Hepatitis B epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jolanta Marszalek, M.D. [2]

Overview

Chronic Hepatitis B (HBV) is a major global health problem. According to the World Health Organization (WHO), more than 2 billion people have been infected with HBV. It is a major cause of chronic liver disease worldwide, affecting an estimated 1.25 million people in the United States and more than 240 million people worldwide.

Epidemiology and Demographics

Prevalence

Worldwide, the prevalence rate of HBV ranges from <2% in developed countries to ≥8% in developing countries. Chronic HBV affects an estimated 800,000 - 1.4 million people in the United States.

Source: https://www.cdc.gov/

The prevalence of HBV is greater in certain high-risk groups:

• People who engage in high-risk sexual activity (79% of persons with newly aquired HBV infection engage in high-risk sexual activity or IDU)
• Injection-drug users
• People who might be exposed to infected blood or body fluids (e.g., occupational, household, travel, and healthcare-related)

16% of persons deny a specific risk factor for infection.

Source: https://www.cdc.gov/

Incidence

In the United States, the overall incidence rate in 2011 was 0.9 cases per 100,000 people. A total of 2,890 cases of acute HBV were reported. Between 1991 and 2010, the incidence of HBV has decreased by approximately 82%. The decrease was greatest among children, largely due to the implementation of routine vaccination in 1991. Since 2001, fewer than 30 cases of acute HBV have been reported annually among children born in 1991 or later, the majority of whom were international adoptees or children born outside of the United States who were not fully vaccinated.

Although the incidence of HBV is declining in the United States, it is important to note that reported cases underestimate the true incidence of HBV infection due to the asymptomatic nature of early infections and under-reporting of symptomatic cases.

Worldwide, there are over 4 million cases of acute HBV every year.

Source: https://www.cdc.gov/

Age

In many low-risk regions of the world, the highest incidence of HBV is observed in teenagers and young adults. In endemic regions of Africa and Asia, most infections occur in infants and children. In 2011, the highest rates of HBV were observed among people aged 30–39 years (2.00 cases/100,000 people), and the lowest rates of HBV were observed among adolescents and children aged <19 years (0.04 cases/100,000 people).

Gender

In 2011, the rate of HBV in the United States was 1.7 times higher among males than among females (1.18 cases and 0.69 cases per 100,000 people, respectively).

Race

The incidence of HBV infection in the United States differs significantly by race and ethnicity, with the highest rates observed among African-Americans. Rates are higher among Hispanics than non-Hispanics.

Developed Countries

Countries and regions with the highest standards of living, including North America, Western and Northern Europe, Australia, and parts of South America, have the lowest prevalence of HBV infection. The carrier rate in these regions is less than 2%, and less than 20% of the population is infected with HBV. In the United States, chronic HBV is responsible for approximately 3,000 annual deaths from associated chronic liver disease. 47 - 70% of United States residents with chronic HBV were born in other countries. While the prevalence of chronic HBV infection among younger, vaccinated, foreign-born United States residents is decreasing, the rate of liver cancer deaths continues to be high among certain foreign-born United States populations. The rate of liver cancer deaths is highest among Asians/Pacific Islanders, which reflects the high prevalence of chronic HBV in this population.

Developing Countries

Regions with the highest prevalence of HBV include Sub-Saharan Africa, Southeast Asia, and the Pacific Basin (excluding Japan, Australia, and New Zealand). Higher rates of chronic HBV are also found in southern parts of Eastern and Central Europe, the Amazon Basin, the Middle East, and India. In these areas, about 70 - 90% of the population becomes HBV-infected before the age of 40, and 8 - 20% of people are HBV carriers. In countries such as China, Senegal, and Thailand, infection rates are very high in infants, and continue through early childhood. In Panama, New Guinea, Solomon Islands, Greenland, and in populations such as Alaskan Indians, infection rates in infants are relatively low but increase rapidly during early childhood. The prevalence of HBV is decreasing in many regions including North Africa, the Middle East, Latin America, and Southeast Asia.