BMJ 2014;349:g5398 doi: 10.1136/bmj.g5398 (Published 3 September 2014)
Page 1 of 1
Letters
LETTERS HEPATITIS B
Prevalence of chronic hepatitis B in Canada Carla K Osiowy research scientist Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada R3E 3R2
Davison and Strasser provide an excellent overview of the interpretation and use of hepatitis B virus (HBV) serology in the identification and management of people infected with the virus.1 Their summary included a map of HBV prevalence estimates throughout the world to guide screening of those born in countries with a high or intermediate prevalence of chronic infection. However, the estimated prevalence of chronic HBV infection in Canada in this map is incorrect. The map shows intermediate prevalence (2-7%) throughout the country, whereas the prevalence of chronic HBV infection in the Canadian born population is estimated to be less than 1%.2 3 Canada has a large immigrant population,4 and most new immigrants originate from countries with an intermediate or high prevalence of chronic HBV infection.5 6 Thus, specific populations, such as immigrants and injection drug users,7 are expected to have a higher prevalence than the general population of Canada.
This misconception may be the result of most of the literature describing an intermediate or high prevalence of hepatitis B virus throughout the northern regions of Canada, mainly the Nunavut and Northwest Territories. The Inuit and First Nations populations of these regions have been reported to have HBV prevalence rates greater than 2%,8 although most of these studies were conducted before universal infant vaccination programmes were implemented there, about 20 years ago. Studies are
currently under way to characterise the current prevalence of chronic HBV infection in Nunavut, and preliminary evidence indicates that the prevalence rate has dropped significantly owing to a successful vaccination programme. Competing interests: None declared. 1 2
3 4 5 6 7 8
Davison SA, Strasser SI. Ordering and interpreting hepatitis B serology. BMJ 2014;348:g2522. (17 April.) Rotermann M, Langlois K, Andonov A, Trubnikov M. Seroprevalence of hepatitis B and C virus infections: results from the 2007 to 2009 and 2009 to 2011 Canadian Health Measures Survey. Statistics Canada health reports, 2013. www.statcan.gc.ca/pub/82003-x/2013011/article/11876-eng.pdf. Merrill RM, Hunter BD. Seroprevalence of markers for hepatitis B viral infection. Int J Infect Dis 2011;15:e78-121. Statistics Canada. Immigration and ethnocultural diversity in Canada: national household survey, 2011. SC, 2013. www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-010-x/99-010x2011001-eng.cfm. Wong WWL, Woo G, Heathcote EJ, Krahn M. Disease burden of chronic hepatitis B among immigrants in Canada. Can J Gastroenterol 2013;27:137-48. Sherman M, Bilodeau M, Cooper C, Mackie D, Depew W, Villeneuve J, et al. Liver disease in Canada: a crisis in the making. Canadian Liver Foundation, 2013. www.liver.ca/supportliver-foundation/advocate/Liver_Disease_in_Canada_Report.aspx. Panessa C, Hill WD, Giles E, Yu A, Yu CF, Harvard S, et al. Genotype D amongst injection drug users with acute hepatitis B virus infection in British Columbia. J Viral Hepatitis 2009;16:64-73. Osiowy C, Simons B, Rempel JD. Distribution of viral hepatitis in indigenous populations of North America and the circumpolar Arctic. Antivir Ther 2013;18:467-73.
Cite this as: BMJ 2014;349:g5398 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Letters
LETTERS HEPATITIS B
Prevalence of chronic hepatitis B in Canada Carla K Osiowy research scientist Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada R3E 3R2
Davison and Strasser provide an excellent overview of the interpretation and use of hepatitis B virus (HBV) serology in the identification and management of people infected with the virus.1 Their summary included a map of HBV prevalence estimates throughout the world to guide screening of those born in countries with a high or intermediate prevalence of chronic infection. However, the estimated prevalence of chronic HBV infection in Canada in this map is incorrect. The map shows intermediate prevalence (2-7%) throughout the country, whereas the prevalence of chronic HBV infection in the Canadian born population is estimated to be less than 1%.2 3 Canada has a large immigrant population,4 and most new immigrants originate from countries with an intermediate or high prevalence of chronic HBV infection.5 6 Thus, specific populations, such as immigrants and injection drug users,7 are expected to have a higher prevalence than the general population of Canada.
This misconception may be the result of most of the literature describing an intermediate or high prevalence of hepatitis B virus throughout the northern regions of Canada, mainly the Nunavut and Northwest Territories. The Inuit and First Nations populations of these regions have been reported to have HBV prevalence rates greater than 2%,8 although most of these studies were conducted before universal infant vaccination programmes were implemented there, about 20 years ago. Studies are
currently under way to characterise the current prevalence of chronic HBV infection in Nunavut, and preliminary evidence indicates that the prevalence rate has dropped significantly owing to a successful vaccination programme. Competing interests: None declared. 1 2
3 4 5 6 7 8
Davison SA, Strasser SI. Ordering and interpreting hepatitis B serology. BMJ 2014;348:g2522. (17 April.) Rotermann M, Langlois K, Andonov A, Trubnikov M. Seroprevalence of hepatitis B and C virus infections: results from the 2007 to 2009 and 2009 to 2011 Canadian Health Measures Survey. Statistics Canada health reports, 2013. www.statcan.gc.ca/pub/82003-x/2013011/article/11876-eng.pdf. Merrill RM, Hunter BD. Seroprevalence of markers for hepatitis B viral infection. Int J Infect Dis 2011;15:e78-121. Statistics Canada. Immigration and ethnocultural diversity in Canada: national household survey, 2011. SC, 2013. www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-010-x/99-010x2011001-eng.cfm. Wong WWL, Woo G, Heathcote EJ, Krahn M. Disease burden of chronic hepatitis B among immigrants in Canada. Can J Gastroenterol 2013;27:137-48. Sherman M, Bilodeau M, Cooper C, Mackie D, Depew W, Villeneuve J, et al. Liver disease in Canada: a crisis in the making. Canadian Liver Foundation, 2013. www.liver.ca/supportliver-foundation/advocate/Liver_Disease_in_Canada_Report.aspx. Panessa C, Hill WD, Giles E, Yu A, Yu CF, Harvard S, et al. Genotype D amongst injection drug users with acute hepatitis B virus infection in British Columbia. J Viral Hepatitis 2009;16:64-73. Osiowy C, Simons B, Rempel JD. Distribution of viral hepatitis in indigenous populations of North America and the circumpolar Arctic. Antivir Ther 2013;18:467-73.
Cite this as: BMJ 2014;349:g5398 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
