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Epidemiological patterns of hepatitis B virus (HBV) in highly endemic areasr

Published online by Cambridge University Press:  15 May 2009

W. J. Edmunds
Affiliation:
Department of Biological Sciences, University of Warwick, Coventry CV4 7AL, UK
G. F. Medley
Affiliation:
Department of Biological Sciences, University of Warwick, Coventry CV4 7AL, UK
D. J. Nokes
Affiliation:
Department of Biological Sciences, University of Warwick, Coventry CV4 7AL, UK
C. J. O'Callaghan
Affiliation:
Department of Biological Sciences, University of Warwick, Coventry CV4 7AL, UK
H. C. Whittle
Affiliation:
MRC Laboratories, Fajara, PO Box 273, Banjul, The Gambia
A. J. Hall
Affiliation:
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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This paper uses meta-analysis of published data and a deterministic mathematical model of hepatitis B virus (HBV) transmission to describe the patterns of HBV infection in high endemicity areas. We describe the association between the prevalence of carriers and a simple measure of the rate of infection, the age at which half the population have been infected (A50), and assess the contribution of horizontal and perinatal transmission to this association. We found that the two main hyper-endemic areas of sub-Saharan Africa and east Asia have similar prevalences of carriers and values of A50, and that there is a negative nonlinear relationship between A50 and the prevalence of carriers in high endemicity areas (Spearman's Rank, P = 0·0086). We quantified the risk of perinatal transmission and the age-dependent rate of infection to allow a comparison between the main hyper-endemic areas. East Asia was found to have higher prevalences of HBeAg positive mothers and a greater risk of perinatal transmission from HBeAg positive mothers than sub-Saharan Africa, though the differences were not statistically significant. However, the two areas have similar magnitudes and age-dependent rates of horizontal transmission. Results of a simple compartmental model suggest that similar rates of horizontal transmission are sufficient to generate the similar patterns between A50 and the prevalences of carriers. Interrupting horizontal transmission by mass immunization is expected to have a significant, nonlinear impact on the rate of acquisition of new carriers.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1996

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