The Prevalence and Transmission of Hepatitis B Virus Infection in Urban, Rural and Institutionalized Black Children of Natal/KwaZulu, South Africa

Abstract

The sera of statistically selected urban (805), rural (238) and institutionalized (127) black children were tested for markers of hepatitis B virus (HBV) infection. The age-standardized (6-14 years) prevalence rates of HBs antigenaemia for comparison between urban, rural and institutionalized children were 10%, 18.5% and 25.1% and the HBV exposure rates were 31.4%, 62.1% and 72.0% respectively. In the newborn to six years age group the prevalence rates of HBsAg and HBV exposure were 2.5% and 7.1% for urban children and 53.1% and 70.3% for institutionalized children. Peak prevalences of HBsAg occurred in the 6-8 year age group and were 14.4% and 22.6% in urban and rural children respectively. Hepatitis Be Antigen (HBeAg) was detected in 46.5% and antibodies to hepatitis Be antigen (HBeAb) in 10.0% of all HBsAg positive children. Multiple mechanisms involving horizontal rather than vertical transmission appeared to be important in urban children, with HBV exposure in females being significantly associated with ear-piercing (p less than 0.001) and scarification (p less than 0.05). In addition, HBsAg was detected in 25 of 29 pools of bloodfed mosquitoes caught at the children's institution and was negative in all four pools of unfed mosquitoes, suggesting that these arthropods may also be one factor in the horizontal spread of HBV infection. Familial clustering of HBV infection was suggested by a significantly higher (p less than 0.01) prevalence of HBsAg amongst family contacts of HBsAg positive urban children (17.7%) than in the control groups of family contacts of HBsAb positive children (8%) and children who were negative for all HBV markers (2.4%). The significance and implications of these findings are discussed.

The prevalence of hepatitis B virus infection in HIV-positive and HIV-negative infants: KwaZulu-Natal, South Africa

“…27 In the pre-immunisation era, hepatitis B surface antigenaemia was reported to range from 10% amongst urban children to 18.5% amongst rural children in KwaZulu-Natal. 13 A retrospective database analysis conducted for a nine-year period (2002 to 2010) in a reference laboratory in KwaZulu-Natal estimated the overall seroprevalence of hepatitis B surface antigen in all age groups to be 12.05%. 27 Our finding of a 10% prevalence in this infant cohort is clinically significant.…”

“…31 Our study specifically considered HBV rates amongst HIV-positive and HIV-negative infants and therefore differs from previous studies conducted in the pre-HIV epidemic era. 4,13 Further, in the HIV era, higher prevalences of HBV have been reported amongst HIV-positive adults 7,8,9,10 owing to shared routes of transmission. However, the observed prevalence of HBV amongst HIV-positive infants in our study was not statistically significant compared with HIV-negative infants, suggesting that high HBV infection rates may be independent of HIV in infants.…”

“…4 Another, earlier study in KwaZulu-Natal province reported the prevalence of HBV in urban, rural and institutionalised children to be 10%, 18.5% and 25.1%, respectively. 13 In the era of the South African HIV epidemic, a study conducted in the Western Cape in 2011 found the prevalence of HBV amongst HIV-exposed infants to be 0.4%. 14 The rate of HIV/HBV co-infection amongst infants and children remains poorly reported compared with reports of high exposure to HBV in HIV-infected pregnant women.…”

Hepatitis B Virus-Associated Nephropathy

“…Familial clustering of HBV infection has been extensively documented in regions such as South Africa [22], although the precise mechanisms of transmission are not known [23, 24]. The first (and largest) wave of HBV infection in black Africans begins during the latter half of the first year of life and high carrier rates are already present by the age of 3–5 years [21, 25, 26, 27].…”

Hepatitis B incidence and prevention with antiretroviral therapy among HIV-positive individuals in Uganda

“…Among men who have sex with men and IV drug users in the US, there is a strong association between the incidences of both HIV and HBV (7). This association is however less clear in SSA where HIV is predominantly transmitted via the heterosexual route and HBV horizontally during childhood (8, 9). Data on HBV incidence is scarce but emerging evidence suggests ongoing sexual transmission of this disease among HIV infected adults (10, 11), who represent a high risk group for HIV acquisition.…”