Seroprevalence of hepatitis B virus infection among children and adolescents in Singapore, 2008-2010.

A national pediatric survey was undertaken to determine the prevalence of hepatitis B virus markers in Singapore. The aim was to assess the impact of the national childhood immunization program against hepatitis B implemented for all newborns since 1987. The survey involved prospective collection of residual sera from Singapore residents aged 1-17 years attending inpatient services or day surgery in two public hospitals between August 2008 and July 2010. A total of 1,200 sera were collected comprising 400 in each of the three age groups of 1-6, 7-12, and 13-17 years. The sera were tested for hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). Four of the 1,200 samples tested positive for HBsAg, giving an overall prevalence of 0.3%. One and three in the 7-12 years and 13-17 years age groups, respectively, were positive for HBsAg. About 40% possessed anti-HBs (≥10 mIU/ml); the antibody prevalence decreased significantly from 63.8% in children aged 1-6 years to 32.8% in 7-12 year olds, and 23.5% in 13-17 year olds (P < 0.0005). The successful implementation of the national childhood hepatitis B immunization program over the last two decades has resulted in a low prevalence of HBsAg among children and adolescents. Singapore has achieved the World Health Organization Western Pacific Region's goal in reducing the prevalence of chronic HBV infection to below 2% among children aged 5 years and older by 2012 and to below 1% by 2017.