Differing profiles of people diagnosed with acute and chronic hepatitis B virus infection in British Columbia,Canada

AIM To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus(HBV) infection in British Columbia(BC).METHODS We used data from the BC Hepatitis Testers Cohort(BCHTC),which includes all individuals tested for hepatitis C virus(HCV) or human immunodeficiency virus(HIV) or those diagnosed with HBV or active tuberculosis in BC since 1990.These data were integrated with prescription drug,medical visit,hospitalization and mortality data.HBV cases were classified as acute or chronic according to provincial guidelines.We compared characteristics of individuals by HBV infection group(acute,chronic and negative).Factors associated with acute or chronic HBV infection were assessed with multinomial logistic regression models in comparison to the HBV negative group.RESULTS46498 of the 1058056 eligible BC-HTC participants were diagnosed with HBV infection.4.3% of HBV positive individuals were diagnosed with acute HBV infections while 95.7% had chronic infections.Problematic alcohol use,injection drug use,and HIV or HCV co-infection were more common among individuals diagnosed with acute HBV compared to those with chronic infections and HBV negative individuals.In multivariable multinomial logistic regression models,we observed significant associations between acute or chronic HBV diagnosis and being male,age at HBV diagnosis or birth cohort,South and East Asian ethnicity,HCV or HIV infection,and injection drug use.The odds of acute HBV decreased with increasing age among people who inject drugs,while the opposite was true for chronic HBV.Persons with acute HBV were predominantly White(78%) while those with chronic HBV were mostly East Asian(60%).Relative to Whites,East Asians had 12 times greater odds of being diagnosed with chronic HBV infection.These odds increased with increasing socioeconomic deprivation.CONCLUSION Differences in the profiles of people diagnosed with acute and chronic HBV infection necessitate differentiated screening,prevention,care and treatment programs.

Towards safe injection practices for prevention of hepatitis C transmission in South Asia: Challenges and progress

AIM: To summarize the available information about injection use and its determinants in the South Asian region. METHODS: We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords "injection" "unsafe injection" and "immunization injection" and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use. RESULTS: Although information is very limited for certain countries(i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventionsto change population and practitioner behavior. CONCLUSION: Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse.