Hepatitis B infection is a major global health problem. Vertical transmission is the commonest route of spreading hepatitis B virus (HBV) in many endemic areas. In order to control such transmission in Hong Kong, neonatal immunization programme was implemented for more than two decades. A declining prevalence of HBV infection was expected. However, the prevalence remained unabated at around 10% in recent studies. We suspect that one of the explanations of this persistent high prevalence is deficient knowledge on infection with the HBV and its prevention. Our paper gives an overview of the knowledge on HBV infection among Chinese population in both high and low endemic areas and discusses the potential factors that influenced the knowledge on as well as the implication of the sources of information for HBV infection, which was not addressed in previous studies. 1. Background Hepatitis B infection is a worldwide problem with over 350 million carriers [1]. Subjects with chronic hepatitis B virus (HBV) infection are at increased risk of hepatocellular carcinoma, cirrhosis, and chronic hepatitis [2–4]. Chronic infection with HBV is endemic in the Asia-Pacific region and China. Hong Kong, as part of China, is a high-prevalence area for HBV infection according to the WHO definition, and antenatal screening for maternal infection, in the form of screening for hepatitis B surface antigen (HBsAg), is a standard procedure. Hong Kong is one of the first cities that introduced immunoprophylaxis to the neonates in 1983, with combined immunoglobulin and vaccine given to offspring of mothers with positive screening, and this was followed by universal vaccination to all newborn infants from 1988 [5, 6]. Compliance is ensured by means of a vaccination record issued to all children, which has to be checked by teachers at primary and secondary schools (under the enforced free education system) to ensure that incompletion of any vaccination could be remedied. Furthermore, all nonimmune adult residents of Hong Kong have opportunities in obtaining vaccination from various institutions such as universities and nongovernment organizations. Good compliance with the vaccination, especially in a nationwide government-initiated public health programme as implemented in Taiwan, has resulted in a decline in the HBV carrier rate in children from 10% to <1% and reduction in mortality from fulminant hepatitis and hepatoma in children [7, 8]. Yet in the past four decades, studies on maternal HBV infection in Hong Kong yielded the prevalence of 6.6% in 1976 [9], 7.4% in 1983 [10], and
References
[1]
World Health Organization, “Hepatitis B,” Fact Sheet No. 204, World Health Organization, Geneva, Switzerland, 2000, http://www.who.int/mediacentre/factsheets/fs204/en/index.html.
[2]
R. P. Beasley, L. Y. Hwang, C. C. Lin, and C. S. Chien, “Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22 707 men in Taiwan,” The Lancet, vol. 2, no. 8256, pp. 1129–1133, 1981.
[3]
R. P. Beasley, “Hepatitis B virus as the etiologic agent in hepatocellular carcinoma—epidemiologic considerations,” Hepatology, vol. 2, supplement 2, pp. 21S–26S, 1982.
[4]
R. P. Beasley, “Hepatitis B virus. The major etiology of hepatocellular carcinoma,” Cancer, vol. 61, no. 10, pp. 1942–1956, 1988.
[5]
L. C. Kwan, Y. Y. Ho, and S. S. Lee, “The declining HBsAg carriage rate in pregnant women in Hong Kong,” Epidemiology and Infection, vol. 119, no. 2, pp. 281–283, 1997.
[6]
Department of Health, Hong Kong, Surveillance of viral hepatitis in Hong Kong—2006 update report, http://www.info.gov.hk/hepatitis/doc/hepsurv06.pdf.
[7]
C. Y. Chan, S. D. Lee, and K. J. Lo, “Legend of hepatitis B vaccination: the Taiwan experience,” Journal of Gastroenterology and Hepatology, vol. 19, no. 2, pp. 121–126, 2004.
[8]
M. H. Chang, C. J. Chen, M. S. Lai et al., “Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children,” The New England Journal of Medicine, vol. 336, no. 26, pp. 1855–1859, 1997.
[9]
A. K. Y. Lee, H. M. H. Ip, and V. C. W. Wong, “Mechanisms of maternal-fetal transmission of hepatitis B virus,” Journal of Infectious Diseases, vol. 138, no. 5, pp. 668–671, 1978.
[10]
V. C. W. Wong, H. M. H. Ip, H. W. Reesink, et al., “Prevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis B vaccine and hepatitis B immunoglobulin. Double-blind randomised placebo-controlled study,” The Lancet, vol. 1, no. 8383, pp. 921–926, 1984.
[11]
S. S. H. Suen, T. T. Lao, D. S. Sahota, T. K. Lau, and T. Y. Leung, “Implications of the relationship between maternal age and parity with hepatitis B carrier status in a high endemicity area,” Journal of Viral Hepatitis, vol. 17, no. 5, pp. 372–378, 2010.
