Skip to main content
The American Journal of Pathology logoLink to The American Journal of Pathology
. 1975 Dec;81(3):629–650.

Recent advances in the study of the epidemiology of hepatitis B.

W Szmuness
PMCID: PMC2032336  PMID: 1108668

Abstract

Recent advances in the study of hepatitis B shed much light on the basic epidemiologic patterns of this unique infection. The spectrum of host responses following exposure is unusually wide. Hepatitis B appears to be one of the most widespread infections; the total number of chronic carriers of the hepatitis B antigen has been estimated as at least 120 million. The following factors have been found to be closely associated with the risk of hepatitis B; geography, sex, age at testing, age at primary infection, socioeconomic status, ethnicity, occupation, sharing a household with a carrier, sexual promiscuity, and immunologic responsiveness. Data concerning the infectivity of an asymptomatic carrier are ambiguous; whether a carrier can transmit the virus by sexual intercourse also remains unknown. Available evidence seems to suggest that genetic factors may be of importance in the aggregation and segregation of hepatitis B.

Full text

PDF
632

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alpert E., Isselbacher K. J. Hepatitis-associated antigen and hepatoma in the U.S. Lancet. 1971 Nov 13;2(7733):1087–1087. doi: 10.1016/s0140-6736(71)90399-0. [DOI] [PubMed] [Google Scholar]
  2. Alter H. J., Chalmers T. C., Freeman B. M., Lunceford J. L., Lewis T. L., Holland P. V., Pizzo P. A., Plotz P. H., Meyer W. J., 3rd Health-care workers positive for hepatitis B surface antigen. Are their contacts at risk? N Engl J Med. 1975 Feb 27;292(9):454–457. doi: 10.1056/NEJM197502272920904. [DOI] [PubMed] [Google Scholar]
  3. Barker L. F., Shulman N. R., Murray R., Hirschman R. J., Ratner F., Diefenbach W. C., Geller H. M. Transmission of serum hepatitis. JAMA. 1970 Mar 2;211(9):1509–1512. [PubMed] [Google Scholar]
  4. Blumberg B. S., Friedlaender J. S., Woodside A., Sutnick A. I., London W. T. Hepatitis and Australia antigen: autosomal recessive inheritance of susceptibility to infection in humans. Proc Natl Acad Sci U S A. 1969 Apr;62(4):1108–1115. doi: 10.1073/pnas.62.4.1108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Blumberg B. S., Gerstley B. J., Hungerford D. A., London W. T., Sutnick A. I. A serum antigen (Australia antigen) in Down's syndrome, leukemia, and hepatitis. Ann Intern Med. 1967 May;66(5):924–931. doi: 10.7326/0003-4819-66-5-924. [DOI] [PubMed] [Google Scholar]
  6. Blumberg B. S., Melartin L., Guint R. A., Werner B. Family studies of a human serum isoantigen system (Australia antigen). Am J Hum Genet. 1966 Nov;18(6):594–608. [PMC free article] [PubMed] [Google Scholar]
  7. Blumberg B. S., Sutnick A. I., London W. T., Melartin L. Sex distribution of Australia antigen. Arch Intern Med. 1972 Aug;130(2):227–231. [PubMed] [Google Scholar]
  8. Chalmers T. C., Alter H. J. Management of the asymptomatic carrier of the hepatitis-associated (Australia antigen. Tentative considerations of the clinical and public-health aspects. N Engl J Med. 1971 Sep 9;285(11):613–617. doi: 10.1056/NEJM197109092851106. [DOI] [PubMed] [Google Scholar]
