Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil.
Instituto de Patologia Tropical e Saúde Pública, Federal University of Goiás, Goiânia, Goiás, Brazil.
BMC Public Health. 2019 Apr 29;19(1):443. doi: 10.1186/s12889-019-6828-8.
People living in poverty (PLP) are highly vulnerable to hepatitis B virus (HBV) infection. This study aimed to investigate the epidemiology of HBV infection in PLP in the metropolitan region of Goiânia, Goiás State, in the Central-West Region of Brazil.
A cross-sectional study was conducted from August to December 2016 in adults aged ≥12 years living in poverty. The following serological markers for HBV were investigated: hepatitis B surface antigen (HBsAg), antibody to HBV core antigen (total anti-HBc), IgM anti-HBc, and hepatitis B surface antibody (anti-HBs), which were detected by enzyme-linked immunosorbent assay (ELISA). Poisson regression analysis with robust variance was performed to verify the factors associated with HBV exposure.
The study included 378 participants. The overall prevalence rate of HBV (any viral marker) was 9.8% (95% confidence interval [CI], 7.2-13.2). The prevalence rate of HBsAg in combination with total anti-HBc was 0.8% (95% CI, 0.3-2.4), total anti-HBc in combination with anti-HBs was 7.7% (95% CI, 5.4-10.9), and total anti-HBc alone was 1.3% (95% CI, 0.5-3.0) in the population. Furthermore, isolated positivity for anti-HBs was identified in only 25.4% (95% CI, 21.3-30.0) of the participants. Multiple regression analysis revealed that age (adjusted prevalence ratio [APR], 1.04; 95% CI, 1.01-1.07), female sex (APR, 2.18; 95% CI, 1.01-4.73), sexual intercourse under the influence of alcohol (APR, 2.49; 95% CI, 1.36-7.06), and exposure to Treponema pallidum (APR, 3.10; 95% CI, 1.36-7.06) were associated with HBV exposure.
There was a high prevalence of HBV exposure in PLP in the Central-West Region of Brazil, indicating significant viral spread of the infection. Additionally, there was low serological evidence of immunisation against hepatitis B, indicating that a large proportion of the participants in this study are susceptible to the infection. The results support the need for public health policies that facilitate access to the existing healthcare services in hard-to-reach groups with special regard to immunisation programmes against hepatitis B.
生活贫困的人（PLP）极易感染乙型肝炎病毒（HBV）。本研究旨在调查巴西中西部戈亚尼亚大都市地区 PLP 人群中 HBV 感染的流行病学情况。
2016 年 8 月至 12 月期间，对居住在贫困地区的≥12 岁成年人进行了横断面研究。通过酶联免疫吸附试验（ELISA）检测 HBV 的以下血清学标志物：乙型肝炎表面抗原（HBsAg）、乙型肝炎核心抗原抗体（总抗-HBc）、IgM 抗-HBc 和乙型肝炎表面抗体（抗-HBs）。采用稳健方差的 Poisson 回归分析来验证与 HBV 暴露相关的因素。
本研究共纳入 378 名参与者。HBV（任何病毒标志物）的总流行率为 9.8%（95%置信区间 [CI]，7.2-13.2）。HBsAg 与总抗-HBc 联合阳性的流行率为 0.8%（95%CI，0.3-2.4），总抗-HBc 与抗-HBs 联合阳性的流行率为 7.7%（95%CI，5.4-10.9），而总抗-HBc 单独阳性的流行率为 1.3%（95%CI，0.5-3.0）。此外，仅 25.4%（95%CI，21.3-30.0）的参与者抗-HBs 呈阳性。多因素回归分析显示，年龄（调整后患病率比 [APR]，1.04；95%CI，1.01-1.07）、女性（APR，2.18；95%CI，1.01-4.73）、受酒精影响的性行为（APR，2.49；95%CI，1.36-7.06）和梅毒螺旋体暴露（APR，3.10；95%CI，1.36-7.06）与 HBV 暴露相关。
巴西中西部地区 PLP 人群中 HBV 感染的流行率较高，表明该地区 HBV 感染的病毒传播较为严重。此外，抗乙型肝炎的血清学证据表明免疫接种率较低，这表明该研究中的大多数参与者易感染乙型肝炎。研究结果支持采取公共卫生政策，为难以接触到的人群提供现有医疗服务，并特别关注乙型肝炎免疫接种计划。
