The majority of hepatitis B carriers are not on regular surveillance in Singapore

Carriers of hepatitis B virus (HBV) are at risk of developing long-term complications. Regular surveillance helps detect treatable chronic hepatitis, cirrhosis and liver cancer, and is recommended by practice guidelines in the United States, Europe and Singapore. However, there have been few studies evaluating the follow-up of HBV carriers. This study seeks to determine the proportion of HBV carriers on regular follow-up in Singapore and the impact on hepatitis B disease.

An advertisement was taken in local newspapers advertising for free screening to HBV carriers. 387 persons answered the advertisement. The screening comprised history-taking, physical examination, blood tests (liver panel, alphafoetoprotein, hepatitis B surface antigen (Ag) and hepatitis B eAg) and ultrasonography of liver. Further evaluation was conducted if the screening results were abnormal.

Of the 387 HBV carriers, 346 (89 percent) were male and 375 (97 percent) were Chinese. Their mean age was 39 years (range 20-60 years) and 36 percent were positive for HBeAg. 247 (64 percent) were not on regular screening over the past 12 months. 19 (5.4 percent) patients were diagnosed to have complications, namely: 13 had HBeAg-positive chronic hepatitis, two had HBeAg-negative chronic hepatitis, one had early liver cancer who recovered well after a curative resection and three had compensated cirrhosis.

Our screening programme diagnosed 5.4 percent of complications among 387 asymptomatic HBV carriers. However, 64 percent of the study subjects were not screened regularly and may pose an important public health threat if they develop long-term complications. Further studies are needed to evaluate and improve patient compliance for screening.