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Grandi G, Lopez LF, Burattini MN. Regional differences and temporal trend analysis of Hepatitis B in Brazil. BMC Public Health 2022; 22:1931. [PMID: 36253757 PMCID: PMC9578265 DOI: 10.1186/s12889-022-14296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Burden disease related to chronic HBV infection is increasing worldwide. Monitoring Hepatitis B occurrence is difficult due to intrinsic characteristics of the infection, nonetheless analyzing this information improves strategic planning towards reducing the burden related to chronic infection. In this line of thought, this study aims to analyze national and regional epidemiology of Hepatitis B and it's temporal trends based on Brazilian reported cases. METHODS Data obtained from the Brazilian National Notifiable Disease Reporting System (SINAN) from 2007 to 2018 were classified by infection status with an original classification algorithm, had their temporal trends analyzed by Joinpoint regression model and were correlated with gender, age and region. RESULTS Of the 487,180 hepatitis B cases notified to SINAN, 97.65% had it infection status correctly classified by the new algorithm. Hepatitis B detection rate, gender and age-distribution were different among Brazilian regions. Overall, detection rates remained stable from 2007 to 2018, achieving their maximal value (56.1 cases per 100,000 inhabitants) in North region. However, there were different temporal trends related to different hepatitis B status and age. Women mean age at notification were always inferior to those of men and the difference was higher in Central-West, North and Northeast regions. CONCLUSION Hepatitis B affects heterogeneously different populations throughout Brazilian territory. The differences shown in its temporal trends, regional, gender and age-related distribution helps the planning and evaluation of control measures in Brazil.
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Affiliation(s)
- Giuliano Grandi
- Infectious Diseases Division, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP Brazil
- Institute of Mathematics and Statistics, The University of São Paulo, São Paulo, SP Brazil
- Present Address: Rua Botucatu, 740–5th floor. Room 507, CEP 04023-062 São Paulo, SP Brazil
| | - Luis Fernandez Lopez
- Discipline of Medical Informatics and LIM-01 HCFMUSP, School of Medicine, The University of São Paulo, São Paulo, SP Brazil
- Center for Internet Augmented Research and Assessment - CIARA, Florida International University, Florida, USA
| | - Marcelo Nascimento Burattini
- Infectious Diseases Division, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP Brazil
- Discipline of Medical Informatics and LIM-01 HCFMUSP, School of Medicine, The University of São Paulo, São Paulo, SP Brazil
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Mozalevskis A, Eramova I, Safreed-Harmon K, Lazarus JV. Hepatitis B and C surveillance and screening programmes in the non-EU/EEA Member States of the WHO European Region: survey findings from 10 countries, 2012. ACTA ACUST UNITED AC 2017; 21:30245. [PMID: 27277421 DOI: 10.2807/1560-7917.es.2016.21.22.30245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 06/02/2016] [Indexed: 11/20/2022]
Abstract
The hepatitis B virus (HBV) and hepatitis C virus (HCV) epidemics warrant a comprehensive response based on reliable population-level information about transmission, disease progression and disease burden, with national surveillance systems playing a major role. In order to shed light on the status of surveillance in countries of the World Health Organization (WHO) European Region outside of the European Union and European Economic Area (EU/EEA), we surveyed 18 countries in Central and Eastern Europe. Among the 10 countries that responded, the common features of many surveillance systems included mandatory surveillance, passive case-finding and the reporting of both acute and chronic HBV and HCV. Only some countries had surveillance systems that incorporated the tracking of associated conditions and outcomes such as cirrhosis and liver transplantation. Screening programmes for some key populations appeared to be in place in many countries, but there may be gaps in relation to screening programmes for people who inject drugs, prisoners, sex workers and men who have sex with men. Nonetheless, important components of a surveillance structure are in place in the responding study countries. It is advisable to build on this structure to develop harmonised HBV and HCV surveillance for all 53 Member States of the WHO European Region following the example of the system recently instituted in EU/EEA countries.
