Hepatitis B status of Hmong patients

This study was conducted to determine the hepatitis B status, by age, of Hmong patients attending a St. Paul family practice residency clinic.

The clinic records of 1585 Hmong patients 4 years of age and older were reviewed for information about hepatitis B status. Those without evidence of previous serologic testing or vaccination were invited to participate in the study by being tested for three hepatitis B virus (HBV) markers-hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), and hepatitis B core antibody (anti-HBc); those whose results were positive for HBsAg and anti-HBc were also tested for hepatitis B e antigen (HBeAg) and alanine aminotransferase (ALT). Patients whose results were positive for only anti-HBc had their serologic tests repeated after 3 or more months, and those patients whose results remained positive for only anti-HBc were offered the vaccine and further follow-up serologic tests.

Of the 434 total participants, 77 (18 percent) had acute or chronic infection (HBsAg present). The rate of infection was highest-28 percent-in the group of patients 15 to 19 years old. Of 66 patients with positive test results only for anti-HBc, 33 of 36 (92 percent) who had follow-up serologic tests after 3 or more months had the same result again in the absence of intervention. Six of 8 (75 percent) patients with results positive only for anti-HBc who received hepatitis B vaccine subsequently converted to an immune status (anti-HBs positive). For all age groups, the cost of pretesting patients with an unknown HBV status and vaccinating susceptible patients was less than the cost of vaccinating without pretesting.

This study, which confirmed previous findings of a high occurrence of hepatitis B virus infection in Hmong refugee communities, found the highest rate of infection to be among adolescents. Prevaccination testing appeared to be a cost-saving procedure for patients whose hepatitis status was unknown.