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

8

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%)

13

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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