  9. Cherubin C. E., Prince A. M. Serum hepatitis specific antigen (SH) in commercial and volunteer sources of blood. Transfusion. 1971 Jan-Feb;11(1):25–27. doi: 10.1111/j.1537-2995.1971.tb04370.x. [DOI] [PubMed] [Google Scholar]
  10. Cherubin C. E. Risk of post-transfusion hepatitis in recepients of blood containing S.H. antigen at Harlem Hospital. Lancet. 1971 Mar 27;1(7700):627–630. doi: 10.1016/s0140-6736(71)91556-x. [DOI] [PubMed] [Google Scholar]
  11. Darani M., Gerber M. Letter: Hepatitis-B antigen in vaginal secretions. Lancet. 1974 Oct 26;2(7887):1008–1008. doi: 10.1016/s0140-6736(74)92094-7. [DOI] [PubMed] [Google Scholar]
  12. Dodd R. Y., Holland P. V., Ni L. Y., Smith H. M., Greenwalt T. J. Hepatitis B antigen: regional variation in incidence and subtype ratio in the American Red Cross donor population. Am J Epidemiol. 1973 Feb;97(2):111–115. doi: 10.1093/oxfordjournals.aje.a121487. [DOI] [PubMed] [Google Scholar]
  13. Dudley F. J., Scheuer P. J., Sherlock S. Natural history of hepatitis-associated antigen-positive chronic liver disease. Lancet. 1972 Dec 30;2(7792):1388–1393. doi: 10.1016/s0140-6736(72)92963-7. [DOI] [PubMed] [Google Scholar]
  14. Feinman S. V., Berris B., Sinclair J. C., Wrobel D. M., Alter H. J., Holland P. V. Relation of hepatitis-B-antigen subtypes in symptom-free carriers to geographical origin and liver abnormalities. Lancet. 1973 Oct 20;2(7834):867–869. doi: 10.1016/s0140-6736(73)92003-5. [DOI] [PubMed] [Google Scholar]
  15. Fulford K. W., Dane D. S., Catterall R. D., Woof R., Denning J. V. Australia antigen and antibody among patients attending a clinic for sexually transmitted diseases. Lancet. 1973 Jun 30;1(7818):1470–1473. doi: 10.1016/s0140-6736(73)91810-2. [DOI] [PubMed] [Google Scholar]
  16. Galbraith R. M., Eddleston A. L., Smith M. G., Williams R., McSween R. N., Watkinson G., Dick H., Kennedy L. A., Batchelor J. R. Histocompatibility antigens in active chronic hepatitis and primary biliary cirrhosis. Br Med J. 1974 Sep 7;3(5931):604–605. doi: 10.1136/bmj.3.5931.604. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gitnick G. L., Gleich G. J., Schoenfield L. J., Baggenstoss A. H., Sutnick A. I., Blumberg B. S., London W. T., Summerskill W. H. Australia antigen in chronic active liver disease with cirrhosis. Lancet. 1969 Aug 9;2(7615):285–288. doi: 10.1016/s0140-6736(69)90052-x. [DOI] [PubMed] [Google Scholar]
  18. Glazer R. I., Spatz S. S., Catone G. A. Viral hepatitis: a hazard to oral surgeons. J Oral Surg. 1973 Jul;31(7):504–508. [PubMed] [Google Scholar]
  19. Gocke D. J., Kavey N. B. Hepatitis antigen. Correlation with disease and infectivity of blood-donors. Lancet. 1969 May 31;1(7605):1055–1059. doi: 10.1016/s0140-6736(69)91701-2. [DOI] [PubMed] [Google Scholar]
  20. Grossman R. A., Benenson M. W., Scott R. M., Snitbhan R., Top F. H., Jr, Pantuwatana S. An epidemiologic study of hepatitis B virus in Bangkok, Thailand. Am J Epidemiol. 1975 Feb;101(2):144–159. doi: 10.1093/oxfordjournals.aje.a112079. [DOI] [PubMed] [Google Scholar]
