A cross-sectional seroepidemiologic survey of chronic hepatitis B virus infections in Southeast Asian immigrants residing in a Canadian urban centre.

To document the number of individuals who might qualify for interferon therapy and what impact the costs of treatment will have on the health care system, the serologic and biochemical profiles of 140 hepatitis B surface antigen (HBsAg) positive individuals of Asian descent (72 Vietnamese, 69 Chinese) were evaluated with respect to their hepatitis B e antigen (HBeAg) status and biochemical parameters (ALT, bilirubin, and prothrombin time). The mean +/- SD age of the study population was 33.5 +/- 13.4 y. Eighty-six (61%) were male. The HBeAg was positive in 64 (46%) of cases (41% of Vietnamese and 51% of Chinese) with no apparent sexual predilection. The ALT values exceeded 1.5 x normal in 23/64 (36%) cases. Mean serum bilirubin and prothrombin times were within normal limits. The results of this study demonstrate that approximately 50% of HBsAg positive immigrants from Southeast Asia are also HBeAg positive, and 36% of these individuals have elevated ALT values (> 1.5 x normal). Thus, according to estimated carrier rates and present guidelines for treatment, approximately 1-2% of the total Southeast Asian immigrant population are candidates for interferon therapy. With an immigrant population of approximately 900,000 and a cost of $6,500/patient, the total cost to the Canadian health care system will approach $100 million, or 1.3% of the present health care budget. These results underscore the need for a reappraisal of present treatment guidelines and implementation of universal vaccination in this country.