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