  21. Heathcote J., Cameron C. H., Dane D. S. Hepatitis-B antigen in saliva and semen. Lancet. 1974 Jan 19;1(7847):71–73. doi: 10.1016/s0140-6736(74)92289-2. [DOI] [PubMed] [Google Scholar]
  22. Helske T. Carriers of hepatitis B antigen and transfusion hepatitis in Finland. Scand J Haematol Suppl. 1974;22:1–65. [PubMed] [Google Scholar]
  23. Hersh T., Melnick J. L., Goyal R. K., Hollinger F. B. Nonparenteral transmission of viral hepatitis type B (Australia antigen-associated serum hepatitis). N Engl J Med. 1971 Dec 9;285(24):1363–1364. doi: 10.1056/NEJM197112092852408. [DOI] [PubMed] [Google Scholar]
  24. Hoofnagle J. H., Gerety R. J., Barker L. F. Antibody to hepatitis-B-virus core in man. Lancet. 1973 Oct 20;2(7834):869–873. doi: 10.1016/s0140-6736(73)92004-7. [DOI] [PubMed] [Google Scholar]
  25. Jeannet M., Farquet J. J. Letter: HL-A antigens in asymptomatic chronic HBAg carriers. Lancet. 1974 Dec 7;2(7893):1383–1384. doi: 10.1016/s0140-6736(74)92251-x. [DOI] [PubMed] [Google Scholar]
  26. KRUGMAN S., WARD R., GILES J. P., BODANSKY O., JACOBS A. M. Infectious hepatitis: detection of virus during the incubation period and in clinically inapparent infection. N Engl J Med. 1959 Oct 8;261:729–734. doi: 10.1056/NEJM195910082611501. [DOI] [PubMed] [Google Scholar]
  27. King H., Haenszel W. Cancer mortality among foreign- and native-born Chinese in the United States. J Chronic Dis. 1973 Oct;26(10):623–646. doi: 10.1016/0021-9681(73)90053-2. [DOI] [PubMed] [Google Scholar]
  28. Krugman S., Giles J. P. Viral hepatitis. New light on an old disease. JAMA. 1970 May 11;212(6):1019–1029. doi: 10.1001/jama.212.6.1019. [DOI] [PubMed] [Google Scholar]
  29. Lee A. K. Australia antigen in Hong Kong Chinese. Lancet. 1972 May 20;1(7760):1119–1120. doi: 10.1016/s0140-6736(72)91456-0. [DOI] [PubMed] [Google Scholar]
  30. London W. T., Di Figlia M., Sutnick A., Blumberg B. S. An epidemic of hepatitis in a chronic-hemodialysis unit. Australia antigen and differences in host response. N Engl J Med. 1969 Sep 11;281(11):571–578. doi: 10.1056/NEJM196909112811101. [DOI] [PubMed] [Google Scholar]
  31. Mackay I. R., Morris P. J. Association of autoimmune active chronic hepatitis with HL-A1,8. Lancet. 1972 Oct 14;2(7781):793–795. doi: 10.1016/s0140-6736(72)92149-6. [DOI] [PubMed] [Google Scholar]
  32. Markenson J. A., Gerety R. J., Hoofnagle J. H., Barker L. F. Effects of cyclophosphamide on hepatitis B virus infection and challenge in chimpanzees. J Infect Dis. 1975 Feb;131(2):79–87. doi: 10.1093/infdis/131.2.79. [DOI] [PubMed] [Google Scholar]
  33. Mazzur S., Blumberg B. S., Friedlaender J. S. Silent maternal transmission of Australia antigen. Nature. 1974 Jan 4;247(5435):41–43. doi: 10.1038/247041a0. [DOI] [PubMed] [Google Scholar]
  34. Mazzur S. Menstrual blood as a vehicle of Australia-antigen transmission. Lancet. 1973 Apr 7;1(7806):749–751. doi: 10.1016/s0140-6736(73)92131-4. [DOI] [PubMed] [Google Scholar]
  35. Mosley J. W. Editorial: The HBV carrier--a new kind of leper? N Engl J Med. 1975 Feb 27;292(9):477–478. doi: 10.1056/NEJM197502272920912. [DOI] [PubMed] [Google Scholar]
