Pan Yuchen, Jia Zhifang, Zhang Yangyu, Wu Yanhua, Jiang Jing
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Xinmin Street No. 1163, Changchun, 130021, Jilin, China.
Department of Clinical Epidemiology, the First Hospital of Jilin University, Xinmin Street No. 1, Changchun, 130021, Jilin, China.
Hepatol Int. 2025 Apr 4. doi: 10.1007/s12072-025-10816-4.
Occult hepatitis B virus infection (OBI) is defined by the presence of hepatitis B virus (HBV) DNA, while HBsAg (Hepatitis B surface antigen) remains undetectable. The infectivity of OBI and its potential ability to contribute to cirrhosis and hepatocellular carcinoma has been reported, with infection in children potentially leading to more severe outcomes. However, the global prevalence and disease burden remain unclear, and this study aimed to assess the prevalence of OBI in population under 18 years old.
We conducted a systematic literature search in PubMed, Embase, Scopus, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Chinese databases for articles evaluating OBI in population under 18 years old. The prevalence of OBI was pooled after quality assessment.
A total of 49 studies was included, allowing a meta-analysis of 1,070,526 HBsAg-negative individuals. Data from 28 and 25 studies were extracted for analysis of the high- and low-risk population, respectively. The overall prevalence of OBI in population ≤ 18 years old was 2.1% [95% confidence interval (CI): 0.9%-3.8%] and 9.7% (95% CI: 4.9%-15.8%) in the low- and high-risk population, respectively. In the subgroup analysis of the high-risk population, the OBI prevalence in the African, Eastern Mediterranean, and Western Pacific regions was 21.5% (95% CI: 0.0%-69.9%), 26.8% (95% CI: 13.0%-43.4%), and 4.3% (95% CI: 1.5%-8.2%), respectively. The OBI prevalence was 6.3% (95% CI: 2.7%-11.1%) in children born to mothers infected with HBV, 20.5% (95% CI: 0.0%-66.6%) in population infected with HIV or HCV, and 37.8% (95% CI: 30.8%-45.1%) in population who received blood transfusion. The OBI prevalence was 6.0% (95% CI: 2.4%-11.0%) in participants whose mothers were infected with HBV and vaccinated with hepatitis B vaccine (HepB) and HBIG, 7.1% (95% CI: 0.0%-22.9%) in participants only vaccinated with HepB.
The global prevalence of OBI among individuals under 18 years old, particularly in high-risk population, cannot be neglected. Given the stealthy transmission of OBI and its potential for serious clinical outcomes, OBI in population younger than 18 years old should be emphasized as a global health issue.
隐匿性乙型肝炎病毒感染（OBI）的定义是存在乙型肝炎病毒（HBV）DNA，但检测不到乙型肝炎表面抗原（HBsAg）。已有报道称OBI具有传染性及其导致肝硬化和肝细胞癌的潜在能力，儿童感染可能导致更严重的后果。然而，全球患病率和疾病负担仍不明确，本研究旨在评估18岁以下人群中OBI的患病率。
我们在PubMed、Embase、Scopus、Cochrane图书馆、中国知网和万方中文数据库中进行了系统的文献检索，以查找评估18岁以下人群中OBI的文章。在质量评估后汇总OBI的患病率。
共纳入49项研究，对1,070,526名HBsAg阴性个体进行了荟萃分析。分别从28项和25项研究中提取数据，用于分析低风险和高风险人群。18岁及以下人群中OBI的总体患病率分别为2.1%[95%置信区间（CI）：0.9%-3.8%]和9.7%（95%CI：4.9%-15.8%）。在高风险人群的亚组分析中，非洲、东地中海和西太平洋地区的OBI患病率分别为21.5%（95%CI：0.0%-69.9%）、26.8%（95%CI：13.0%-43.4%）和4.3%（95%CI：1.5%-8.2%）。母亲感染HBV的儿童中OBI患病率为6.3%（95%CI：2.7%-11.1%），感染HIV或HCV的人群中为20.5%（95%CI：0.0%-66.6%），接受输血的人群中为37.8%（95%CI：30.8%-45.1%）。母亲感染HBV并接种乙型肝炎疫苗（HepB）和乙肝免疫球蛋白（HBIG）的参与者中OBI患病率为6.0%（95%CI：2.4%-11.0%），仅接种HepB的参与者中为7.1%（95%CI：0.0%-22.9%）。
18岁以下个体中OBI的全球患病率不容忽视，尤其是在高风险人群中。鉴于OBI的隐匿传播及其严重临床后果的可能性，18岁以下人群中的OBI应作为一个全球健康问题加以重视。
