Epidemiology, course and disease burden of chronic hepatitis B virus infection. HEPNET study for chronic hepatitis B: a multicentre Greek study

Abstract

Hepatitis B virus infection (HBV) has been recognized as a major health problem worldwide. Greece belongs to the intermediate endemicity countries with a trend of decreasing prevalence of HBV infection during the last decade. However, the recent massive immigration to our country may have led to alterations of HBV epidemiology. In this study, we evaluated the epidemiological features of HBV infection in a sample of 3480 patients followed up during the years 1997-2006. Immigrants mainly from Albania represented the 18.6% of the total study population and 56.6% of children. The majority of the patients had no family history of HBV infection (67.3%) or of acute hepatitis (95.4%), no known source of infection (64.6%), with intrafamilial spread accounting for 16.9% of the HBV transmission in adults and 33.9% in children. HBeAg(-) hepatitis B was the predominant form of hepatitis (92.1%) among the Greek patients in contrast to the immigrants where 16.6% were HBeAg(+). Liver cirrhosis was diagnosed in 8.8% of the total population and 0.9% had hepatocellular carcinoma. A high proportion of children were HBeAg(+) (62%), 55% from immigrant families, 25.2% were infected in the perinatal period and had no evidence of disease complications. In conclusion our results showed (a) a changing pattern in the epidemiology of HBV infection in Greece due to the significant number of HBeAg(+) patients, especially among children and (b) a considerable number of patients although aware of their infection, present with advanced disease.

Spontaneous preterm birth in women with chronic hepatitis B virus infection

“…Also, the vast majority of HBsAgpositive women (97.15%) were HBeAg-negative and anti-HBepositive, which is consistent with reports recently published in Greece [15]. The dominance of the HBeAg-negative serologic status favours the efficacy of the immunoprophylactic program in our country, which is almost excellent among the offspring of women with low or undetectable HBV DNA levels during the perinatal period [16,17].…”

Virological suppression does not prevent the development of hepatocellular carcinoma in HBeAg-negative chronic hepatitis B patients with cirrhosis receiving oral antiviral(s) starting with lamivudine monotherapy: results of the nationwide HEPNET. Greece cohort study

“…In 2003, the HEPNET.Greece network was established to collect data from tertiary liver centres throughout the country and evaluate the current epidemiology and course of chronic HBV and hepatitis C virus (HCV) infection in Greece 18 19. This ongoing nationwide HEPNET.Greece cohort study has a retrospective–prospective design, with the recording of data initiated in 1997 for all patients with chronic HBV and HCV infection followed in the participating centres.…”

Problem drug use the public health imperative: what some of the literature says

“…The UK's current Hepatitis B vaccination strategy has been based upon the selective targeting of high risk groups [82-84] and despite a rising prevalence amongst injecting drug users and in particular those within prisons this continues to be pursued [85,86] and whilst it is the case that the UK does not experience the high endemicity and chronic carrier numbers present elsewhere [87-89] there is a wealth of evidence that the recommendations made by the WHO in 1992, namely that Hepatitis B should be incorporated into national vaccination programme globally, was not without foundation since vaccination works and is feasible to introduce [90,91] Moreover it also goes some way to address the low risk perception and knowledge which exists, particularly amongst young adults and most worryingly amongst injecting drug users where there was often a dissonance between their perception or belief of their hepatitis status and laboratory virology [92-96]. …”