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Download references. You can also search for this author in PubMed Google Scholar. HW and JW designed the review, performed data extraction and analysis, and drafted the manuscript. PM and YX conducted the data extraction and quality assessment. All authors have read and approved the final version of the manuscript. Correspondence to Jiang Wu. Because this study was based on information retrieved from published studies, it did not require any ethical approval.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions. Wang, H. Hepatitis B infection in the general population of China: a systematic review and meta-analysis. BMC Infect Dis 19, Download citation.
Received : 12 June Accepted : 30 August Published : 18 September Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Results Of the 27 studies included in the meta-analysis, the pooled estimated prevalence of HBV infection in the general population of China from to was 6.
Conclusion The prevalence of HBV infection in the general population of China was classified as higher intermediate prevalence 5—7. Inclusion and exclusion criteria All articles that reported cross-sectional studies on the general population tested for HBsAg in different regions of China were included.
Statistical analysis Statistical analysis was performed by Stata software Version Results Study general scope A total of English articles and Chinese articles were identified through 7 database searches. Flow diagram of study selection. Full size image. Table 1 Characteristics of the studies included in the meta-analysis Full size table. Forest plot of HBV infection prevalence rate in the general Chinese population from to Bias assessment funnel plot of studies reporting HBV prevalence in China from to Discussion Hepatitis B is a major global public health problem particularly in developing countries.
Conclusion China was classified as a higher intermediate prevalence area 5—7. Availability of data and materials Not applicable. References 1. Article PubMed Google Scholar 5. Article Google Scholar 6. Article PubMed Google Scholar 7. Article PubMed Google Scholar 8.
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View author publications. Ethics declarations Ethics approval and consent to participate Because this study was based on information retrieved from published studies, it did not require any ethical approval. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Additional files. Additional file 1: Table S1. DOCX 16 kb. Additional file 2: Table S2.
Quality assessment of eligible studies. HBV infections were almost entirely in the 20 and older age groups with a male-to-female ratio of 1. However, only These results demonstrate that all people free from HBV infection should obtain injections of the vaccine or booster shots, and conventional virologic detection in a clinical laboratory center should incorporate genotype and mutation alongside the serological factors for etiology and develop better classification methods, such as sequencing.
Hepatitis B virus HBV infection remains one of the most urgent major public health priorities; it is a devastating cause of morbidity and mortality, accounting for more than , deaths per year in China 1 , 2 , despite the fact that the expansion of national immunization programs and the initiation of universal Hepatitis B virus HBV vaccination in all newborns has resulted in a steady decline in the prevalence of HBV since 3.
It is currently estimated that 30 million people are chronic carriers of the virus, which is transmitted to others through high-risk behaviors involving percutaneous or mucosal contact with infected blood or other body fluids 1. Unsuccessful treatment is mostly attributable to drug-resistance after long-term use of NAs Sequential NA monotherapy can select for multidrug-resistant HBV strains with mutations in the reverse transcriptase RT region of the polymerase gene, which can modify the amino acid sequence of the hepatitis B surface antigen HBsAg These HBV strains, if carrying mutations, would definitely result in treatment failure Early detection of mutants and frequent monitoring of viral loads is crucial for clinicians to select NAs for HBV patients in order to achieve successful therapy outcomes.
HBV genotype characteristics are also essential for disease evaluation and treatment Different genotypes distribute differently worldwide, whereas in China, there is a prevalence of genotypes B, C, and D 15 , Many studies have concluded that the prevalence of HBV genotypes exhibit different clinical features, which suggests it was a determinant of the outcome after acute HBV infection and of chronic HBV infection 17 , HBV genotypes were also demonstrated to correlate with the diversity of liver disease and the oxidative damage degree in patients with HBV-induced liver disease 19 , HBV epidemiology and virologic characteristics genotypes and mutations based on a large sample size from Shenzhen has rarely been investigated.
In this study, we have included a total of , cases from Aug. We estimated the positive rate of age-specific cases of HBV by applying distribution in positive samples in the corresponding serological factors group, respectively. To quantify genotype patterns of HBV by age and gender, we applied age-specific and gender-specific case distribution in each genotype of the HBV.
