Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Hepatitis B, C, and D Virus Infections and AFP Tumor Marker Prevalence Among the Elderly Population in Mongolia: A Nationwide Survey

  • Received : 2021.10.26
  • Accepted : 2022.03.10
  • Published : 2022.05.31
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Abstract

Objectives: Infections with hepatitis B, C, and D virus (HBV, HCV, and HDV) are a major public health problem and lead to serious complications such as cirrhosis and hepatocellular carcinoma. We aimed to determine the seroprevalence of hepatitis B surface antigen (HBsAg), anti-HCV, anti-HDV immunoglobulin G, alpha-fetoprotein (AFP), and dual and triple hepatitis virus infections in Mongolia. Methods: A total of 2313 participants from urban and rural regions were randomly recruited for this cross-sectional study. A questionnaire was used to identify the risk factors for hepatitis virus infections, and the seromarkers were measured using immunoassay kits. Results: Among all participants, the prevalence of HBV, HCV, and HDV was 15.6%, 36.6%, and 14.3%, respectively. The infection rates were significantly higher in females and participants with a lower education level, rural residence, older age, and a history of blood transfusion. HBV and HCV co-infection was found in 120 (5.2%) participants and HBV, HCV, and HDV triple infection was detected in 67 (2.9%) participants. The prevalence of elevated AFP was 2.7%, 5.5%, and 2.6% higher in participants who were seropositive for HBsAg (p=0.01), anti-HCV (p<0.001), and anti-HDV (p=0.022), respectively. Elevated AFP was more prevalent in participants co-infected with HBV and HCV (5.8%, p=0.023), HBV and HDV (6.0%, p<0.001), and triple-infected with HBV, HCV, and HDV (7.5%) than in uninfected individuals. Conclusions: Nearly half (49.8%) of the study population aged ≥40 years were infected with HBV, HCV, or HDV, and 22.4% had dual or triple infections.

Keywords

Acknowledgement

We would like to thank the participants for actively participating in our study and extend our thanks to all the contributing centers. We also would like to acknowledge invaluable support from the Department of Public Health and Division of Virology, Department of Infection and Immunity of Jichi Medical University, Japan.

