John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Who screen for HBV and how? Volume 16, special issue 2, septembre 2009

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Service de santé publique, groupe hospitalier Henri-Mondor–Albert-Chenevier, 51, avenue du Maréchal-Delattre-de-Tassigny, 94010 Créteil cedex, France

The French national survey performed in 2003-2004 for the estimation of HBV and HCV prevalence showed that only 45% of HBV chronic carriers were aware of their status. Screening HBV markers is relevant concerning 2 issues : 1) prevention of households of HBV chronic carrier by proposal of vaccination; 2) evaluation of the status of the infection, as inactive or active, leading to a surveillance programme or an anti-viral treatment. HBs Ag screening is mandatory in France during pregnancy, to allow immunisation of newborns to HBs Ag positive mother. However testing of pregnant women and immunisation of newborns at risk may not be exhaustive. Indeed, cases of hepatitis B have been notified in infants born to HBs Ag positive mothers, who had not been immunized at birth, as needed. Apart from this situation, screening is recommended before the vaccination of individuals with most exposure to HBV, mainly households of an infected patient, persons with sexual behaviour at risk, drug users, persons originating from high endemic countries. In these people with most likely previous contact with HBV, search for HBs Ag, anti-HBc and anti-HBs Ab is made in one step, leading to the diagnosis of chronic carrier, immunized status, or being matter for vaccination. Screening is strongly associated with the proposal of vaccination, but HBV vaccine is not popular in France at present time. Thus, to boost vaccination is essential to obtain the improvement of HBV screening. Testing should be made more often and systematically, and in all settings taking care of those populations mostly exposed to HBV.