Hepatitis B virus, human immunodeficiency virus type-1 and syphilis among women attending prenatal clinics in Belize, Central America

Women and their infants may benefit from therapeutic interventions when hepatitis B, human immunodeficiency virus (HIV), or syphilis are detected during the prenatal period. We initiated hepatitis B and HIV screening of women attending prenatal clinics in Belize. Risk factor assessment information for hepatitis B infection and demographic data were determined by interview. Of 543 evaluable women, 81 (14.9 percent) were seropositive for hepatitis B core antibody (anti-HBc); one woman had asymptomatic hepatitis B surface antigenemia. Antibodies to HIV-1 were detected in one woman. Reactive syphilis serologies were detected in 15 (2.8 percent) women. Anti-HBc seroprevalence varied by district (range 3.1-43.5 percent) and ethnicity (range 0.0-40.9 percent). Significant identified risks for anti-HBc seropositivity from univariate analyses included being of the Garifuna ethnic group, residence or birth in the Stann Creek or Toledo districts, a reactive syphilis serology, a household size of eight or greater, and five or more lifetime sexual partners. Multivariate analyses identified ethnicity and a reactive rapid plasma reagin as the best predictors of anti-HBc seropositivity. Highly variable differences in anti-HBc prevalence by district may permit the targeting of limited public health resources for education, screening, and prevention programs.(AU)

Seroprevalence of hepatitis B virus among school-age children in the Stann Creek District of Belize, Central America

Adults in the Stann Creek district of Belize have a high prevalence of hepatitis B virus (HBV) infection, but the age of onset of these infections is unclear. We conducted a seroprevalence study of hepatitis B markers among Stann Creek school-age children to provide information for planning a hepatitis B vaccine program. The overall prevalence in 587 students was high for antibody to hepatitis B core antigen (anti-HBc) (43.3percent) and hepatitis B surface antigen (HBsAg) (7.7 percent). There was marked variation of anti-HBc by school and by the predominant ethnic groups attending those schools. Maya had the highest prevalence (76 percent), followed by Mestizo (50 percent), Garifuna (37 percent), and Creole (25 percent). Children less than nine years of age attending the rural primary schools (mostly Garifuna and Creole) (p< 0.05). Anti-HBc was found in 42 percent and 36 percent of students at the two high schools. Of the five schools tested, only at the urban primary school did anti-HBc positivity increase with age. Based on an analysis of the cost of serologic screening before immunization compared with mass vaccination, preimmunization serologic screening resulted in vaccine program cost savings in four of the five schools. Because most children in the rural areas contract hepatitis B before entering school, immunization against HBV should be integrated into the routine infant immunization program (AU)

Prevalence of hepatitis B virus among health care workers in Belize, Central America

A seroprevalence survey of hepatitis B virus (HBV) markers was conducted among health care workers in Belize to help determine the epidemiology of hepatitis B and to determine if screening before immunization might lower vaccine costs. Of the 330 workers tested, 94 (29 percent) were positive for antibody to HBV core antigen (anti-HBc) and three (1 percent) had HBV surface antigen. The presence of anti-HBc increased significantly with age from 12 percent in those 18-24 years old to 52 percent in those o 50 years old. The rate was 17 percent of 48 men compared with 30 percent of 282 women (P = 0.05). Rates increased with years of medical service and were higher among nurses (69 of 228; 30 percent) and nonprofessional staff (15 of 44; 34 percent) than among physicians (0 of 20). The presence of anti-HBc also differed significantly among ethnic groups: Mestizo, 4 percent; Creole, 33 percent and Garifuna, 57 percent. Rates differed by district ranging from 3 percent in a northern district (mostly Mestizo) to 67 percent in a southern district (mostly Garifuna). Parenteral exposure to hepatitis B through needle stick injuries and blood transfusions was not associated with anti-HBc. Multiple logistic regression analysis confirmed ethnicity, district of residence, and age as the best predictors of anti-HBc in health care workers. Cost analysis suggests that because of regional differences in exposure, testing of health care workers for anti-HBc in the Belize and Stann Creek districts in southern Belize before hepatitis B immunization would result in vaccine program cost savings (AU)

Initial report of a hepatitis investigation in rural Belize

In spring 1991, Belizian health officials expressed concern about a possible hepatitis outbreak in a banana farming district. A study was designed to identify cases and to address the serological prevalence of hepatitis virus markers. Three populations were studied: (i) persons meeting a clinical case definition for hepatitis; (ii) designated banana workers; and (iii) people in a random sample of households in the community. Information was collected using questionnaires and sera were collected for laboratory testing. This report presents the preliminary results of a study conducted in June 1991. Among people who met the clinical case definition, 24 percent of 42 tested had immunoglobulin M antibody to hepatitis B virus (HBV) core antigen (anti-HBc IgM). In the worker and household survey populations, 248 and 280 people, respectively, were tested for anti-HBc IgM. In each group, 4 percent were positive. HBV surface antigen was found in 37 percent of 43 clinical cases, 18 percent of workers, and 13 percent of people in the household survey. Among the 3 study populations, the prevalence of HBV core antibody (anti-HBc) ranged from 73 percent to 81 percent. Almost all tested persons had evidence of prior infection with hepatitis viruses A and B was widespread, but an aetiology could not be established for most of the clinical cases. However, the prevalence of hepatitis B markers in this population was very high compared to other reports from the Caribbean (AU)