Development And Validation Of A Risk Score System Inclusive Of Antiviral Therapy For Predicting Liver Cirrhosis Risk In Diverse Patients With Chronic Hepatitis B Infection

AIM: Hepatitis B Virus (HBV) infection is a growing concern in the Caribbean, and is the primary cause of chronic liver disease worldwide.The seroprevalence of HBV Surface antigen (HBsAG) positivity in the Caribbean is reportedly between 2%-4%, but actual published data is limited.The purpose of this study is to report the epidemiology of HBV infection in The Bahamas.METHODS: This study was a retrospective review of all positive cases of HBsAG reported to the Epidemiology and Surveillance Unit (ESU) of the Department of Public Health of The Bahamas between January 2009 and December 2012.Mandatory reporting to the ESU is required by law when HBsAG is detected.When available, age, sex and nationality were documented.Population statistics were derived from the 2010 national census.RESULTS: 274 HBsAG positive cases were reported during the study period.The mean annual prevalence was 78 cases per 100,000.Prevalence ranged between 0.07% -0.31% and was highest in 2010 with 90 cases per 100,000 and lowest in 2012 with 70 cases per 100,000.Males and females ‡ 15 years made up 78% of reported Hepatitis B cases.Overall, females 15-24 years accounted for the highest mean prevalence of 95 cases per 100,000.Males 15-24 years had a mean prevalence of 47 cases per 100,000.Males ‡ 25 years displayed a mean prevalence with 88 cases per 100,000.Females ‡ 25 years had a mean prevalence of 81 cases per 100,000.Bahamians accounted for 53% of Hepatitis B infections.Persons of Haitians descent accounted for 20% of infections, but comparatively comprise 10% of the population.Other nationalities accounted for the remaining 27% of Hepatitis B infections in The Bahamas.Bahamians showed a constant trend of infection with 47 cases per 100,000 in 2009 to 50 cases per 100,00 in 2012.Haitians showed an increasing trend of infection from 89 cases per 100,000 in 2009 to 174 cases per 100,000 in 2012.Other nationalities showed a decreasing trend of infection from 454 cases per 100,00 in 2009 to 9 cases per 100,000 in 2012.CONCLUSION: To our knowledge this is the first published report of the epidemiology of HBV infection in The Bahamas.While the true overall prevalence is still unknown, this study suggests that any prior estimates of endemicity of HBV in The Bahamas must take into account the large Haitian migrant population, where the seroprevalence rate may be as high as 8%.Equally as important are the rates of chronic HBV (cHBV) infection in The Bahamas.While this study does not identify those persons with chronic infections, less than 5% of adults who become infected with HBV will become carriers.Currently, serological tests that are used to detect cHBV infections are unavailable to public patients in the Bahamas.Additional studies are needed to determine the prevalence of cHBV in this population.