Department of Public Health, Ministry of Health, Thimphu, Bhutan.
Department of Medicine, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan.
BMC Infect Dis. 2020 Jul 8;20(1):485. doi: 10.1186/s12879-020-05176-3.
Bhutan is committed to eliminating hepatitis B and hepatitis C, though recent baseline estimates of disease burden in the general population are unknown. In 2017, we carried out a biomarker survey in the general population to estimate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) biomarkers to evaluate the impact of immunization and guide further efforts.
In 2017, a cross-sectional, population-based, three-stage cluster survey was undertaken of the general population (1-17 and 20+ years of age). We visited households, collected blood specimens and administered a standard questionnaire. Specimens were collected for hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We calculated prevalence of infection and selected characteristics, along with confidence intervals (CIs).
Of 1372 individuals approached, 1358 (99%) participated. Of those, 1321 (97%) had a specimen tested for HBsAg, and among 1173 enrolled individuals 5 years of age or older, 1150 (98%) individuals were tested for anti-HCV. The prevalence of HBsAg was 2.0% in 775 persons 20 years of age or older (95% CI: 1.0-4.0) and 0.5% in 546 persons 1-17 years of age (95% CI: 0.1-1.8). The prevalence of anti-HCV was 0.3% (95% CI: 0.1-0.8) among persons ≥5 years.
Universal hepatitis B immunization of infants has resulted in a low prevalence of chronic HBV infection in persons 1-17 years of age and the prevalence of anti-HCV is low among persons aged ≥5 years. Efforts should continue to reach high coverage of the timely birth dose along with completion of the hepatitis B vaccine series. To reduce the chronic liver disease burden among adults, HBV and HCV testing and treatment as indicated might be restricted to pregnant women, blood donors, individuals with chronic liver diseases, and other groups with history of high-risk exposures.
不丹致力于消除乙型肝炎和丙型肝炎，但目前尚不清楚普通人群中疾病负担的最新基线估计数。2017 年，我们在普通人群中进行了一项生物标志物调查，以估计乙型肝炎病毒 (HBV) 和丙型肝炎病毒 (HCV) 生物标志物的流行率，评估免疫接种的影响，并指导进一步的努力。
2017 年，我们对普通人群（1-17 岁和 20 岁及以上）进行了横断面、基于人群、三阶段聚类调查。我们访问了家庭，采集了血液样本并进行了标准问卷调查。采集样本进行乙型肝炎表面抗原 (HBsAg) 和丙型肝炎病毒抗体 (抗-HCV) 检测。我们计算了感染率和选定特征以及置信区间 (CI)。
在接触的 1372 人中，有 1358 人（99%）参与。其中，1321 人（97%）进行了 HBsAg 检测，在 5 岁及以上的 1173 名入组者中，1150 人（98%）进行了抗-HCV 检测。20 岁及以上人群中 HBsAg 的流行率为 2.0%（95%CI：1.0-4.0），1-17 岁人群中 HBsAg 的流行率为 0.5%（95%CI：0.1-1.8）。≥5 岁人群中抗-HCV 的流行率为 0.3%（95%CI：0.1-0.8）。
婴儿普遍接种乙型肝炎疫苗导致 1-17 岁人群慢性 HBV 感染的流行率较低，≥5 岁人群抗-HCV 的流行率较低。应继续努力确保及时接种出生剂量，完成乙型肝炎疫苗系列接种。为减少成年人的慢性肝病负担，可能仅限于孕妇、献血者、慢性肝病患者和其他有高风险暴露史的人群进行 HBV 和 HCV 检测和治疗。
