hku studies the prevalence of viral hepatitis in hong kong ... hepatitis hon… · clinical...
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HKU Studies the Prevalence of Viral Hepatitisin Hong Kong –
The First Largest Population Territory-based StudyIdentifies Areas of Need in Combating Liver Diseases
Press ConferenceMarch 5, 2019
Department of MedicineLKS Faculty of Medicine, HKU
Professor Richard Yuen Man-fungChair Professor of Gastroenterology and HepatologyLi Shu Fan Medical Foundation Professor in MedicineDepartment of MedicineHKUMed
Dr Walter Seto Wai-kayClinical Associate ProfessorDepartment of MedicineHKUMed
Hepatitis B
Hepatitis C
Alcohol use
Other
1,162,000 deaths due toliver cirrhosis
WHO. Health statistics and information systems: Estimates 2000–2015. Available at:http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html (accessed May 2018)
Hepatitis B
Hepatitis C
Alcohol use
Other
788,000 deaths due toliver cancer
Hepatitis B and C Infections are the main causes of liver-related death in theworld
The WHO Global Health Sector has Established the Goal of Hepatitis Eliminationas a Major Public Heath Target by 2030
WHO Global Health Sector Strategy on Viral Hepatitis 2016–2021;Available at: http://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/ (accessed Feb 2019).
2015 2020 2025 2030
10%reduction
30%reduction
65%reduction
90%reduction
Includes Hepatitis B + C
0
0.5
1.0
3.02.0
4.05.0
7.06.0
8.09.0
10.0
New
Infe
ctio
nsan
dDe
aths
(inm
illio
ns) New infections
Deaths
Years
TARGET: Between6 and 10 million infections reduced
to fewer than1 million by 2030
TARGET: 1.4 million deaths reducedto fewer than
0.5 million by 2030
Diagnosis and Treatment CoverageWorld Health Organization
90%
80%
9% 8%
20%
7.4%
0%
20%
40%
60%
80%
100%
Diagnosis Treatment (among eligible)
WHO 2030 Target Hepatitis B 2015 Hepatitis C 2015WHO Global Hepatitis Report 2017;
Available at: http://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/ (accessed Feb 2019).
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• Study period: Feb 2015 – Jul 2016• Visit different districts every month
• to give health promotion lectures on viral hepatitis• to complete a 2-page questionnaire by participants• to test for hepatitis serology (A, B, C, D, E) in participants
• Inclusion criteria• Han Chinese ethnicity• Age 18 – 75
• Referral letters were given to participants tested positive for HBV or HCV
The First and the Largest Community Screening Study onall 5 common viral hepatitis in Hong Kong
Organizations1) Division of Gastroenterology & Hepatology, HKUMed
2) Hong Kong Liver Foundation3) School of Public Health, HKUMed
Demographics• Recruited 10,256 subjects over 19 months• Mean age: Male 50.4±16 years; Female 52.3±14 years
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0%
2%
4%
6%
8%
10%
12%
Hepatitis A and Hepatitis E
9
0%
20%
40%
60%
80%
100%
18-29 30-39 40-49 50-59 ≥60
Sero
prev
alen
cera
te
Age (years)
Anti-HAV (2015)Anti-HEV (2015)Anti-HAV (2001)Anti-HEV (2001)
% of people with antibodies to hepatitis A
% of people with antibodies to hepatitis E
2001 2015/201671%
18.8%
65.1%
33.3%
Infection rate increased with older age
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Hepatitis A and Hepatitis EFamily Income (per month)
Infection rate increased in low income groups
80.7%
60.2%54.9%
48.2%41.4%
32.3%27.5%
22.9%
0%
20%
40%
60%
80%
<10,000 HKD >10,000 - 20,000 HKD >20,000 - 30,000 HKD >30,000 HKDHAV Antibodies HEV Antibodies
• Overall HBV prevalence 7.8% (8.8% in 2001)• Male 8.8%; Female 7.3%• 48% HBV patients did not know their hepatitis B status prior to this study• In relationship to commencement of universal vaccination:
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Hepatitis B
1.8%
8.3%
<Aged 26, Born after commencement ofuniversal HBV vaccination
>=Aged 26, Born before universal HBVvaccination
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Hepatitis B• Risk Factor
– Male > female (1.2 fold)– Mother also Hepatitis B (4.8 folds)– Other family members also Hepatitis B (3.4 folds)
• Protective factor– Vaccination (reduced by 85%)
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HCV remains to have low prevalence in HongKong•0.5% (n= 48) were tested anti-HCV positive•0.3% (n= 29) were hepatitis C carriers
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Risk factors for hepatitis C
0%
20%
40%
60%
80%
Self reported historyof hepatitis
Family history ofhepatitis/HCC
Previous bloodtransfusion
History ofintravenous drug use
History of Dentaltreatment
Hemodialysis Skin tattoo
Anti-HCV Negative Anti-HCV Positive
RR 7.1
RR 11.0 RR 10.4
RR 5.47
Summary• Hepatitis B is still a very common disease in Hong Kong• Support the effectiveness of universal hepatitis B vaccination
programme• Significant change in hepatitis A and E prevalence over the years• Support the importance of raising public awareness of chronic
hepatitis B and screening
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What’s next in Hong Kong?• To achieve the goal of WHO in 2030, tremendous efforts needed to be
made• Implement population based vaccination programme for hepatitis B and hepatitis A• Implement whole population screening for hepatitis B• Implement high risk group screening for hepatitis C• Layout health care strategy for the Hong Kong population: get diagnosed, get
treated and get the risk of liver cancer and cirrhosis down inHong Kong!
• It’s time to ACT NOW!
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