 deaths annually worldwide [1-3]. ... real-world cohort study, we aimed to investigate the association of HBsAg levels and clinical outcomes in treatment-naïve HBeAg-negative patients with undetectable HBV DNA and normal ALT, with a ...
Hepatitis A and B Case Study
Hepatitis A and B Case Study. Jon and Laura Green are siblings sharing similar symptoms. Both have a yellow tinge to their skin and the whites of their eyes. Both have flu-like symptoms. Jon, however, has been living in Brazil while Laura has been in San Francisco. Is this a weird sibling connection?
The Role of Primary Health Care in Hepatitis B Testing and Management
Given the projected high hepatitis B prevalence of the case study site and cultural diversity of its residents, the low number of patients identified with CHB attending the clinic was an unexpected finding. Based on the available data it was assumed there was an evidence-practice gap related to implementation of the Australian Hepatitis B ...
Prevalence of viral hepatitis infection in India: A systematic review
A meta-analysis of case-control studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma in China. Br J Cancer. 2005; 92 :607-12.