Ingmar Wolffram1, David Petroff2, Olaf Bätz3, Katrin Jedrysiak3, Jan Kramer3, Hannelore Tenckhoff4, Thomas Berg4, Johannes Wiegand5. 1. Südstadtpraxis Paderborn, Paderborn, Germany. 2. Clinical Trial Centre Leipzig, University of Leipzig, Germany. 3. LADR GmbH Medizinisches Versorgungszentrum Dr. Kramer und Kollegen, Geesthacht, Germany. 4. Universitätsklinikum Leipzig, Klinik für Gastroenterologie und Rheumatologie, Sektion Hepatologie, Leipzig, Germany. 5. Universitätsklinikum Leipzig, Klinik für Gastroenterologie und Rheumatologie, Sektion Hepatologie, Leipzig, Germany. Electronic address: johannes.wiegand@medizin.uni-leipzig.de.
Abstract
BACKGROUND & AIMS: Prevalence data for hepatitis B and C and an evaluation of a guideline based screening in the primary care setting are not yet available. We therefore implemented a hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) screening and developed guideline based screening strategies. METHODS: HBsAg, anti-HCV, and alanine aminotransferase (ALT) were included in a routine check-up together with a questionnaire covering 16 guideline adapted risk scenarios. Significant risk factors were identified by stepwise logistic regression. RESULTS: 51 private practices screened 21,008 patients. The HBsAg, anti-HCV, and HCV-RNA prevalence was 0.52%, 0.95%, and 0.43%, respectively. Infections were previously unknown in 85% and 65% of HBsAg and anti-HCV positive individuals, respectively. Sexual risk factors were under-reported, while the following scenarios were significantly associated with viral infections (Odds ratio [95% confidence interval]). HBV: Immigration (4.4 [2.9, 6.7]), infection in household (2.5 [1.2, 4.5]), male gender (1.6 [1.1, 2.4]). Male immigrants had a 2.1% HBsAg prevalence and 80% were unaware of the infection. HCV: IV drug use (384 [233, 644]), blood transfusion before 1992 (5.3 [3.5, 7.9]), immigration (2.4 [1.5, 3.6]). Presence of either one of the HBV related guideline defined risk scenarios or elevated ALT identified 82% of previously undiagnosed patients. Presence of one of the three significant HCV risk factors or elevated ALT levels diagnosed 83% of unknown HCV-RNA positive cases by screening only 26% of the population. CONCLUSIONS: Undiagnosed hepatitis B and C infections frequently exist in the primary care setting. Easy to apply guideline defined risk scenarios help to diagnose previously unknown infections.
BACKGROUND & AIMS: Prevalence data for hepatitis B and C and an evaluation of a guideline based screening in the primary care setting are not yet available. We therefore implemented a hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) screening and developed guideline based screening strategies. METHODS: HBsAg, anti-HCV, and alanine aminotransferase (ALT) were included in a routine check-up together with a questionnaire covering 16 guideline adapted risk scenarios. Significant risk factors were identified by stepwise logistic regression. RESULTS: 51 private practices screened 21,008 patients. The HBsAg, anti-HCV, and HCV-RNA prevalence was 0.52%, 0.95%, and 0.43%, respectively. Infections were previously unknown in 85% and 65% of HBsAg and anti-HCV positive individuals, respectively. Sexual risk factors were under-reported, while the following scenarios were significantly associated with viral infections (Odds ratio [95% confidence interval]). HBV: Immigration (4.4 [2.9, 6.7]), infection in household (2.5 [1.2, 4.5]), male gender (1.6 [1.1, 2.4]). Male immigrants had a 2.1% HBsAg prevalence and 80% were unaware of the infection. HCV: IV drug use (384 [233, 644]), blood transfusion before 1992 (5.3 [3.5, 7.9]), immigration (2.4 [1.5, 3.6]). Presence of either one of the HBV related guideline defined risk scenarios or elevated ALT identified 82% of previously undiagnosed patients. Presence of one of the three significant HCV risk factors or elevated ALT levels diagnosed 83% of unknown HCV-RNA positive cases by screening only 26% of the population. CONCLUSIONS: Undiagnosed hepatitis B and C infections frequently exist in the primary care setting. Easy to apply guideline defined risk scenarios help to diagnose previously unknown infections.
Authors: Kirsty Roberts; John Macleod; Chris Metcalfe; Joanne Simon; Jeremy Horwood; William Hollingworth; Sharon Marlowe; Fiona H Gordon; Peter Muir; Barbara Coleman; Peter Vickerman; Graham I Harrison; Cherry-Ann Waldron; William Irving; Matthew Hickman Journal: Trials Date: 2016-07-29 Impact factor: 2.279
Authors: Roman Chlibek; Jan Smetana; Renata Sosovickova; Peter Gal; Petr Dite; Vlasta Stepanova; Lenka Pliskova; Stanislav Plisek Journal: PLoS One Date: 2017-04-13 Impact factor: 3.240
Authors: Urbano Sbarigia; Daniel Wirth; Karen Van Nuys; Caroline Huber; Ron Brookmeyer; Jona Stahmeyer; Christian Krauth Journal: BMJ Open Gastroenterol Date: 2017-04-04
Authors: Abby M Falla; Irene K Veldhuijzen; Amena A Ahmad; Miriam Levi; Jan Hendrik Richardus Journal: BMC Health Serv Res Date: 2017-02-20 Impact factor: 2.655
Authors: Abby M Falla; Irene K Veldhuijzen; Amena A Ahmad; Miriam Levi; Jan Hendrik Richardus Journal: Eur J Public Health Date: 2017-04-01 Impact factor: 3.367