[12]
O. K. Chan, T. T. Lao, S. S. H. Suen, T. K. Lau, and T. Y. Leung, “Correlation between maternal hepatitis B surface antigen carrier status with social, medical and family factors in an endemic area: have we overlooked something?” Infection, vol. 39, no. 5, pp. 419–426, 2011.
[13]
O. K. Chan, T. T. Lao, S. S. H. Suen, T. K. Lau, and T. Y. Leung, “Knowledge on hepatitis B infection among pregnant women in a high endemicity area,” Patient Education and Counseling, vol. 85, no. 3, pp. 516–520, 2010.
[14]
M. J. Thompson, V. M. Taylor, J. C. Jackson et al., “Hepatitis B knowledge and practices among Chinese American women in Seattle, Washington,” Journal of Cancer Education, vol. 17, no. 4, pp. 222–226, 2002.
[15]
M. J. Thompson, V. M. Taylor, Y. Yasui et al., “Hepatitis B knowledge and practices among Chinese Canadian Women in Vancouver, British Columbia,” Canadian Journal of Public Health, vol. 94, no. 4, pp. 281–286, 2003.
[16]
G. D. Coronado, V. M. Taylor, S. P. Tu et al., “Correlates of hepatitis B testing among Chinese Americans,” Journal of Community Health, vol. 32, no. 6, pp. 379–390, 2007.
[17]
V. M. Taylor, S. P. Tu, E. Woodall et al., “Hepatitis B knowledge and practices among Chinese immigrants to the United States,” Asian Pacific Journal of Cancer Prevention, vol. 7, no. 2, pp. 313–317, 2006.
[18]
T. G. Hislop, C. Teh, A. Low et al., “Hepatitis B knowledge, testing and vaccination levels in Chinese immigrants to British Columbia, Canada,” Canadian Journal of Public Health, vol. 98, no. 2, pp. 125–129, 2007.
[19]
G. X. Ma, S. E. Shive, J. I. Toubbeh, Y. Tan, and D. Wu, “Knowledge, attitudes, and behaviors of Chinese hepatitis B screening and vaccination,” American Journal of Health Behavior, vol. 32, no. 2, pp. 178–187, 2008.
[20]
S. J. Cotler, S. Cotler, H. Xie, B. J. Luc, T. J. Layden, and S. S. Wong, “Characterizing hepatitis B stigma in Chinese immigrants,” Journal of Viral Hepatitis, vol. 19, no. 2, pp. 147–152, 2012.
[21]
P. W. Chung, S. H. Suen, O. K. Chan, T. H. Lao, and T. Y. Leung, “Awareness and knowledge of hepatitis B infection and prevention and the use of hepatitis B vaccination in the Hong Kong adult Chinese population,” Chinese Medical Journal, vol. 125, no. 3, pp. 422–427, 2012.
[22]
C. M. Leung, W. H. Wong, K. H. Chan et al., “Public awareness of hepatitis B infection: a population-based telephone survey in Hong Kong,” Hong Kong Medical Journal, vol. 16, no. 6, pp. 463–469, 2010.
[23]
J. L. Yao, “Perinatal transmission of hepatitis B virus infection and vaccination in China,” Gut, vol. 38, supplement 2, pp. S37–S38, 1996.
[24]
J. Hou, Z. Liu, and F. Gu, “Epidemiology and prevention of hepatitis B virus infection,” International Journal of Medical Sciences, vol. 2, no. 1, pp. 50–57, 2005.
[25]
Y. Poovorawan, S. Sanpavat, W. Pongpunlert, S. Chumdermpadetsuk, P. Sentrakul, and A. Safary, “Protective efficacy of a recombinant DNA hepatitis B vaccine in neonates of HBe antigen-positive mothers,” The Journal of the American Medical Association, vol. 261, no. 22, pp. 3278–3281, 1989.
[26]
C. Y. Lee, L. M. Huang, M. H. Chang et al., “The protective efficacy of recombinant hepatitis B vaccine in newborn infants of hepatitis B e antigen-positive-hepatitis B surface antigen carrier mothers,” Pediatric Infectious Disease Journal, vol. 10, no. 4, pp. 299–303, 1991.
[27]
R. P. Beasley, L. Y. Hwang, C. C. Lin, et al., “Hepatitis B immune globulin (HBIG) efficacy in the interruption of perinatal transmission of hepatitis B virus carrier state. Initial report of a randomised double-blind placebo-controlled trial,” The Lancet, vol. 2, no. 8243, pp. 388–393, 1981.