  36. Mosley J. W., White E. Viral hepatitis as an occupational hazard of dentists. J Am Dent Assoc. 1975 May;90(5):992–997. doi: 10.14219/jada.archive.1975.0239. [DOI] [PubMed] [Google Scholar]
  37. Prince A. M. An antigen detected in the blood during the incubation period of serum hepatitis. Proc Natl Acad Sci U S A. 1968 Jul;60(3):814–821. doi: 10.1073/pnas.60.3.814. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Prince A. M., Leblanc L., Krohn K., Masseyeff R., Alpert M. E. S.H. antigen and chronic liver disease. Lancet. 1970 Oct 3;2(7675):717–718. doi: 10.1016/s0140-6736(70)91981-1. [DOI] [PubMed] [Google Scholar]
  39. Prince A. M. Role of serum hepatitis virus in chronic liver disease. Gastroenterology. 1971 May;60(5):913–921. [PubMed] [Google Scholar]
  40. Prince A. M., Szmuness W., Michon J., Demaille J., Diebolt G., Linhard J., Quenum C., Sankale M. A case/control study of the association between primary liver cancer and hepatitis B infection in Senegal. Int J Cancer. 1975 Sep 15;16(3):376–383. doi: 10.1002/ijc.2910160304. [DOI] [PubMed] [Google Scholar]
  41. Redeker A. G. Viral hepatitis: clinical aspects. Am J Med Sci. 1975 Jul-Aug;270(1):9–16. doi: 10.1097/00000441-197507000-00003. [DOI] [PubMed] [Google Scholar]
  42. Schweitzer I. L., Wing A., McPeak C., Spears R. L. Hepatitis and hepatitis-associated antigen in 56 mother-infant pairs. JAMA. 1972 May 22;220(8):1092–1095. [PubMed] [Google Scholar]
  43. Simons M. J., Yap E. H., Ong Y. W., Okochi K., Mayumi M., Nishioka K. Frequency of Australia antigen in blood donors in Singapore. Am J Dis Child. 1972 Apr;123(4):405–406. doi: 10.1001/archpedi.1972.02110100137051. [DOI] [PubMed] [Google Scholar]
  44. Stevens C. E., Beasley R. P., Tsui J., Lee W. C. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med. 1975 Apr 10;292(15):771–774. doi: 10.1056/NEJM197504102921503. [DOI] [PubMed] [Google Scholar]
  45. Sutnick A. I., London W. T., Millman I., Gerstley B. J., Blumberg B. S. Ergasteric hepatitis: endemic hepatitis associated with Australia antigen in a research laboratory. Ann Intern Med. 1971 Jul;75(1):35–40. doi: 10.7326/0003-4819-75-1-35. [DOI] [PubMed] [Google Scholar]
  46. Szmuness W., Harley E. J., Prince A. M. Intrafamilial spread of asymptomatic hepatitis B. Am J Med Sci. 1975 Sep-Oct;270(2):293–304. doi: 10.1097/00000441-197509000-00009. [DOI] [PubMed] [Google Scholar]
  47. Szmuness W., Hirsch R. L., Prince A. M., Levine R. W., Harley E. J., Ikram H. Hepatitis B surface antigen in blood donors: further observations. J Infect Dis. 1975 Feb;131(2):111–118. doi: 10.1093/infdis/131.2.111. [DOI] [PubMed] [Google Scholar]
  48. Szmuness W., Pick R., Prince A. M. The serum hepatitis virus specific antigen (SH): a preliminary report of epidemiologic studies in an institution for the mentally retarded. Am J Epidemiol. 1970 Jul;92(1):51–61. doi: 10.1093/oxfordjournals.aje.a121179. [DOI] [PubMed] [Google Scholar]
  49. Szmuness W., Prince A. M., Diebolt G., Leblanc L., Baylet R., Masseyeff R., Linhard J. The epidemiology of hepatitis B infections in Africa: results of a pilot survey in the Republic of Senegal. Am J Epidemiol. 1973 Aug;98(2):104–110. doi: 10.1093/oxfordjournals.aje.a121535. [DOI] [PubMed] [Google Scholar]
