A population-based hepatitis
survey was carried out to estimate the prevalence of hepatitis B virus (HBV)
infection and its predictive factors for the state capitals from the north,
south, and southeast regions of Brazil.
A multistage cluster sampling was used
to select, successively, census tracts, blocks, households, and residents in
the age group 10–69 years in each state capital. The prevalence of hepatitis B
surface antigen (HBsAg) was lower than 1% in the north, southeast, and south
regions. Socioeconomic condition was associated with HBV infection in north and
south regions. Variables related to the blood route transmission were
associated with HBV infection only in the south whereas those related to sexual
behavior were associated with HBV infection in the north and south regions.
Drug use was associated in all regions, but the type of drug differed.
The
findings presented herein highlight the diversity of the potential transmission
routes for hepatitis B transmission in Brazil. In one hand, it reinforces the
importance of national control strategies of large impact already in course
(immunization of infants, adolescents, and adults up to 49 years of age and
blood supply screening). On the other hand, it shows that there is still room
for further control measures targeted to different groups within each region.
Below: Distribution of population aged 13–69 years in the state capitals of the North, South and Southeast Regions of Brazil and of the census tracts, households and individuals sampled.
Table 6
Factors associated with hepatitis B infection in three regions of Brazil, 2005
| Characteristics | North | Southeast | South |
|---|
| OR (95% CI)* | P value | OR (95% CI) | P value | OR (95% CI) | P value |
|---|
| Sex |
| Female | – | – | 1.0 | – | – | – |
| Male | – | – | 1.49 (1.02–2.19) | 0.041 | – | – |
| Age (in years) | 1.05 (1.03–1.06) | 0.000 | 1.06 (1.05–1.08) | 0.000 | 1.04 (1.03–1.05) | 0.000 |
| Read and write |
| Yes | 1.0 | – | – | – | – | – |
| No | 3.14 (1.53–6.46) | 0.002 | – | – | – | – |
| Schooling |
| Illiterate | – | – | – | – | 1.0 | – |
| Basic level | – | – | – | – | 0.78 (0.53–1.15) | 0.214 |
| 2nd level & univ | – | – | – | – | 0.51 (0.32–0.81) | 0.004 |
| Paid work past week |
| Yes | 1.0 | – | – | – | – | – |
| No | 0.56 (0.40–0.76) | 0.000 | – | – | – | – |
| Sewage disposal |
| Pubic system | 1.0 | – | – | – | 1.0 | – |
| Septic tanks | 0.61 (0.40–0.93) | 0.021 | – | – | 1.71 (1.28–2.29) | 0.000 |
| Other destination | 0.83 (0.40–1.72) | 0.617 | – | – | – | – |
| Blood transfusion |
| Never | – | – | – | – | 1.0 | – |
| Past 12 months | – | – | – | – | 2.28 (1.11–4.67) | 0.024 |
| Ever | – | – | – | – | 0.68 (0.41–1.15) | 0.152 |
| Endoscopy |
| Never | – | – | – | – | 1.0 | – |
| Past 12 months | – | – | – | – | 1.27 (0.80–2.05) | 0.311 |
| Ever | – | – | – | – | 1.33 (0.99–1.80) | 0.059 |
| Share toothbrush |
| No | – | – | – | – | 1.0 | – |
| Yes | – | – | – | – | 1.81 (1.05–3.12) | 0.032 |
| Condom use |
| Not started sex life | – | – | – | – | 1.0 | – |
| Yes, regularly | – | – | – | – | 2.41 (0.96–6.06) | 0.060 |
| Yes, sometimes | – | – | – | – | 3.68 (1.65–8.22) | 0.001 |
| Never | – | – | – | – | 3.90 (1.54–9.88) | 0.004 |
| Bisexual partner |
| Not started sex life | 1.0 | | – | – | – | – |
| No | 2.37 (0.87–6.42) | 0.089 | – | – | – | – |
| Yes | 1.68 (1.17–2.41) | 0.005 | – | – | – | – |
| Ever used smoked drugs |
| No | 1.0 | – | – | – | – | – |
| Yes | 1.58 (1.05–2.36) | 0.026 | – | – | – | – |
| Ever used inhaled drugs |
| No | – | – | 1.0 | – | – | – |
| Yes | – | – | 3.85 (1.19–12.4) | 0.024 | – | – |
| Ever sniffed drugs |
| No | – | – | – | – | 1.0 | – |
| Yes | – | – | – | – | 1.73 (1.01–2.97) | 0.048 |
| Ever injecting drugs |
| No | – | – | – | – | 1.0 | – |
| Yes | – | – | – | – | 2.49 (0.82–7.54) | 0.106 |
| Classification elitism |
| Abstemious | – | – | – | – | – | – |
| Light drinker | – | – | 0.95 (0.63–1.44) | 0.815 | – | – |
| Heavy drinker | – | – | 1.96 (1.06–3.59) | 0.030 | – | – |
CI = confidence interval; OR = odds ratio.
By: Ricardo A. A. Ximenes,* Gerusa M. Figueiredo, Maria Regina A. Cardoso, Airton T. Stein, Regina C. Moreira, Gabriela Coral, Deborah Crespo, Alex A. dos Santos, Ulisses R. Montarroyos, Maria Cynthia Braga, Leila M. M. B. Pereira, and for the Hepatitis Study Group
Hospital
Universitário Oswaldo Cruz, Faculdade de Ciências Médicas de Pernambuco,
Universidade de Pernambuco, Pernambuco, Brazil; Departamento de Medicina
Tropical, Universidade Federal de Pernambuco, Cidade Universitária, Pernambuco,
Brazil; Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo,
Brazil; Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade
de São Paulo, São Paulo, Brazil; Fundação Universidade Federal de Ciências da
Saúde de Porto Alegre, Rio Grande do Sul, Brazil; Instituto Adolfo Lutz, São
Paulo, Brazil; Secretaria de Saúde Pública do Estado do Pará, Pará, Brazil;
Instituto Bioestatístico, Pará, Brazil; Instituto de Ciências Biológicas, Universidade
de Pernambuco, Pernambuco, Brazil; Fundação Oswaldo Cruz, Centro de Pesquisas
Aggeu Magalhães, Cidade Universitária, Pernambuco, Brazil; Instituto do Fígado
de Pernambuco, Pernambuco, Brazil
*Address correspondence to Ricardo A. A. Ximenes, Faculdade
de Ciências Médicas de Pernambuco, Hospital Universitário Oswaldo Cruz,
Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, CEP
50100-130, Recife, Pernambuco, Brazil. E-mail:rb.moc.lou@senemixaar
