Lau Keith C K, Shaheen Abdel Aziz, Aspinall Alexander A, Ricento Ba Tazuko, Qureshi Mba Kamran, Congly Stephen E, Borman Meredith A, Jayakumar Saumya, Eksteen Bertus, Lee Samuel S, Stinton Laura, Swain Mark G, Burak Kelly W, Coffin Carla S
Affiliations: Calgary Liver Unit (Lau, Shaheen, Aspinall, Congly, Borman, Jayakumar, Eksteen, Lee, Stinton, Swain, Burak, Coffin), Division of Gastroenterology and Hepatology, Department of Medicine; Department of Microbiology, Immunology and Infectious Diseases (Lau, Coffin), Cumming School of Medicine, University of Calgary; Alberta Health Services (Ricento, Qureshi), Calgary, Alta.
CMAJ Open. 2017 Jun 6;5(2):E431-E436. doi: 10.9778/cmajo.20170002.
Despite universal vaccination, chronic hepatitis B virus (HBV) infection remains a public health concern in North America owing to immigration. We aimed to characterize the number of people with a positive result of testing for HBV surface antigen (HBsAg) in Calgary, a large urban Canadian health care region, and to assess whether recommended laboratory tests and specialist consultation were done for those identified as HBsAg-positive.
Based on laboratory and Alberta Health Services administrative data, we identified all adults (age > 18 yr) with a positive HBsAg test result from Jan. 1 to Dec. 31, 2014 within the Calgary Zone. Demographic and relevant laboratory data were extracted within 6 months of a positive HBsAg test result, and referral to hepatology (2011-2014) was identified from data on referral to a centralized clinic. Parametric and nonparametric statistical methods were used for analyses.
We identified 1214 HBsAg-positive people (584 women [48.1%]; median age 44 [interquartile range (IQR) 36-55] yr). A total of 1192 people (98.2%) had alanine aminotransferase testing (median level 23 [IQR 16-34] U/L; 117 [9.8%] with elevated levels), 682 (56.2%) had testing for HBV DNA (median level 2.8 [IQR 2.1-3.8] logIU/mL), 630 (51.9%) had HBV e antigen testing (negative result in 548 [87.0%]), and 145 (11.9%) had HBV e antibody testing (positive result in 111 [76.6%]). Overall, 144 people (11.9%) received anti-HBV treatment, and 390 (32.1%) were referred to a hepatologist.
Many HBsAg-positive people in Calgary did not receive the recommended laboratory assessments. The results highlight the necessity of continual public health efforts to screen for chronic HBV infection in Canada and to ensure adequate follow-up in order to reach the World Health Organization's goal of viral hepatitis elimination by 2030.
尽管进行了普遍接种疫苗，但由于移民问题，慢性乙型肝炎病毒（HBV）感染在北美仍是一个公共卫生问题。我们旨在确定加拿大一个大型城市医疗保健区域卡尔加里HBV表面抗原（HBsAg）检测呈阳性的人数，并评估对于那些被确定为HBsAg阳性的人是否进行了推荐的实验室检测和专科会诊。
基于实验室数据和艾伯塔省卫生服务管理数据，我们确定了2014年1月1日至12月31日期间卡尔加里地区所有HBsAg检测结果呈阳性的成年人（年龄>18岁）。在HBsAg检测结果呈阳性后的6个月内提取人口统计学和相关实验室数据，并从转诊至一家集中诊所的数据中确定肝病科转诊情况（2011 - 2014年）。采用参数和非参数统计方法进行分析。
我们确定了1214名HBsAg阳性者（584名女性[48.1%]；中位年龄44岁[四分位间距（IQR）36 - 55岁]）。共有1192人（98.2%）进行了丙氨酸转氨酶检测（中位水平23[IQR 16 - 34]U/L；117人[9.8%]水平升高），682人（56.2%）进行了HBV DNA检测（中位水平2.8[IQR 2.1 - 3.8]logIU/mL），630人（51.9%）进行了HBV e抗原检测（548人[87.0%]结果为阴性），145人（11.9%）进行了HBV e抗体检测（111人[76.6%]结果为阳性）。总体而言，144人（11.9%）接受了抗HBV治疗，390人（32.1%）被转诊至肝病科医生处。
卡尔加里许多HBsAg阳性者未接受推荐的实验室评估。结果凸显了持续开展公共卫生工作以筛查加拿大慢性HBV感染并确保充分随访的必要性，以便实现世界卫生组织到2030年消除病毒性肝炎的目标。