  50. Szmuness W., Prince A. M., Etling G. F., Pick R. Development and distribution of hemagglutinating antibody against the hepatitis B antigen in institutionalized populations. J Infect Dis. 1972 Nov;126(5):498–506. doi: 10.1093/infdis/126.5.498. [DOI] [PubMed] [Google Scholar]
  51. Szmuness W., Prince A. M., Grady G. F., Mann M. K., Levine R. W., Friedman E. A., Jacobs M. J., Josephson A., Ribot S., Shapiro F. L. Hepatitis B infection. A point-prevalence study in 15 US hemodialysis centers. JAMA. 1974 Feb 25;227(8):901–906. doi: 10.1001/jama.227.8.901. [DOI] [PubMed] [Google Scholar]
  52. Szmuness W., Prince A. M., Hirsch R. L., Brotman B. Familial clustering of hepatitis B infection. N Engl J Med. 1973 Nov 29;289(22):1162–1166. doi: 10.1056/NEJM197311292892203. [DOI] [PubMed] [Google Scholar]
  53. Szmuness W., Prince A. M. The epidemiology of serum hepatitis (SH) infections: a controlled study in two closed institutions. Am J Epidemiol. 1971 Dec;94(6):585–595. doi: 10.1093/oxfordjournals.aje.a121357. [DOI] [PubMed] [Google Scholar]
  54. Taylor J. S., Shmunes E., Holmes A. W. Hepatitis B in plasma fractionation workers. A seroepidemiologic study. JAMA. 1974 Nov 11;230(6):850–853. [PubMed] [Google Scholar]
  55. Tong M. J., Sun S. C., Schaeffer B. T., Chang N. K., Lo K. J., Peters R. L. Hepatitis-associated antigen and hepatocellular carcinoma in Taiwan. Ann Intern Med. 1971 Nov;75(5):687–691. doi: 10.7326/0003-4819-75-5-687. [DOI] [PubMed] [Google Scholar]
  56. Villarejos V. M., Visoná K. A., Gutiérrez A., Rodríguez A. Role of saliva, urine and feces in the transmission of type B hepatitis. N Engl J Med. 1974 Dec 26;291(26):1375–1378. doi: 10.1056/NEJM197412262912602. [DOI] [PubMed] [Google Scholar]
  57. Vogel C. L., Anthony P. P., Sadikali F., Barker L. F., Peterson M. R. Hepatitis-associated antigen and antibody in hepatocellular carcinoma: results of a continuing study. J Natl Cancer Inst. 1972 Jun;48(6):1583–1588. [PubMed] [Google Scholar]
  58. Vyas G. N. Evidence against recessive inheritance of susceptibility to the chronic carrier state for hepatitis B antigen. Nature. 1974 Mar 8;248(5444):159–160. doi: 10.1038/248159a0. [DOI] [PubMed] [Google Scholar]
  59. Wands J. R., Walker J. A., Davis T. T., Waterbury L. A., Owens A. H., Carpenter C. C. Hepatitis B in an oncology unit. N Engl J Med. 1974 Dec 26;291(26):1371–1375. doi: 10.1056/NEJM197412262912601. [DOI] [PubMed] [Google Scholar]
  60. Zuckerman A. J., Taylor P. E. Persistence of the serum hepatitis (SH-Australia) antigen for many years. Nature. 1969 Jul 5;223(5201):81–82. doi: 10.1038/223081a0. [DOI] [PubMed] [Google Scholar]
  61. al-Sarraf M., Kithier K., Sardesai S., Vaitkevicius V. K., Poulik M. D. The incidence and significance of Australia antigen in cancer patients. Oncology. 1973;27(2):128–136. doi: 10.1159/000224728. [DOI] [PubMed] [Google Scholar]

Articles from The American Journal of Pathology are provided here courtesy of American Society for Investigative Pathology

RESOURCES