title: Hepatitis B prevalence and treatment needs among Tibetan refugees residing in India.
abstract: Untreated chronic hepatitis B can lead to liver failure and/or liver cancer. These complications can be avoided through prevention with vaccination or treatment of disease. To inform health policy for the Tibetan community in India, we conducted study of hepatitis B prevalence and treatment needs. We conducted a cross-sectional study over 3 months of 2013. Households were randomly selected for participation via a satellite map; one boarding school and one residential monastery were also included. Participants were asked questions and a whole blood sample was collected for HBsAg assay. Participants with a positive HBsAg result were tested for hepatitis B e antigen, ALT, and AST. Participants with a negative HBsAg result were tested for anti-hepatitis B core antibodies. We recruited 2,769 participants; of which 247 (8.9%) were positive for HBsAg. Participants more likely to have a positive HBsAg result were those born in Tibet (12.4%) and aged 30-59 years old. Of those with a positive HBsAg result, 60.7% were positive for hepatitis B e antigen 7% of whom fit into a likely treatment-needed category; the others fit into management categories requiring repeat ALT testing with or without liver fibrosis assessment. Among participants negative for HBsAg, 52.9% from household sampling had anti-HBc antibodies. We identified a high endemicity of chronic hepatitis B in a Tibetan community in India. Resource appropriate approaches are needed for managing chronic hepatitis B in settings such as this one. J. Med. Virol. 88:1357-1363, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Stevens
authors.affiliation: Department of Health, Central Tibetan Administration, Dharamsala, India.
authors.forename: Trinley
authors.initials: T
authors.lastname: Palmo
authors.affiliation: Department of Health, Central Tibetan Administration, Dharamsala, India.
authors.forename: Tsering
authors.initials: T
authors.lastname: Wangchuk
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Sunil
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Partners in Health, Sierra Leone.
authors.forename: Kerry
authors.initials: K
authors.lastname: Dierberg
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hoffmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006301:Health Services Needs and Demand; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology* / Q000276:immunology; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008113:Liver Neoplasms / Q000517:prevention & control / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012036:Refugees; D012574:Schools; D018609:Tibet / Q000208:ethnology; D014611:Vaccination; D055815:Young Adult
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens
keywords: chronic hepatitis B; epidemiology; prevalence; refugee; treatment; vaccination