[28]
E. K. Yeoh, “Hepatitis B vaccination—who should be vaccinated?” Journal of the Hong Kong Medical Association, vol. 39, pp. 208–209, 1987.
[29]
P. I. Lee, C. Y. Lee, L. M. Huang, J. M. Chen, and M. H. Chang, “A follow-up study of combined vaccination with plasma-derived and recombinant hepatitis B vaccines in infants,” Vaccine, vol. 13, no. 17, pp. 1685–1689, 1995.
[30]
R. P. Beasley, L. Y. Hwang, C. E. Stevens, et al., “Efficacy of hepatitis B immune globulin for prevention of perinatal transmission of the hepatitis B virus carrier state: final report of a randomized double-blind, placebo-controlled trial,” Hepatology, vol. 3, no. 2, pp. 135–141, 1983.
[31]
A. S. F. Lok, “Hepatitis B vaccination in Hong Kong,” Journal of Gastroenterology and Hepatology, vol. 8, supplement 1, pp. S27–S29, 1993.
[32]
H. Obata, N. Hayashi, Y. Motoike, et al., “A prospective study on the development of hepatocellular carcinoma from liver cirrhosis with persistent hepatitis B virus infection,” International Journal of Cancer, vol. 25, no. 6, pp. 741–747, 1980.
[33]
K. C. Hyams, “Risks of chronicity following acute hepatitis B virus infection: a review,” Clinical Infectious Diseases, vol. 20, no. 4, pp. 992–1000, 1995.
[34]
M. J. Alter and H. S. Margolis, “The emergence of hepatitis B as a sexually transmitted disease,” Medical Clinics of North America, vol. 74, no. 6, pp. 1529–1541, 1990.
[35]
L. Simonsen, A. Kane, J. Lloyd, M. Zaffran, and M. Kane, “Unsafe injections in the developing world and transmission of bloodborne pathogens: a review,” Bulletin of the World Health Organization, vol. 77, no. 10, pp. 789–800, 1999.
[36]
A. Kane, J. Lloyd, M. Zaffran, L. Simonsen, and M. Kane, “Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates,” Bulletin of the World Health Organization, vol. 77, no. 10, pp. 801–807, 1999.
[37]
J. T. Dongdem, S. Kampo, I. N. Soyiri, P. N. Asebga, J. B. Ziem, and K. Sagoe, “Prevalence of hepatitis B virus infection among blood donors at the Tamale Teaching Hospital, Ghana (2009),” BMC Research Notes, vol. 5, no. 1, article 115, 2012.
[38]
J. Heathcote, C. H. Cameron, and D. S. Dane, “Hepatitis B antigen in saliva and semen,” The Lancet, vol. 1, no. 7847, pp. 71–73, 1974.
[39]
G. R. Irwin, A. M. Allen, W. H. Bancroft, et al., “Hepatitis B antigen in saliva, urine, and stool,” Infection and Immunity, vol. 11, no. 1, pp. 142–145, 1975.
[40]
S. V. Feinman, O. Krassnitski, J. C. Sinclair, D. M. Wrobel, and B. Berris, “Hepatitis B surface antigen in saliva of HB(s)Ag carriers,” Journal of Laboratory and Clinical Medicine, vol. 85, no. 6, pp. 1042–1048, 1975.
[41]
H. Ben-Aryeh, I. Ur, and E. Ben-Porath, “The relationship between antigenaemia and excretion of hepatitis B surface antigen in human whole saliva and in gingival crevicular fluid,” Archives of Oral Biology, vol. 30, no. 1, pp. 97–99, 1985.
[42]
S. J. Cunningham, R. Cunningham, M. G. A. Izmeth, B. Baker, and C. A. Hart, “Seroprevalence of hepatitis B and C in a Merseyside hospital for the mentally handicapped,” Epidemiology and Infection, vol. 112, no. 1, pp. 195–200, 1994.
[43]
A. A. van der Eijk, H. G. M. Niesters, H. M. G？tz et al., “Paired measurements of quantitative hepatitis B virus DNA in saliva and serum of chronic hepatitis B patients: implications for saliva as infectious agent,” Journal of Clinical Virology, vol. 29, no. 2, pp. 92–94, 2004.
[44]
K. Kidd-Ljunggren, A. Holmberg, J. Bl？ckberg, and B. Lindqvist, “High levels of hepatitis B virus DNA in body fluids from chronic carriers,” Journal of Hospital Infection, vol. 64, no. 4, pp. 352–357, 2006.
[45]
I. L. Heiberg, M. Hoegh, S. Ladelund, H. G. M. Niesters, and B. Hogh, “Hepatitis B virus dna in saliva from children with chronic hepatitis B infection: implications for saliva as a potential mode of horizontal transmission,” Pediatric Infectious Disease Journal, vol. 29, no. 5, pp. 465–467, 2010.
