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Epidemiologic Survey of Chronic Hepatitis B and C in the

Burmese Population of Maryland


1
MD ;

2
PA-C ;

3
Phan-Hoang ,

3
Pan ,

Natarajan Ravendhran,
Sean Byrne,
Dan-Tam
Jane
Khin Rupa Maung,
1Johns Hopkins University, Department of Medicine, Baltimore, MD;
2Gilead Sciences, Inc.; 3Hepatitis B Initiative of Washington, DC
ABSTRACT
Background: According to the WHO, an
estimated 350 million people are infected
globally1 with chronic hepatitis B (CHB),
with approximately 1.25 million living in
the U.S.2 Chronic Hepatitis C (CHC)
affects approximately 170 million
globally,3 3 million of whom live in the
United States4. Studies conducted in
Myanmar found that between 10-12% of
the population were found to be HBsAg+
and 3% anti-HCV+. In this study we
attempted to discover the prevalence of
CHB and CHC within a community of
Burmese living in Maryland.
Methods: A prospective epidemiologic
screening survey was conducted in which
patients were screened at community
screening events within the Burmese
community of Maryland for both HBV and
HCV. HBV status was assessed by
screening blood test for HBsAg and antiHBs. For HCV assessment, patients were
screened for anti-HCV and if anti-HCV+,
HCV RNA was drawn to quantify virus
levels.
Results: A total of 892 patients were
screened over 30 screening events
between March 2013 and October 2014.
The prevalence rate for HBsAg+ was 4.4%
(n=838). 26% required vaccination. The
prevalence rate for anti-HCV+ (n=840)
was 4.8%. 8% had a family member with
CHB and 3% had a family member with
HCC.
Conclusions: HBsAg prevalence was less
in this population than was reported in
Myanmar. The anti-HCV rate was higher
in our study group than was reported in
Myanmar.

RESULTS

INTRODUCTION
In the United States, there are an estimated 1.25 million
hepatitis B carriers2, 70% of whom would have acquired the
disease outside of the US5 and prevalence increases with
immigration into the country2. CHC affects approximately
170 million people worldwide, of whom three million live in
the United States, representing 1.3% of the US population.
Studies conducted in Myanmar found between 10-12% of
the study population was found to be seropositive for
HBsAg6 and approximately 3% seropositive for anti-HCV7.
The influx of immigrants from areas of high endemnicity
has contributed to an increased prevalence of CHB and
CHC, particularly in urban areas and other communities
with a high immigrant population.
Our primary objective was to conduct a serosurveillance
study to identify prevalence of CHB & CHC within the
Burmese immigrant population in Baltimore and
surrounding areas from a high prevalence country such as
Myanmar. The secondary objective was to educate the
Burmese population and local providers on Hepatitis B & C
and to use this campaign to improve CHB & CHC screening
and linkage to care in this community

A total of 892 patients were screened over 29 screening events


between March 2013 and September 2014.

43% were Female, 51% were Male and 6% did not report.
The HBsAg+ prevalence rate was 4.4% (n=838).

26% required vaccination.


Received 1st vaccination 143/229 (16%)*
Received 2nd vaccination 77/229 (9%)*
Received 3rd vaccination 46/229 (5%)*

*At the time of this poster presentation we continue to follow these


subjects for completion of the vaccination series
8% had a family member with CHB and 3% had a family member
with HCC.
4.8% were anti-HCV+ (n=840).
Chart 1. Overall HBsAg+ and anti-HCV + Prevalence by Gender

DISCUSSION
HBsAg prevalence rate was lower (4.4%) among the
Burmese population in Baltimore, MD and the surrounding
areas than was reported in Myanmar (10-12%).
Anti-HCV prevalence was higher in the Baltimore, MD and
the surrounding areas (4.8%) than was reported in
Myanmar (3%).
HBsAg prevalence and anti-HCV prevalence was highest in
men compared to women overall.
Only 48% had a primary doctor and only 55% had
insurance
This study highlights the need for vaccination among
populations at risk, even for those who claimed prior
vaccination
Interaction and support from local community leaders is
important in successfully educating an immigrant
population

CONCLUSIONS

METHODS
In this prospective epidemiologic screening survey, patients
were screened at community screening events within the
Burmese community for both HBV and HCV. Different
ethnic sects, and religious groups were sampled.
HBV status was assessed by screening for HBsAg and antiHBs. If HBsAg+, the patient was monitored and offered
treatment as per standard of care or enrollment in a clinical
trial. Additional contacts were screened as needed. If
HBsAg was negative, immune status was assessed and
vaccination was offered if anti-HBs AND anti-HBc total were
negative.
For HCV assessment, patients were screened for anti-HCV
and if anti-HCV+, HCV RNA was drawn. If found to be
viremic, patients were monitored, offered treatment as per
standard of care or enrollment in a clinical trial. Additional
contacts were screened as needed. If the patient was antiHCV negative, then the test results were explained and risk
factors were assessed with education on prevention.

3
MD

Initial serosurveillance of the Burmese population of


Baltimore and the surrounding areas in Maryland resulted
in an HBsAg positivity rate of 4.4% and anti-HCV positivity
was 4.8% which is different than what was reported in
Myanmar.
Chart 2. HBsAg Prevalence by Age and Gender

This type of screening program may provide access to


linkage to care to populations that have limited access to
insurance and/or primary care providers
This study also highlighted the need for hepatitis B
vaccination and viral hepatitis education among this at risk
group

REFERENCES
Chart 3. anti-HCV Prevalence by Age and Gender

1. World Health Organization. Hepatitis B Fact Sheet No. 204 (August 2008). Retrieved July 2, 2012
from http://www.who.int/mediacentre/factsheets/fs204/en/
2. Lok ASF, McMahon BJ. AASLD Practice Guidelines Update. Chronic Hepatitis B: Update 2009.
Hepatology, 2009; 50 (3) pg. 1-36.

CONTACT

3. World Health Organization. Viral Hepatitis in the WHO South-East Asia Region. (2011). Retrieved
November 24, 2012 from http://www.searo.who.int/LinkFiles/Diarrhoea,_ARI_and_hepatitis_SEACD-232.pdf
4. Centers for Disease Control and Prevention. Hepatitis C Information for Health Professionals (March
2011). Retrieved November 22, 2012 from http://www.cdc.gov/hepatitis/HCV/index.htm

Natarajan Ravendhran, M.D.


Digestive Disease Associates, P.A.
Email: n.ravendhran@ddamd.com
Website: www.ddamd.com
Phone: 410-247-4227

5. Massoumi H, Martin P, and Tan HH. Management of chronic hepatitis B. European Journal of
Gastroenterology & Hepatology, 23 (8), August 2011, pg. 642-650. 2011 Lippincott, Williams and
Wilkins, Inc.
6. World Health Organization. Viral Hepatitis in the WHO South East Asia Region. 2011 World
Health Organization. Retrieved June 3, 2012 from
http://www.searo.who.int/LinkFiles/Diarrhoea,_ARI_and_hepatitis_SEA-CD-232.pdf

Figure 1. Map of Myanmar

Figure 2. Baltimore and surrounding area

7. Myo-Khin, et. al., Prevalence and Factors Associated with Hepatitis C Virus Infection Among
Myanmar Blood Donors, Acta Medica Okayama, 2010, Vol.64, No. 5, pp. 317-321