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Affiliation(s)
- Antons Mozalevskis
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
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Yong Hao G, Da Xing F, Jin X, Xiu Hong F, Pu Mei D, Jun L, Ying Y, Yan Yang Z, Wan Shen G. The prevalence of hepatitis B infection in central China: An adult population-based serological survey of a large sample size. J Med Virol 2016; 89:450-457. [PMID: 27504586 DOI: 10.1002/jmv.24649] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 12/29/2022]
Abstract
The objective of this study was to determine the prevalence of serum HBsAg among adults in Henan province, China. A provincial serosurvey of people aged 18-74 years was conducted and individuals for analysis were selected using a multistage stratified random cluster sampling method. A 5-ml serum sample from each person was collected and the serum was tested for the presence of HBsAg, HBcAb, HBsAb, HBeAg, and HBeAb by ELISA. Multivariate analysis was used to identify factors associated with the prevalence of HBsAg. A total of 16,685 residents, aged 18-74 years who resided in 60 communities or villages in Henan, China were surveyed. Among the eligible study population, 642 HBsAg positive cases (3.7%) were found. The prevalence increased steadily from 3.1% among population aged 18-35 years old, to 5.1% among population aged 55-74 years. Accordingly, HBsAb declined steadily from 53.4% to 24.7%. Six hundred and forty-two positive HBsAg blood samples were screened for the HBeAg and HBeAb. HBeAg prevalence declined steadily from 27.7% among population age 18-35 years old to 6.8% among population age 55-74 years old. The single factor analysis was used for 16 possible risk factors and multivariate analysis showed that five risk factors were significantly related to HBV infection. HBV infection is a serious public health problem among adult population in Henan. Strengthening administrative regulations of medical practices, especially in rural areas, and providing health education propaganda to the public of HBV infection should be given more attention on public health policy. J. Med. Virol. 89:450-457, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Guo Yong Hao
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Feng Da Xing
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Xu Jin
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Feng Xiu Hong
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Dong Pu Mei
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Li Jun
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Ye Ying
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Zhang Yan Yang
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Guo Wan Shen
- Henan Center for Disease Control and Prevention, Zhengzhou, China
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Lazarus JV, Mozalevskis A, Safreed-Harmon K, Eramova I. Strengthening hepatitis B and C surveillance in Europe: results from the two global hepatitis policy surveys (2013 and 2014). HEPATOLOGY, MEDICINE AND POLICY 2016; 1:3. [PMID: 30288307 PMCID: PMC5918699 DOI: 10.1186/s41124-016-0009-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/30/2016] [Indexed: 01/16/2023]
Abstract
Background Hepatitis B and C are major public health threats in the World Health Organization (WHO) European Region. Viral hepatitis surveillance shortcomings have resulted in many WHO Member States having insufficient data available to guide decision-making. This study describes surveillance in the region based on a quantitative sub-analysis of findings from the 2013 WHO viral hepatitis policy report and a qualitative analysis of civil society survey responses associated with these findings. Methods Descriptive statistics were created from information that national government focal points for viral hepatitis in 44 countries had previously reported in response to the WHO survey. Bivariate analysis was performed to compare data from within and outside of the European Union/European Economic Area (EU/EEA). Survey responses from civil society organizations in the countries of the WHO European Region were collated, and a descriptive analysis of the comments on surveillance-related questions was performed to identify key themes. Results The response rate for the survey of governments was 83 % among both EU/EEA countries (25/30) and non-EU/EEA countries (19/23). More than 90 % of governments reported having national surveillance systems for the acute forms of hepatitis B and hepatitis C, but less than two-thirds reported surveillance for the chronic forms of both diseases. High proportions of governments reported having central registries for the reporting of deaths (96 %) and liver cancer cases (80 %), while less than half reported regularly conducting viral hepatitis sero-surveys. All responding Member States reported having adequate laboratory capacity nationally to support hepatitis outbreak investigations and other surveillance activities. Target populations for sero-surveys most commonly included people who inject drugs (27 %), the general population (25 %), men who have sex with men (20 %) and pregnant women (20 %). Few statistically significant differences were found between EU/EEA and non-EU/EEA countries. Conclusions Study findings indicated a capacity for robust viral hepatitis surveillance across the WHO European Region, with most countries having important surveillance components in place, but notable weaknesses were also identified. There is an urgent need for countries throughout the region to strengthen their surveillance programs in order to maximize the population-level impact of advances in HBV and HCV prevention and treatment. Electronic supplementary material The online version of this article (doi:10.1186/s41124-016-0009-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey V Lazarus
- 1CHIP, Centre for Health and Infectious Disease Research and WHO Collaborating Centre on HIV and Viral Hepatitis, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Antons Mozalevskis
- 2World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Kelly Safreed-Harmon
- 1CHIP, Centre for Health and Infectious Disease Research and WHO Collaborating Centre on HIV and Viral Hepatitis, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Irina Eramova
- 2World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
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Papatheodoridis G, Thomas HC, Golna C, Bernardi M, Carballo M, Cornberg M, Dalekos G, Degertekin B, Dourakis S, Flisiak R, Goldberg D, Gore C, Goulis I, Hadziyannis S, Kalamitsis G, Kanavos P, Kautz A, Koskinas I, Leite BR, Malliori M, Manolakopoulos S, Matičič M, Papaevangelou V, Pirona A, Prati D, Raptopoulou-Gigi M, Reic T, Robaeys G, Schatz E, Souliotis K, Tountas Y, Wiktor S, Wilson D, Yfantopoulos J, Hatzakis A. Addressing barriers to the prevention, diagnosis and treatment of hepatitis B and C in the face of persisting fiscal constraints in Europe: report from a high level conference. J Viral Hepat 2016; 23 Suppl 1:1-12. [PMID: 26809941 DOI: 10.1111/jvh.12493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 12/26/2022]
Abstract
In the WHO-EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120,000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence-based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost-effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.
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Affiliation(s)
- G Papatheodoridis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - H C Thomas
- Hepatology and Gastroenterology Section, Department of Medicine, Imperial College, London, UK
| | - C Golna
- Hepatitis B & C Public Policy Association, Luxembourg, Luxembourg
| | - M Bernardi
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy
| | - M Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - M Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - G Dalekos
- University of Thessaly Medical School, Karditsa, Greece
| | - B Degertekin
- Acibadem University Medical School, Istanbul, Turkey
| | - S Dourakis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - R Flisiak
- Medical University of Bialystok, Bialystok, Poland
| | | | - C Gore
- Hepatitis B & C Public Policy Association, Luxembourg, Luxembourg.,World Hepatitis Alliance, The Hepatitis C Trust, London, UK
| | - I Goulis
- Medical School, Aristotle University, Thessaloniki, Greece
| | - S Hadziyannis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Kalamitsis
- Hellenic Liver Patient Association "Prometheus", Athens, Greece
| | - P Kanavos
- London School of Economics, London, UK
| | - A Kautz
- European Liver Patients Association (ELPA), Sint-Truiden, Belgium
| | - I Koskinas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - B R Leite
- National Parliament, Lisbon, Portugal
| | - M Malliori
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Manolakopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M Matičič
- Viral Hepatitis Department, Infectious Diseases Clinic, University Medical Centre, Ljubljana, Slovenia
| | - V Papaevangelou
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Pirona
- European Monitoring Center for Drugs and Drug Addiction, Lisbon, Portugal
| | - D Prati
- Alessandro Manzoni Hospital, Lecco, Italy
| | - M Raptopoulou-Gigi
- Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece
| | - T Reic
- European Liver Patients Association (ELPA), Sint-Truiden, Belgium
| | - G Robaeys
- Department of Gastroenterology and Hepaatology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - E Schatz
- Correlation Network, Amsterdam, the Netherlands
| | | | - Y Tountas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Wiktor
- World Health Organization, Geneva, Switzerland
| | | | - J Yfantopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Hatzakis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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