[46]
A. Y. Hui, L. C. T. Hung, P. C. H. Tse, W. K. Leung, P. K. S. Chan, and H. L. Y. Chan, “Transmission of hepatitis B by human bite—confirmation by detection of virus in saliva and full genome sequencing,” Journal of Clinical Virology, vol. 33, no. 3, pp. 254–256, 2005.
[47]
R. M. Scott, R. Snitbhan, W. H. Bancroft, H. J. Alter, and M. Tingpalapong, “Experimental transmission of hepatitis B virus by semen and saliva,” Journal of Infectious Diseases, vol. 142, no. 1, pp. 67–71, 1980.
[48]
T. P. Cancio Bello, M. de Medina, J. Shorey, M. D. Valledor, and E. R. Schiff, “An institutional outbreak of hepatitis B related to a human biting carrier,” Journal of Infectious Diseases, vol. 146, no. 5, pp. 652–656, 1982.
[49]
C. Stornello, “Transmission of hepatitis B via human bite,” The Lancet, vol. 338, no. 8773, pp. 1024–1025, 1991.
[50]
I. J. B. Spijkerman, L. J. van Doorn, M. H. W. Janssen et al., “Transmission of hepatitis B virus from a surgeon to his patients during high-risk and low-risk surgical procedures during 4 years,” Infection Control and Hospital Epidemiology, vol. 23, no. 6, pp. 306–312, 2002.
[51]
C. Lobato, J. Tavares-Neto, M. Rios-Leite et al., “Intrafamilial prevalence of hepatitis B virus in Western Brazilian Amazon region: epidemiologic and biomolecular study,” Journal of Gastroenterology and Hepatology, vol. 21, no. 5, pp. 863–868, 2006.
[52]
N. J. Petersen, D. H. Barrett, W. W. Bond, et al., “Hepatitis B surface antigen in saliva, impetiginous lesions, and the environment in 2 remote Alaskan villages,” Applied and Environmental Microbiology, vol. 32, no. 4, pp. 572–574, 1976.
[53]
W. W. Bond, M. S. Favero, N. J. Petersen, C. R. Gravelle, J. W. Ebert, and J. E. Maynard, “Survival of hepatitis B virus after drying and storage for one week,” The Lancet, vol. 1, no. 8219, pp. 550–551, 1981.
[54]
R. Zachoval, G. Fr？sner, F. Deinhardt, and D. H？ss, “Persistence of hepatitis B virus antigens in dried blood,” The Lancet, vol. 1, no. 8223, article 778, 1981.
[55]
K. T. Goh, J. L. Ding, E. H. Monteiro, and C. J. Oon, “Hepatitis B infection in households of acute cases,” Journal of Epidemiology and Community Health, vol. 39, no. 2, pp. 123–128, 1985.
[56]
O. K. Chan, S. S. H. Suen, T. T. H. Lao, V. K. T. Leung, S. W. Yeung, and T. Y. Leung, “Determinants of hepatitis B vaccine uptake among pregnant Chinese women in Hong Kong,” International Journal of Gynecology and Obstetrics, vol. 106, no. 3, pp. 232–235, 2009.
[57]
A. Mele, R. Corona, M. E. Tosti et al., “Beauty treatments and risk of parenterally transmitted hepatitis: results from the hepatitis surveillance system in Italy,” Scandinavian Journal of Infectious Diseases, vol. 27, no. 5, pp. 441–444, 1995.
[58]
A. Mariano, A. Mele, M. E. Tosti, et al., “Role of beauty treatment in the spread of parenterally transmitted hepatitis viruses in Italy,” Journal of Medical Virology, vol. 74, no. 2, pp. 216–220, 2004.
[59]
Department of Health, Viral Hepatitis Preventive Service, http://www.info.gov.hk/hepatitis.
[60]
C. Davis, M. B. Noel, S. F. F. Chan, and L. S. Wing, “Knowledge, attitudes and behaviours related to HIV and AIDS among Chinese adolescents in Hong Kong,” Journal of Adolescence, vol. 21, no. 6, pp. 657–665, 1998.
[61]
C. S. Chu, T. W. Chan, H. M. Hui, L. P. Samaranayake, J. C. Chan, and S. H. Wei, “The knowledge and attitude of Hong Kong secondary school teachers and students towards HIV infection and dentistry,” Community Dental Health, vol. 12, no. 2, pp. 110–114, 1995.
[62]
Ministry of Health of the People's Republic of China, 2009, http://medicine.people.com.cn/GB/135894/178335/index.html.