To quantify every single mutation site, we applied age-specific and gender-specific case distributions in each mutation group. To quantify HBV drug-resistant mutation occurrence patterns, we applied those case distributions in each HBV genotype group. These investigations will help to assess the burden of the diseases and the effects of ongoing prevention campaigns, and will be indispensable for the development of future strategic plans. Between Aug. The clinical and laboratory data was extracted from medical records, including basic demographic information sex and date of birth , date of illness onset, sample type serum , symptoms, date of symptoms onset, diagnosis if applicable , date of diagnosis, date of sampling, method used for HBV test, results at the time of sampling positive or negative , HBV-DNA level, virus genotype wild type, B, C, D, mixed, or unclassified , and mutation no mutation, rtI, rtM, rtV, rtT, rtV, rtV, rtG, rtL, rtT, rtI, rtL, rtI, rtS, rtI, rtA, or rtF.
All information and patient identifiers were kept anonymous to protect patient confidentiality. Since all data obtained was de-identified, and no extra samples were required, written consent from the patients was waived. We included all , cases from Aug.
We also evaluated the positive rate of age-specific cases of HBV by applying distribution to the positive samples in the corresponding serological factors group, respectively. To quantify genotype patterns of HBV by age and gender, we applied age-specific and gender-specific case distributions in each genotype of the HBV.
To quantify each mutation site, we applied age-specific and gender-specific case distributions in each mutation group. The incidence of HBV infection had a male-to-female ratio of 1. The overall prevalence of HBV infection had remained high, up to 9. The incidence was very low the 6—19 age group, accounting for only 1.
Among patients more than 20 years old, the positive rate of HBsAg reached 9. It was slightly lower in males than in females with a male-to-female ratio of 0. All age groups had high HBV infection history rates, In summary, The less than 1 age group had the highest immune protection rate of Adults more than 20 years of age had slightly increased immune protection, which was probably because of previous infection Table 1.
Among them, In the subgroup analysis, stratified by age and gender, similar patterns of HBV genotype distribution were observed Fig. Males were significantly higher than female in all genotypes, accounting for In addition to genotyping, all patients received HBV antiviral resistant mutations detection.
A total of mutation occurrences were identified Table 2. In some cases, mutations were present in combinational patterns, so those mutations occurred in only cases. Total of 38 NAs resistant mutation occurrence patterns were present in this study Table 3 , including 10 single mutation patterns and 28 combinational mutation patterns.
Cases with single site mutation accounted for Other occurrences of single site or combinational mutation patterns were very few and no more than 10, respectively. The overall NAs resistant occurrence rate was high, up to It is noteworthy that there were several cases with mutation patterns that were not included in the guideline. HBV infection in China is an enormous economic and social burden Although China has adopted a comprehensive strategy to control HBV and has successfully lowered the prevalence of HBV over the past 3 decades, it still remains a serious health threat in many regions that have high HBsAg prevalence 22 , 23 , 24 , Not surprisingly, Shenzhen was also a high endemic area with a HBsAg prevalence of 9.
Consistent with reports from other areas, the most infectious age was mainly distributed in the above 20 years age groups, accounting for However, this investigation cannot explain the causes for this high prevalence of HBV in this area, since the means of infection in this large-scale patient study are unknown and could not be analyzed.
That there are only 1. Older patients, who were more likely not to be vaccinated and had high-risk behaviors including sexual behavior and taking drugs that could cause HBV spread though mouth mucosa, genital mucosa or blood could be the main cause of this high HBV rate. It is worth explaining that HBV infection varied greatly with age, which showed 6.
Historically, newborns are required to be injected with the HBV vaccine and the vaccine-induced immunity, shown by HBsAb, was spontaneously highest at These results strongly support that persons without HBV infection, in all age groups, should obtain vaccine or booster shots.
However, many studies have demonstrated that different genotypes have different clinical features and outcomes, and therefore detection is extremely important in the evaluation of prognosis and treatment 18 , 30 , In addition, as infectious agents, HBV genotype distribution has geographical features 15 , 16 , 17 , 32 , Based on the large-scale analysis in this study, genotype B was found predominant in Shenzhen, and genotype C was also common, whereas genotype D was rare.
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