References

  1. Alcorn T. Mongolia's struggle with liver cancer. Lancet 2011;377(9772):1139-1140. https://doi.org/10.1016/S0140-6736(11)60448-0
  2. Chimed T, Sandagdorj T, Znaor A, Laversanne M, Tseveen B, Genden P, et al. Cancer incidence and cancer control in Mongolia: results from the National Cancer Registry 2008-12. Int J Cancer 2017;140(2):302-309. https://doi.org/10.1002/ijc.30463
  3. Yan YP, Su HX, Ji ZH, Shao ZJ, Pu ZS. Epidemiology of hepatitis B virus infection in China: current status and challenges. J Clin Transl Hepatol 2014;2(1):15-22. https://doi.org/10.14218/JCTH.2013.00030
  4. Muljono DH. Epidemiology of hepatitis B and C in Republic of Indonesia. Euroasian J Hepatogastroenterol 2017;7(1):55-59.
  5. Pak SC, Alastal Y, Khan Z, Darr U. Viral hepatitis in South Korea. Euroasian J Hepatogastroenterol 2017;7(2):163-165.
  6. Seeger C, Mason WS. Hepatitis B virus biology. Microbiol Mol Biol Rev 2000;64(1):51-68. https://doi.org/10.1128/MMBR.64.1.51-68.2000
  7. Kim CW, Chang KM. Hepatitis C virus: virology and life cycle. Clin Mol Hepatol 2013;19(1):17-25. https://doi.org/10.3350/cmh.2013.19.1.17
  8. Liang TJ. Hepatitis B: the virus and disease. Hepatology 2009;49(5 Suppl):S13-S21. https://doi.org/10.1002/hep.22881
  9. Li HC, Lo SY. Hepatitis C virus: virology, diagnosis and treatment. World J Hepatol 2015;7(10):1377-1389. https://doi.org/10.4254/wjh.v7.i10.1377
  10. Negro F. Hepatitis D virus coinfection and superinfection. Cold Spring Harb Perspect Med 2014;4(11):a021550. https://doi.org/10.1101/cshperspect.a021550
  11. World Health Organization. Global hepatitis report 2017 [cited 2021 Jan 9]. Available from: https://apps.who.int/iris/handle/10665/255016.
  12. Konstantinou D, Deutsch M. The spectrum of HBV/HCV coinfection: epidemiology, clinical characteristics, viralinteractions and management. Ann Gastroenterol 2015;28(2):221-228.
  13. Sultana C, Dita C, Botescu A, Grancea C, Ruta S. Serum alpha fetoprotein, a surrogate marker for liver disease progression in chronic hepatitis C. Roum Arch Microbiol Immunol 2014;73(3-4):69-73.
  14. Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet 2011;378(9791):571-583. https://doi.org/10.1016/S0140-6736(11)61097-0
  15. Davaalkham D, Ojima T, Nymadawa P, Uehara R, Watanabe M, Oki I, et al. Prevalence and risk factors for hepatitis C virus infection in Mongolian children: findings from a nationwide survey. J Med Virol 2006;78(4):466-472. https://doi.org/10.1002/jmv.20563
  16. Kim YA, Estevez J, Le A, Israelski D, Baatarkhuu O, Sarantuya T, et al. Screening and management of viral hepatitis and hepatocellular carcinoma in Mongolia: results from a survey of Mongolian physicians from all major provinces of Mongolia. BMJ Open Gastroenterol 2016;3(1):e000119. https://doi.org/10.1136/bmjgast-2016-000119
  17. Davaalkham D, Ojima T, Uehara R, Watanabe M, Oki I, Nymadawa P, et al. Hepatitis delta virus infection in Mongolia: analyses of geographic distribution, risk factors, and disease severity. Am J Trop Med Hyg 2006;75(2):365-369. https://doi.org/10.4269/ajtmh.2006.75.365
  18. Delgersaikhan Zulkhuu ON, Dashtseren B, Otgonbayar B, Dashdorj N, Yagaanbuyant D, Dashdorj N. Prevalence of HDV infection in Mongolia. In: Falk Symposium 199; 2015 Oct 14-17; Reiburg, Germany. Reiburg: Karger; 2016 (Germany).
  19. Baatarkhuu O, Uugantsetseg G, Munkh-Orshikh D, Naranzul N, Badamjav S, Tserendagva D, et al. Viral hepatitis and liver diseases in Mongolia. Euroasian J Hepatogastroenterol 2017;7(1):68-72.
  20. Minekawa T, Takehara S, Takahashi M, Okamoto H. Development of a highly sensitive bioluminescent enzyme immunoassay for hepatitis B virus surface antigen capable of detecting divergent mutants. Clin Vaccine Immunol 2013;20(8):1255-1265. https://doi.org/10.1128/CVI.00186-13
  21. Inoue J, Takahashi M, Nishizawa T, Narantuya L, Sakuma M, Kagawa Y, et al. High prevalence of hepatitis delta virus infection detectable by enzyme immunoassay among apparently healthy individuals in Mongolia. J Med Virol 2005;76(3):333-340. https://doi.org/10.1002/jmv.20363
  22. Nomura M, Imai M, Usuda S, Nakamura T, Miyakawa Y, Mayumi M. A pitfall in two-site sandwich 'one-step' immunoassay with monoclonal antibodies for the determination of human alpha-fetoprotein. J Immunol Methods 1983;56(1):13-17. https://doi.org/10.1016/0022-1759(83)90044-3
  23. Tserenpuntsag B, Nelson K, Lamjav O, Triner W, Smith P, Kacica M, et al. Prevalence of and risk factors for hepatitis B and C infection among Mongolian blood donors. Transfusion 2010;50(1):92-99. https://doi.org/10.1111/j.1537-2995.2009.02387.x
  24. Tsatsralt-Od B. Viral hepatitis in Mongolia: past, present, and future. Euroasian J Hepatogastroenterol 2016;6(1):56-58. https://doi.org/10.5005/jp-journals-10018-1168
  25. Davaalkham D, Ojima T, Uehara R, Watanabe M, Oki I, Wiersma S, et al. Impact of the universal hepatitis B immunization program in Mongolia: achievements and challenges. J Epidemiol 2007;17(3):69-75. https://doi.org/10.2188/jea.17.69
  26. Moore KJ, Gauri A, Koru-Sengul T. Prevalence and sociodemographic disparities of hepatitis C in baby boomers and the US adult population. J Infect Public Health 2019;12(1):32-36. https://doi.org/10.1016/j.jiph.2018.08.003
  27. Chlibek R, Smetana J, Sosovickova R, Gal P, Dite P, Stepanova V, et al. Prevalence of hepatitis C virus in adult population in the Czech Republic - time for birth cohort screening. PLoS One 2017;12(4):e0175525. https://doi.org/10.1371/journal.pone.0175525
  28. Chen HY, Shen DT, Ji DZ, Han PC, Zhang WM, Ma JF, et al. Prevalence and burden of hepatitis D virus infection in the global population: a systematic review and meta-analysis. Gut 2019;68(3):512-521. https://doi.org/10.1136/gutjnl-2018-316601
  29. Tsatsralt-Od B, Takahashi M, Nishizawa T, Endo K, Inoue J, Okamoto H. High prevalence of dual or triple infection of hepatitis B, C, and delta viruses among patients with chronic liver disease in Mongolia. J Med Virol 2005;77(4):491-499. https://doi.org/10.1002/jmv.20482
  30. Kitab B, Ezzikouri S, Alaoui R, Nadir S, Badre W, Trepo C, et al. Occult HBV infection in Morocco: from chronic hepatitis to hepatocellular carcinoma. Liver Int 2014;34(6):e144-e150. https://doi.org/10.1111/liv.12482
  31. Baatarkhuu O, Kim DY, Ahn SH, Nymadawa P, Dahgwahdorj Y, Shagdarsuren M, et al. Prevalence and genotype distribution of hepatitis C virus among apparently healthy individuals in Mongolia: a population-based nationwide study. Liver Int 2008;28(10):1389-1395. https://doi.org/10.1111/j.1478-3231.2008.01820.x
  32. Tosun S, Aygun O, Ozdemir HO, Korkmaz E, Ozdemir D. The impact of economic and social factors on the prevalence of hepatitis B in Turkey. BMC Public Health 2018;18(1):649. https://doi.org/10.1186/s12889-018-5575-6
  33. Yaseen MR, Aziz S, Aftab S. Socio-economic factors affecting hepatitis C and lack of awareness: a case study of Pakistan. Iran J Public Health 2014;43(10):1456-1457.
  34. Konstantinou D, Deutsch M. The spectrum of HBV/HCV coinfection: epidemiology, clinical characteristics, viralinteractions and management. Ann Gastroenterol 2015;28(2):221-228.